A mixed methods systematic review of informal caregivers' experiences of fall risk among community‐dwelling elders with dementia

Abstract

Evidence on effective fall prevention strategies for community‐dwelling elders with dementia is limited, although these elders are at high risk of falling. Informal caregivers may play an essential role in managing fall risk for elders with dementia. Thus, understanding caregiver's experiences is critically important. This systematic review aims to (a) identify caregivers' perceptual, emotional and behavioural responses to fall risk in elders with dementia and (b) examine the outcomes and effects of caregiver behavioural responses. A mixed methods systematic review of 10 databases (PubMed, PsycINFO, CINAHL, Social Service Abstracts, Social Work Abstracts, EMBASE, Web of Science, Scopus, Cochrane Library and TRIP Medical Database) was conducted. We searched English language, peer‐review articles (January 1, 1985–March 20, 2020) that met the predefined inclusion/exclusion criteria. Study quality was assessed using the Mixed Methods Appraisal Tool. Data were analysed using thematic synthesis techniques. Twenty‐nine studies were included. Six analytic themes were generated concerning caregivers' perceptual, emotional and behavioural responses: (a) fear of the negative health consequences of falls; (b) limited insights into factors contributing to falls; (c) varying expectations of managing fall risk; (d) multi‐level efforts; (e) struggling with responsibilities; and (f) inaction and withdrawal. The findings about the outcomes and effects of caregivers' behaviours were synthesised into three analytic themes: (a) multi‐faceted outcomes; (b) uncertain and inconsistent evidence; and (c) unclear associations. The study generated new insights in understanding caregivers' responses of fall risk among community‐dwelling elders with dementia and identified significant gaps in examining the impact of caregivers' responses and what shapes these responses. Investment in understanding caregivers' perspectives will inform future interventions and policies to reduce negative outcomes for elders, caregivers and care systems.

Physical Activity and its Influencing Factors in Community-Dwelling Older Adults With Dementia: A Path Analysis

“…On the one hand, the limitation of physical capacity reduced their energy to participate in PA (Cedervall et al, 2015). On the other hand, as the interviews with caregivers indicated, their limited reduced physical capacity reduced opportunities for the patients to take part in outdoor activities alone, because of anxiety about them falling (Malthouse & Fox, 2014;Zhou et al, 2020). In line with "COM-B system," capacity and opportunity were key factors for participation in PA.…”

“…The neuropsychiatric symptoms were mainly expressed as emotion (e.g., apathy) and behavioral problems (e.g., psychomotor alterations) in this survey (Table 2). These symptoms are not only associated with negative thought processes to engage in activities (Rist et al, 2015), but also are the leading causes of disturbance in normality of the ADL and augment the caregivers' worries about their falling (Urwyler et al, 2017;Zhou et al, 2020). The continuity and regularity of daily life are convenient for the arrangement of PA based on the patients' physical conditions.…”

Development of a behavioural framework for dementia care partners’ fall risk management

“…Previous studies suggested that supporting care partners to manage fall risk might be effective in reducing this risk for community-dwelling OLWD [ 14 ]. A recent systematic review found that care partners adopted multi-level (individual, interpersonal, physical environment, and community/institutional level) strategies to manage fall risk for OLWD that they cared for; however, these review findings were based on studies that were not designed to systematically examine care partners’ experiences of fall risk management (FRM) [ 15 ]. Available tools and interventions developed to support or involve care partners in managing fall risk for OLWD included a decision-making discussion tool for the falls prevention [ 16 ], a Home Safety Toolkit [ 17 ], and a dyadic Tai Chi exercise program [ 18 ].…”

“…Primary care partners tend to provide practically round-the-clock care, including OLWD’s activities of daily living, mobility, instrumental activities of daily living, and overall health management; secondary care partners often provide supplementary support to OLWD, especially supporting OLWD’s basic daily tasks [ 22 – 25 ]. However, previous studies have not described how care partners’ FRM behaviours differ by their caring responsibilities [ 15 ], which might not give a complete picture of FRM in the context of dementia caregiving.…”

Untitled

“…His scheme is in psychological approach, to prevent elders from falling is from the framework of managing fear of falling. Y Zhou, et al [3] Published a paper in 2020.…”