Bantry White Eleanor, Montgomery Paul
School of Applied Social Studies, University College Cork, Cork, Ireland.
Centre for Evidence-based Intervention, University of Oxford, Oxford, UK.
Health Soc Care Community. 2016 Jul;24(4):473-84. doi: 10.1111/hsc.12226. Epub 2015 Mar 27.
People with dementia while missing are at risk of harm including death. Yet, welfare concerns arise when freedom to walkabout outdoors is restricted and in particular, getting lost is a risk factor for admission to long-term care. Accurate methods of assessing the risks posed to community-dwelling people with dementia from getting lost are needed to ensure intervention is proportionate. Currently available assessment tools focus upon the identification of dementia-related changes in a person's walking behaviour, traditionally referred to as 'wandering'. 'Wandering' and getting lost are conceptually distinct; measures of 'wandering' are not sufficient to support the assessment of risk while walking outdoors. The objective of this study was to develop an assessment schedule that can evaluate safety in community-dwelling people with dementia who walkabout outdoors. A structured assessment schedule was generated from research on the aetiology of getting lost, a review of existing assessment tools, an observational study of incidents of getting lost and qualitative data from families experiencing this issue. A content validity study was then undertaken with a panel of 17 health and social care practitioners and researchers in the field. A schedule of 7 domains and 38 items was generated, 33 of which were deemed valid by the expert panel. Panel feedback suggests the schedule needs to be used flexibly to reflect an individual's unique living circumstances. Reflecting the complex aetiology of getting lost, considerable challenges exist when assessing risk in this field. The implications of this study for practitioners are discussed with reference to the merits of narrative and structured models of assessment, and the balance between objective safety and subjective well-being that is required when making decisions about intervention. The direction of further research is examined as a means of supporting professional assessment of this complex issue.
患有痴呆症的人在走失时面临包括死亡在内的伤害风险。然而，当户外行走的自由受到限制时，福利问题就会出现，特别是走失是入住长期护理机构的一个风险因素。需要准确的方法来评估社区痴呆症患者走失所带来的风险，以确保干预措施适度。目前可用的评估工具侧重于识别与痴呆症相关的人的行走行为变化，传统上称为“徘徊”。“徘徊”和走失在概念上是不同的；“徘徊”的测量不足以支持对户外行走时的风险评估。本研究的目的是制定一个评估方案，以评估在户外行走的社区痴呆症患者的安全性。通过对走失病因的研究、对现有评估工具的回顾、对走失事件的观察性研究以及来自经历过此问题的家庭的定性数据，生成了一个结构化的评估方案。然后，与17名该领域的健康和社会护理从业者及研究人员组成的小组进行了内容效度研究。生成了一个包含7个领域和38个条目的方案，其中33个被专家小组认为是有效的。小组反馈表明，该方案需要灵活使用，以反映个人独特的生活情况。由于走失的病因复杂，在该领域评估风险时存在相当大的挑战。本研究对从业者的影响将结合评估的叙述性和结构化模型的优点以及在做出干预决策时所需的客观安全与主观幸福感之间的平衡进行讨论。作为支持对这一复杂问题进行专业评估的一种手段，将探讨进一步研究的方向。
