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Risk assessment for people living with dementia: a systematic review

Hoe, J. ORCID: 0000-0003-4647-8950, Profyri, E., Kemp, C. , Manela, M., Webster, L., Anthony, J., Costafreda, S., Arrojo, F., Souris, H. & Livingston, G. (2023). Risk assessment for people living with dementia: a systematic review. International Psychogeriatrics, doi: 10.1017/s1041610223004398

Abstract

Objective:
This systematic review identified key components of risk assessment for people with dementia, examined attitudes toward risk identification and risk assessment, and appraised existing risk assessment tools.

Methods:
Systematic searches of five databases on two platforms (EBSCO, OVID) and gray literature databases (Open Grey, Base) were conducted. Studies were screened for inclusion based on predetermined eligibility criteria and quality assessed using the Mixed Methods Appraisal Tool. Findings were tabulated and synthesized using thematic synthesis.

Results:
Our review found people with dementia, their family carers, and healthcare professionals differed in how risk is conceptualized, with views being shaped by media perceptions, personal experiences, socio-cultural influences, dementia knowledge, and dementia severity. We found that mobilization (causing falls inside and getting lost outside) is the most frequently identified risk factor. Our findings show people with dementia are generally risk-tolerant, while healthcare professionals may adopt risk-averse approaches because of organizational requirements. We found factors that disrupt daily routines, living and caring arrangements, medication management, and unclear care pathways contribute toward adverse risk events. We discovered that most studies about risk and risk assessment scales did not consider insight of the person with dementia into risks although this is important for the impact of a risk. No risk instrument identified had sufficient evidence that it was useful.

Conclusion:
Accurate risk assessment and effective communication strategies that include the perspectives of people with dementia are needed to enable risk-tolerant practice. No risk instrument to date was shown to be widely acceptable and useful in practice.

Publication Type: Article
Additional Information: This article has been published in a revised form in International Psychogeriatrics https://doi.org/10.1017/S1041610223004398. This version is free to view and download for private research and study only. Not for re-distribution or re-use. © copyright holder.
Publisher Keywords: dementia, risk identification, risk assessment, home safety, risk enablement, decision-making, care-planning
Subjects: R Medicine > RC Internal medicine
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments: School of Health & Psychological Sciences
School of Health & Psychological Sciences > Nursing
SWORD Depositor:
[thumbnail of Final version - accepted International Psychogeriatrics.pdf] Text - Accepted Version
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