Person-centered risk assessment framework: assessing and managing risk in older adults living with dementia

Practice points

• Persons living with dementia are at increased risk for motor vehicle accidents, getting lost, medication errors and other adverse events.
• There is a critical need for feasible, effective ways of proactively assessing and managing risks associated with dementia, with the aim of averting crises, and unnecessary suffering and costly healthcare service utilization.
• The person-centered risk assessment framework (PCRAF) is a person-centered risk enablement framework that is focused on physical risks, as well as the unintended emotional, psychological and spiritual harm of taking away activities that are meaningful and contribute to quality of life. The PCRAF allows persons with dementia to contribute as much as possible to decisions about high risk activities and alternate solutions to meeting underlying psychosocial needs.
• This study assessed healthcare providers’, persons with dementia, and care partners’ perceptions of the PCRAF as well as the feasibility of using this framework in Primary Care Collaborative Memory Clinics.
• The PCRAF was well received; use of the PCRAF was sometimes challenging in the context of busy clinic assessments and when the person with dementia had limited insight into potential safety risks.
• Proactive assessment and management of risks may be feasibly conducted within primary care when appropriate to ensure that the care delivered is respectful of individual needs and preferences.

With the aging Canadian population, increasing prevalence of older adults living in the community with dementia and increasing costs of dementia care (1), the healthcare system will be challenged to develop solutions to allow persons suffering from dementia to remain living in the community safely, for as long as possible, and with the best quality of life. Persons living with dementia (PLWD) are at increased risk for motor vehicle accidents, getting lost, medical errors and other adverse events that contribute to early institutionalization, and high healthcare utilization (2-4).

Supporting safe longer-term community living among PLWD requires a major shift in approach to care. Traditionally the management of risk has been reactive, occurring after major crises events result in emergency department visits and hospitalizations (5,6). There is a critical need for feasible, effective ways of proactively assessing and managing risks associated with living with dementia with the aim of averting these crisis events, resulting in avoidance of unnecessary suffering and costly acute care hospital utilization...