Mapping the nature, type, and association network of safety incidents among individuals with cognitive impairment in China: a large-scale multicenter cross-sectional study - 19/05/26

Doi : 10.1016/j.tjpad.2026.100606

Ying Zhou ^a,^b,^{^{#
Joint first authors}} , Guoping Peng ^c,^{^{#
Joint first authors}} , Zhengluan Liao ^d , Huayan Liu ^e , Jun Liu ^f , Wang Niao ^f , Qiumin Qu ^g , Jingping Shi ^h , Jieli Geng ^a , Nan Zhi ^a , Wenwei Cao ^a , Yaying Song ^a , Yang Zhang ⁱ , Xiaohong Wang ^j , Lin Wang ^b , Yuan Zhu ^k , Yan Zhou ^a , Huali Wang ^l , Yongan Sun ^m , Rujing Ren ⁿ, Hengge Xie ^o,^{⁎
Joint Corresponding authors.} , Gang Wang ^a,^⁎

representing ADC

^a Department of Neurology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200127, China

^b School of Nursing, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200025, China

^c Department of Neurology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China

^d Department of Psychiatry, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, China

^e Department of Neurology, First Affiliated Hospital, China Medical University, Shenyang, 110001, China

^f Department of Neurology, The Second Affiliated Hospital, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510260, China

^g Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Shanxi,710061, China

^h Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, 210029, Nanjing, China

ⁱ Yuyuan Community Health Service Center, Huangpu District, Shanghai 200010, China

^j Shanghai Jinshan Zhongren Geriatric Nursing Hospital, Shanghai, 201501, China

^k Department of Nursing, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200025, China

^l Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, NHC Key Laboratory for Mental Disorders, Beijing, 100191, China

^m Department of Neurology, Peking University First Hospital, Beijing, 100044, China

ⁿ Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

^o Department of Neurology, The Second Medical Center, National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, 100853, China

^⁎⁎ Corresponding author: Gang Wang, MD, PhD, Department of Neurology, Renji Hospital, Shanghai Jiao Tong University, Shanghai School of Medicine, 200127, China. Tel: +8610-18917762271. Department of Neurology Renji Hospital Shanghai Jiao Tong University Shanghai School of Medicine 200127 China

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Highlights

•	Over half of individuals with cognitive impairment experienced safety incidents.
•	Medication errors and verbal aggression were most common safety incidents.
•	Incidence rates varied by care setting, and geographic region, and disease stages.
•	Medication errors and getting lost acted as central nodes bridging other incidents.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

Patient safety critically influences both quality of life and disease progression in older adults with cognitive impairment, yet large-scale multicenter data remain scarce. This study aims to systematically analyze the types of safety incidents experienced by patients with Alzheimer’s disease and related cognitive impairments, and explore the network associations of different safety incidents.

Methods

Initiated by the Alzheimer's Disease China (ADC), this survey recruited 1057 older individuals with Alzheimer’s and related cognitive impairments, along with their families, across 31 provinces, autonomous regions, and municipalities. The safety incidents evaluated in this study included falls, getting lost, medication errors, verbal aggression, physical aggression, household fire, aspiration, and choking. Incidence rates for overall and specific safety incidents were calculated. Correlation analyses and network analysis were performed to examine relationships between incidents.

Results

A high proportion (73.5%) of participants reported at least one safety incident in the past year, with over one-third (36.0%) experiencing three or more concurrent incidents. Medication errors (55.9%) and verbal aggression (39.6%) were most frequent, followed by falls (32.5%) and physical aggression (22.7%). Incidence rates varied significantly by cognitive impairment stage, care setting, and geographic region. Network analysis highlighted medication errors and getting lost as central nodes bridging other incidents.

Conclusions

This study reveals an alarmingly high incidence of safety incidents among cognitively impaired patients, affecting their physical, psychological, and familial well-being. A collaborative, multidisciplinary effort involving healthcare professionals, family caregivers, fire and police emergency responders, and public health policymakers is essential to develop individualized safety strategies aligned with patient needs and contextual considerations.

Le texte complet de cet article est disponible en PDF.