Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK.
School of Health Sciences, University of Nottingham, Nottingham, UK.
BMJ Open. 2019 Feb 11;9(2):e025702. doi: 10.1136/bmjopen-2018-025702.
To explore the experiences of healthcare professionals working in falls prevention and memory assessment services in providing assessments and interventions for falls risk reduction in people with dementia.
This is a qualitative study using 19 semistructured interviews. Interviews were analysed through thematic analysis.
Community-based falls and memory assessment services in the East Midlands, UK.
Nurses (n=10), physiotherapists (n=5), occupational therapists (n=3) and a psychiatrist (n=1).
Three substantive themes were identified: challenges posed by dementia, adaptations to make falls prevention appropriate for people with dementia and organisational barriers. Patients' poor recall, planning and increased behavioural risk associated with dementia were key problems. Healthcare professionals provided many suggestions on how to overcome these challenges, such as adapting exercise interventions by using more visual aids. Problems associated with cognitive impairment created a need for additional support, for instance longer interventions, and supervision by support workers, to enable effective intervention, yet limited resources meant this was not always achievable. Communication between mental and physical health teams could be ineffective, as services were organised as separate entities, creating a reliance on third parties to be intermediaries. Structural and organisational factors made it difficult to deliver optimal falls prevention for people living with dementia.
Healthcare professionals experience challenges in providing falls prevention to people with dementia at the individual and organisational levels. Interventions can be adapted for people with dementia, but this requires additional resources and improved integration of services. Future research is needed to develop and test the effectiveness and cost-effectiveness of such services.
探索从事防跌和记忆评估服务的医疗保健专业人员在为痴呆症患者降低跌伤风险提供评估和干预方面的经验。
这是一项使用 19 次半结构化访谈的定性研究。通过主题分析对访谈进行分析。
英国东米德兰兹社区防跌和记忆评估服务。
护士（n=10）、物理治疗师（n=5）、职业治疗师（n=3）和精神科医生（n=1）。
确定了三个实质性主题：痴呆症带来的挑战、为适合痴呆症患者而进行的调整以及组织障碍。患者记忆力差、计划能力差和行为风险增加是主要问题。医疗保健专业人员提出了许多如何克服这些挑战的建议，例如通过使用更多视觉辅助工具来调整运动干预措施。与认知障碍相关的问题需要额外的支持，例如更长的干预时间和支持工作人员的监督，以实现有效的干预，但有限的资源意味着这并不总是可行的。精神和身体健康团队之间的沟通可能无效，因为服务是作为独立的实体组织的，这就需要依靠第三方作为中介。结构和组织因素使得为痴呆症患者提供最佳的防跌服务变得困难。
医疗保健专业人员在个人和组织层面上为痴呆症患者提供防跌服务时会遇到挑战。可以为痴呆症患者调整干预措施，但这需要额外的资源和更好的服务整合。需要进一步研究来开发和测试此类服务的有效性和成本效益。
