Institute of Health and Society, Newcastle University , Newcastle-upon-Tyne , UK.
Institute of Health Research, University of Exeter , UK.
Aging Ment Health. 2019 Nov;23(11):1524-1532. doi: 10.1080/13607863.2018.1501664. Epub 2018 Nov 15.
People with dementia are more likely to fall and less likely to recover well after a fall than cognitively intact older people. Little is known about how best to deliver services to this patient group. This paper explores the importance of compensating for cognitive impairment when working with people with dementia. Qualitative methods - interviews, focus groups and observation - were used to explore the views and experiences of people with dementia, family carers and professionals providing services to people with dementia following an injurious fall. A thematic, iterative analysis was undertaken in which emerging themes were identified from each individual dataset, prior to an integrative analysis. A key theme across all datasets was the need to deliver services in ways that compensate for cognitive impairment, such as negotiating meaningful activities that can be embedded into the routines of people with dementia. Professionals varied in their ability to adapt their practice to meet the needs of people with dementia. Negative attitudes towards dementia, a lack of knowledge and understanding of dementia limited the ability of some professionals to work in person-centred ways. Improving outcomes for people with dementia following a fall requires the principles of person-centred care to be enacted by professionals with a generic role, as well as specialist staff. This requires additional training and support by specialist staff to address the wide variability in current practice.
痴呆症患者比认知功能正常的老年人更容易跌倒,且跌倒后恢复不佳。对于如何为这一患者群体提供最佳服务,我们知之甚少。本文探讨了在与痴呆症患者合作时补偿认知障碍的重要性。
我们采用定性方法(访谈、焦点小组和观察),探讨了在发生意外伤害性跌倒后,痴呆症患者、家庭照顾者以及为痴呆症患者提供服务的专业人员对这一问题的看法和经验。在进行综合分析之前,我们先对每个单独数据集进行主题迭代分析,以确定新出现的主题。
所有数据集的一个关键主题是需要以补偿认知障碍的方式提供服务,例如协商有意义的活动,将这些活动嵌入到痴呆症患者的日常生活中。专业人员在调整实践以满足痴呆症患者的需求方面能力各不相同。一些专业人员对痴呆症的负面态度、缺乏对痴呆症的知识和理解,限制了他们以以人为中心的方式工作的能力。
要改善痴呆症患者跌倒后的康复效果,需要由具有通用角色的专业人员以及专家人员来实施以人为本的护理原则。这需要专家人员提供额外的培训和支持,以解决当前实践中存在的广泛差异。