Inclusive Decision Making for Falls Prevention: A Discussion Tool for Use With People With Dementia and Their Caregivers

Abstract

Provision of choice and participation in falls prevention strategies is challenging for people with dementia. This study outlines development of a discussion tool to aid engagement of people with dementia and their caregivers in falls prevention strategies. The tool is based on a literature review of falls prevention and dementia care (1990–2016) and decision aid principles and was trialed over 6 months. A total of 25 community-dwelling people with dementia (Mage = 80 years, SD = 7.7, 52% male) and their caregivers (Mage = 73 years, SD = 12.3, 36% male) underwent falls risk assessment and evaluation of their preparedness to change falls risk behaviors. Most commonly rated, and prioritized for intervention, high falls risk factors were impaired balance/mobility (92%), polypharmacy (60%), and incontinence (56%). This discussion tool facilitated collaboration between people with dementia, their caregivers, and health professionals, to increase uptake of acceptable and feasible evidence-based falls prevention strategies.

How do person‐centered outcome measures enable shared decision‐making for people with dementia and family carers?—A systematic review

“…Qualitative studies included in this review used focus groups, 29 interviews, 30 or observations. 31 Others were feasibility studies ( n = 2), 32 , 33 pilot study, 34 pilot randomized controlled trial ( n = 1), 35 quasi‐experiment ( n = 1), 36 and quality improvement ( n = 2). 37 , 38 Studies originated from the United States, 30 , 35 , 37 Canada, 33 Europe, 31 , 32 , 36 , 38 , 39 and Australia.…”

“… 37 , 38 Studies originated from the United States, 30 , 35 , 37 Canada, 33 Europe, 31 , 32 , 36 , 38 , 39 and Australia. 29 , 34 , 40 Half of the studies were conducted in long‐term care settings ( n = 5), such as nursing homes. 31 , 32 , 33 , 36 , 37 The remainder were based in a mixed setting, 38 community, 34 emergency department, 29 , 30 and a geriatric/primary care clinic.…”

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

“…Despite the limited number of studies that posed clear research questions about caregivers' experiences ( n = 5, 17%; Faes et al, 2010; Mcintyre & Reynolds, 2012; Meyer, Hill K. D., et al, 2019; Meyer, Hill, S., et al, 2019; Peach et al., 2017; Suttanon et al., 2012), all the studies collected data that permitted the first study question to be addressed. By contrast, only one study posted clear research questions that were relevant to the second review question, and only 16 studies (55%) collected data that allow this question to be addressed.…”

“…First, this review demonstrates the need for clinicians to assess both the fall risk for elders with dementia and their caregivers' needs and capacities in managing such risk. For example, a research team in Australia has developed an inclusive decision‐making tool to aid the engagement of people with dementia and their caregivers in fall prevention strategies (Meyer, Hill K. D., et al, 2019; Meyer, Hill, S., et al, 2019). Future education and training programs need to be developed for care providers to utilise various tools to work with elders with dementia and their caregivers.…”

“…A previous study in the United States found that high levels of informal care receipt were associated with a 54% reduction in risk of fall‐related injuries among the cognitively impaired (Hoffman et al., 2017). However, little is known how caregivers reduce the risk of falls among elders with dementia and how healthcare teams can support and bolster caregivers' efforts (Meyer, C., Hill, K. D., Hill, S., & Dow, B., 2019; Meyer, C., Hill, S., Hill, K. D., & Dow, B., 2019). As caregivers often take on the primary responsibility for managing the health of elders with dementia who live at home (Sadak, Wright, & Borson, 2016), a robust understanding of their experiences may help inform the design of falls management programs for elders with dementia.…”