Research progress on influencing factors and preventive measures of falls in senile dementia patients

Research progress on influencing factors and preventive measures of falls in senile dementia patients

JIAO,Xinhan

Suzhou Health Vocational and Technical College, Suzhou Jiangsu 215009,China

【Abstract】To review the influencing factors and preventive measures of falls in the elderly with dementia. The main factors affecting falls of the elderly with dementia were summarized, including age, gender, inability to move alone, intellectual impairment, environmental risk factors and psychological factors. This paper discusses the preventive measures for the elderly with dementia, including the ACMMM management model, the knowledge, belief and practice intervention model, the fall prevention sensory treatment, the fall prevention drug treatment, and the patient protection measures, and comprehensively analyzes the effects and limitations of these preventive measures, so as to provide a reference for the further development of the prevention plan for the elderly with dementia.

【Key words】Fall; The elderly; Dementia; Nursing

Fall refers to people falling to the ground or below the initial position after unintentional sudden stop, and is the fourth largest cause of death of Chinese people due to accidental injury [1]. In 2005, the Ministry of Health of the People's Republic of China took the prevention of patient falls as an important indicator to evaluate the quality of care [2]. The proportion of patients falling down in hospital adverse events is as high as 40%, and the high-risk group is the elderly, while the elderly patients who are hospitalized and need long-term care in the community health service center account for about 95% of all patients [3]. All organs of the elderly are degraded, and all functions are reduced, which is prone to fall. Especially for the elderly with dementia, the incidence of unsafe events is higher, resulting in more medical disputes [4-6], which also aggravates the economic burden of the patient's family and society to a certain extent. This article summarizes the influencing factors and preventive measures of falls in the elderly with dementia, and provides reference for further formulating the fall prevention plan for the elderly with dementia.

1 Influencing factors of falls in the elderly with dementia

1.1 Age

Age is one of the main factors that lead to falls in patients with Alzheimer's disease. Chen Xueming [7] believes that from the perspective of biology, the level of muscle strength in the elderly population has decreased, the main joints of the body have degenerative changes, and some patients have loose ligaments, which leads to a high risk of falls when walking and moving. In addition, the balance ability and coordination ability of the elderly population are insufficient, and their vision, hearing and reaction ability are low, which makes it difficult to effectively cope with falls, Therefore, the incidence of falls in elderly patients with mental disorders is high [8]. In addition, mental disorders need long-term medication. The elderly patients' metabolism slows down and their sensitivity to drugs increases, so the possibility of adverse drug reactions is higher. This is also the reason why the elderly patients with mental disorders have a higher incidence of falls compared with other patients.

1.2 Gender

Li Xinhua, Li Feng [9] Research shows that the incidence of falls in female elderly patients with mental disorders is twice as high as that in men, which is closely related to the fact that women's coordination and motor function are lower than those of men. Cheng Jianping [10] found in the study that the incidence of falls in female elderly patients with mental disorders was about 14.90%, while that in male patients was 15.30%. There was no significant difference between the two. Whether gender has an impact on the fall of Alzheimer's patients needs further study.

1.3 Cannot move alone

You Liming, Zhang Jun, Liu Keyan et al. [11] found that "unable to move alone" and "living alone" are risk factors for falls in the elderly. People who can't move alone often fall at home, and falls are mostly related to physical factors [11]. The elderly with dementia have mental retardation, often unable to move alone, and need to be accompanied by nursing staff or family members. At the same time, the elderly patients with dementia may not be able to exercise alone due to other physical diseases, age, psychology and other factors. The related factors of the elderly with dementia who can't move alone need to be further explored.

1.4 Intellectual impairment

Alzheimer's disease is a primary and degenerative disease with unknown etiology. It has latent onset, progressive aggravation, slow and irreversible course. It is often manifested as progressive deterioration of memory, understanding, judgment, self-control and other abilities and sustained intellectual impairment [12]. The study found that [11] widowhood and "intellectual impairment" may be indirect risk factors for falls. The School of Nursing of Guangzhou Sun Yat-sen Medical University [11] investigated 415 elderly people aged 60 years and above, collected data by means of interview, observation and medical records, conducted single and multiple factor analysis on various factors, and analyzed the relevant characteristics of the selected risk factors. It is concluded that "intelligence impairment" in intelligence test is a risk factor for falls, but it fails to enter the logistic regression model. However, since the survey was conducted in 2001, it is still to be further investigated whether the impact of intellectual impairment on the fall has increased in recent years.

1.5 Environmental hazards

The study found that [11] environmental risk factors are important factors for falls, and nearly half of falls are related to environmental factors. This may be related to the wet bathroom, uneven and dry floor, and dim indoor light. At the same time, inappropriate clothing and shoes of the elderly with dementia may also be the cause of falling.

1.6 Psychological factors

The psychology and spirit of senile dementia patients are one of the important factors that lead to falls. Chen Xueming [7] believes that anxiety, fear and delirium are the strongest factors that cause falls among many bad emotions and mental states. Among them, anxiety patients have a high proportion of falls in their daily life and during hospitalization. Patients are prone to fall because of anxiety, which results in a decline in their ability to concentrate and coordinate. Fear generally exists in some patients with mild mental disorders, especially some patients with the fear of falling. The fear of falling in their daily life is too high, which makes them not dare to participate in daily activities and exercise, which accelerates the rate of body degradation, and then increases the risk of falling. After delirium, the elderly patients with mental disorders are in a state of consciousness disorder, abnormal behavior, and difficulty to concentrate. At this time, the possibility of falling is very high.

2. Prevention measures for falls of the elderly with dementia

2.1 ACMMM management model

ACMMM management model includes five aspects [13]: assessment (A), communication (C), monitoring (M), patient (M) and environment (M). ACMMM management model is a new management model proposed by China Hignett [14] in 2010. Since its clinical application, it has achieved good application results. Nansha et al. [15] applied it to the prevention of falls in the elderly. The results showed that ACMMM can reduce the incidence of falls and promote the improvement of nursing quality.

2.1.1 Assessment

Accurate assessment of fall risk is the prerequisite for effective prevention of falls. After the patient is admitted to hospital, the nursing staff should assess the fall risk of the patient as soon as possible. If the patient's ability to live is low, it is necessary to increase the risk assessment of balance, gait and fear of falls to provide basis for nursing work [1].

2.1.2 Communication

Chen Xuehong et al. [16] believed that the communication of the elderly with dementia could be strengthened from four aspects: strengthening psychological communication, informing of unsafe factors, application and education of medical equipment, and strict shift handover. During psychological communication, nurses, family members and other nursing staff can go to the patient's side for "face-to-face" communication, feel the patient's current emotional state, and take targeted psychological counseling to improve treatment confidence. At the same time, hospital nurses and community nurses can introduce the unsafe factors of patients to patients and their families in detail to prevent the occurrence of unsafe events [17]. In the ward, nurses can strengthen the application education of medical equipment, introduce the use and use methods of various instruments and equipment in the ward to patients and their families, and mark the unsafe factors of patients in detail during the shift handover process, and inform the handover nurses

[18].

2.1.3 Monitoring

First of all, if the patient is complicated with basic diseases and needs to take medicine, the nursing staff should understand the drugs, pharmacological effects and adverse reactions taken by the patient, guide the patient to take medicine, and strengthen the observation and inspection of the changes in the patient's vital signs. Secondly, strengthen the safety monitoring of patients, and set up a video monitoring system in the public areas of the ward, such as corridors, stairs, and corners, to monitor the activities of patients at any time, so as to quickly rescue in case of danger.

2.1.4 Patients

Do a good job of correct medication guidance and health knowledge education, strengthen night patrol, and help patients with mobility difficulties or fractures to implement rehabilitation training, so as to improve the status of patients.

2.1.5 Environment

After the patient is admitted to the hospital, the nursing staff should introduce the environment of the ward and ward in detail, prompt the places that are prone to fall, and arouse the attention of the patient and his family; The nursing staff should ensure that the floor of the sick area and the ward is flat and dry, and remove obstacles. The toilet should be placed with anti-slip mats; The nursing staff should regularly check the fixation of tables, chairs and beds in the ward and the lighting facilities, and adjust the lighting to the appropriate state; If the patient has mental disorder or orientation disorder, he/she should inform his/her family members to accompany him/her and strengthen the patrol of the patient; The nursing staff should also inform the patient to wear pants with appropriate length and shoes with proper fit to eliminate the risk factors of falling. The study found that [11] nearly half of falls are related to environmental factors. Nurses and family members need to do a good job of anti-skid in the bathroom, keep the floor flat and dry, and keep the indoor light suitable and family members to accompany, so as to prevent falls.

2.2 Knowledge, trust and practice intervention mode

The research results [19] showed that according to the knowledge, belief and practice intervention model, after one-to-one health education guidance, the incidence of falls in the secondary and tertiary high-risk inpatients decreased significantly. First of all, we can give a lecture on knowledge popularization at the place where the community members gather, distribute relevant books, audio-visual products to them during the lecture for better understanding and learning, educate family pensioners and their families or caregivers in the form of printed knowledge manuals, and introduce the knowledge about fall prevention. Then, strengthen the health awareness of dementia patients and their families and the self-confidence to prevent falling. Finally, strengthen fall prevention and fall prevention techniques, urge family nursing staff to insist on giving patients physical exercises such as limb balance training, lower limb strength training, functional training, Otango training, Taijiquan, etc., and use rational drugs to prevent the elderly from falling. However, in the late stage of Alzheimer's disease, due to the reason of disease, the patient's intelligence is damaged, and it is difficult to implement cognitive training for the patient to prevent falls. Therefore, it is not realistic to prevent falls for the elderly with severe dementia by the intervention mode of knowledge, belief and practice.

2.3 Prevention of falls Sensory treatment

Sensory treatment and stimulation was born in the 1970s, and is popular in Central Europe and Australia. This method is mainly used to provide olfactory, visual, auditory and tactile stimulation for elderly patients with mental disorders. This treatment method is to place the above-mentioned sensory stimulation devices in the same room, and the patients enter the room and give them single, double and multiple sensory stimulation through system settings, using light, sound, touch, smell Balanced training in multiple ways

[20]. Although the above methods can improve the balance and coordination of patients to a certain extent, and reduce the incidence of falls in elderly patients with mental disorders, this method requires more resources. Therefore, the cost and difficulty of universal application are high and difficult to achieve.

2.4 Fall prevention medication

At present, psychotic drugs are one of the reasons that lead to the risk of falls in patients. Therefore, rational use of drugs can reduce the proportion of falls. Wang Hong and Xing Gaishu [21] carried out an investigation and study on the elderly patients with mental disorders who were treated in the hospital. After a comprehensive evaluation of the condition of 150 patients, their antipsychotic drugs were reduced as appropriate, and they were treated continuously for half a year. During the treatment period, the fall rate of patients was reduced by 51%. After the test was stopped, the patients continued to use drugs according to the conventional treatment method, and the fall rate increased by 43% after 1 month. Although in clinical practice, patients can be prevented from falling by reducing antipsychotic drugs. However, it is very difficult to reduce the drug dose for a long time or permanently, which has a high impact on the treatment effect of patients with mental disorders. Therefore, this way of preventing falls needs further study.

2.5 Protective measures for patients

The previous article is mainly based on the fall prevention care and management for early senile dementia patients. However, some senile dementia patients develop with the prolongation of the course of disease, and it is difficult to prevent falls through the above methods at this time. For this kind of senile dementia patients, it is necessary to intervene and manage, strengthen the protection of patients, and prevent patients from being injured after falling. Senile dementia patients with osteoporosis may fracture after falling, which has a great impact on their life safety and quality of life. Calcium or vitamin D can be used as appropriate after detecting the bone density of patients to prevent fractures. In addition, external hip joint protectors can be used for the protection of patients' hip joints. This protector is mainly used to prevent patients from femoral neck fracture or hip joint fracture after falling. More new inventions of protective devices for the elderly with dementia are needed in clinical practice.

To sum up, the incidence of falls in the elderly with dementia is high. Researchers need to further explore the risk factors that lead to falls in the elderly with dementia, take positive countermeasures against age, gender, inability to exercise alone, intellectual impairment, environmental risk factors, psychological factors and other factors, and explore more effective and feasible prevention methods to reduce the incidence of falls in the elderly with dementia.

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