Home safety for people with dementia following hospital discharge: implications for occupational therapists

Background: Occupational therapists (OTs) practising in geriatric units routinely assess their patients with dementia prior to hospital discharge for their ability to perform their daily living activities safely. The aim of... [ view full abstract ]

Background:
Occupational therapists (OTs) practising in geriatric units routinely assess their patients with dementia prior to hospital discharge for their ability to perform their daily living activities safely. The aim of this assessment is to identify what type of assistance (e.g. technical aids, homecare services) will be needed when patients return to their living environment. Because a home visit cannot usually be done prior to discharge, this assessment is performed in hospital. This situation raises two questions: 1-To what extent do the risks assessed and assistance recommended in a hospital setting prior to discharge truly reflect and predict home safety?; 2-How can OTs improve home safety for people with dementia following hospital discharge?

Method:
1-Panel of experts: Twenty-five researchers, managers, policymakers, clinicians (occupational therapists, nurses, social workers and geriatricians) from 5 Canadian cities; 2-Systematic review (Ageline, Pubmed, CINALH - 1998-2014).

Results:
Our data suggest that some risks (e.g. fire) may be overestimated while others (e.g. inappropriate medication intake) may be underestimated before hospital discharge. These results may be explained by: 1-Characteristics of the assessment setting (unfamiliar context); 2-Differences in clinicians’, patients’ and caregivers’ perceptions and values with respect to ethical challenges (safety vs autonomy); 3-Difficulty predicting how safety issues will change following hospital discharge.

Application to Practice:
Developing a clinical decision-making tool to support the assessment and management of risks by health professionals as well as optimizing transitions in care may help to improve home safety for people with dementia following hospital discharge.