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

Abstract

Background Although older adults living with dementia (OLWD) are at high risk for falls, few strategies that effectively reduce falls among OLWD have been identified. Dementia care partners (hereinafter referred to as “care partners”) may have a critical role in fall risk management (FRM). However, little is known about the ways care partners behave that may be relevant to FRM and how to effectively engage them in FRM. Methods Semi-structured, in-depth interviews were conducted with 14 primary care partners (age: 48–87; 79% women; 50% spouses/partners; 64% completed college; 21% people of colour) of community-dwelling OLWD to examine their FRM behaviours, and their observations of behaviours adopted by other care partners who were secondary in the caring role. Results The analysis of interview data suggested a novel behavioural framework that consisted of eight domains of FRM behaviours adopted across four stages. The domains of FRM behaviours were 1. functional mobility assistance, 2. assessing and addressing health conditions, 3. health promotion support, 4. safety supervision, 5. modification of the physical environment, 6. receiving, seeking, and coordinating care, 7. learning, and 8. self-adjustment. Four stages of FRM included 1. supporting before dementia onset, 2. preventing falls, 3. preparing to respond to falls, and 4. responding to falls. FRM behaviours varied by the care partners’ caring responsibilities. Primary care partners engaged in behaviours from all eight behavioural domains; they often provided functional mobility assistance, safety supervision, and modification of the physical environment for managing fall risk. They also adopted behaviours of assessing and addressing health conditions, health promotion support, and receiving, seeking and coordinating care without realizing their relevance to FRM. Secondary care partners were reported to assist in health promotion support, safety supervision, modification of the physical environment, and receiving, seeking, and coordinating care. Conclusions The multi-domain and multi-stage framework derived from this study can inform the development of tools and interventions to effectively engage care partners in managing fall risk for community-dwelling OLWD.

Discriminant Accuracy of Standing Balance Tests for the Level of Gait Dependency in Hospitalized Patients with Alzheimer’s Disease

“…Tandem standing is a test of postural stability, particularly in the lateral direction [26], which is considered an important factor in predicting falls [27,28]. The dependent group in this study included patients who required supervision while walking, and the degree of fall risk is largely related to whether they required supervision [29][30][31]. This reinforces the finding that tandem standing is suitable for determining whether a patient should be supervised.…”

Association Between Pain and Fall Worry Among Community-Dwelling Older People With Cognitive Impairment in the United States

“…However, literature suggested that Black older people in the United States were at a higher risk of experiencing CI ( 66 ) and were more likely to report risk factors associated with falling, such as physical limitations ( 67 ). The lower prevalence of fall worry among older Blacks may reflect their more extensive care networks compared to non-Hispanic Whites ( 68 ) and greater collaborations within care networks ( 69 ) given the importance of informal care partners in reducing fall worry for older people with CI ( 70 ). It may also reflect resilience as a culturally valued trait that has historically helped African American communities deal with oppression and discrimination ( 71 ).…”

“…Visual impairment causes a wide range of challenges to older people’s physical function and psychological health, which are all associated with increased fall worry ( 77 ). However, visual impairment may also enable older people and their care partners to develop adaptive strategies to mitigate the negative impact of fall worry on their daily activities ( 78 ), even before the onset of CI ( 70 ).…”

“…This may be because older people with CI who are female have stronger affective experiences of falls ( 76 ) and emotional responses may have been retained ( 15 ) despite their worsening CI. The associations between marital status and activity-limiting fall worry for the probable dementia group highlight the importance of spouses/partners in reducing fall worry when older people with CI increasingly need support in their everyday activities ( 70 ).…”

Perspectives of People with Mild to Moderate Cognitive Impairment and Their Caregivers about Physical Activity and Exercise for Fall Prevention: A Qualitative Study

“…Management following a fall incurs a high cost and is an issue for policymakers, healthcare providers and many personnel involved in looking after older adults with dementia, including family members [6,7]. For a person with dementia, there are numerous multi-factorial, intrinsic and extrinsic fall risk factors [8], such as lighting, environmental hazards, co-morbidities and polypharmacy, as well as cognitive impairment [9].…”