Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia

Measure Specification

The assessment of safety is an identified gap in dementia care (Black BS, Johnston D, Rabins PV, et al. Unmet Needs of Community-Residing Persons with Dementia and Their Informal Caregivers: Findings from the MIND at Home Study. J Am Geriatr Soc 2013;61(12):2087-2095.) Persons with dementia are at increased risk of having safety concerns for several reasons.

Cognitive loss can lead to confusion regarding use of medications, handling of weapons or machinery, or the ability to remember to turn off appliances, such as ranges and stoves. Dementia also impairs the person’s judgment, and as such, increases the risk for financial abuse and exploitation. The risk of falls among persons with dementia is greater, and following injury, persons with dementia are less likely to recover than other seniors (Allan LM, Ballard CG, Rowan EN, Kenny RA.

Incidence and prediction of falls in dementia: a prospective study in older people. PLoS ONE. 2009;4). Persons with dementia are at greater risk of burns due to hot water. Similarly, persons with dementia may exhibit aggressive behaviors towards themselves or others (Salzman C, Jeste D, Meyer RE, Cohen- Mansfield j, et.al. Elderly Patients with Dementia-Related Symptoms of Severe Agitation and Aggression: Consensus Statement on Treatment Options, Clinical Trials, Methodology and Policy.

J Clin Psychiatry 2008 June:69(6):889-898). These and other types of injuries are preventable through mitigating strategies, however, the risks must be identified. This quality measure requires screening for safety concerns in two risk domains: dangerousness to self/others and environment. Current treatment guidelines for the management of dementia recommend that healthcare providers screen for safety risks.

There are community and online resources to facilitate home safety. By routinely screening for safety issues, the clinician will also become increasingly more familiar with the range of problems identified, and thus be able to continuously improve the quality of care delivered.

The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure: • “Recommended assessments include evaluation of suicidality, dangerousness to self and others, and the potential for aggression, as well as evaluation of living conditions, safety of the environment, adequacy of supervision, and evidence of neglect or abuse (Category I).

Important safety issues in the management of patients with dementia include interventions to decrease the hazards of wandering and recommendations concerning activities such as cooking, driving, hunting, and the operation of hazardous equipment. Caregivers should be referred to available books [and other materials] that provide advice and guidance about maximizing the safety of the environment for patients with dementia…As patients become more impaired, they are likely to require more supervision to remain safe, and safety issues should be addressed as part of every evaluation.

Families should be advised about the possibility of accidents due to forgetfulness (e.g., fires while cooking), of difficulties coping with household emergencies, and of the possibility of wandering. Family members should also be advised to determine whether the patient is handling finances appropriately and to consider taking over the paying of bills and other responsibilities.

At this stage of the disease [i.e., moderately impaired patients], nearly all patients should not drive.” (1) For mild to moderate Alzheimer's disease “Assess for safety risks (e.g.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient during the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.