Perspectives of healthcare professionals in England on falls interventions for people with dementia: a qualitative interview study

Abstract

ObjectiveTo explore the experiences of healthcare professionals working in falls prevention and memory assessment services in providing assessments and interventions for falls risk reduction in people with dementia.DesignThis is a qualitative study using 19 semistructured interviews. Interviews were analysed through thematic analysis.SettingCommunity-based falls and memory assessment services in the East Midlands, UK.ParticipantsNurses (n=10), physiotherapists (n=5), occupational therapists (n=3) and a psychiatrist (n=1).ResultsThree substantive themes were identified: challenges posed by dementia, adaptations to make falls prevention appropriate for people with dementia and organisational barriers. Patients’ poor recall, planning and increased behavioural risk associated with dementia were key problems. Healthcare professionals provided many suggestions on how to overcome these challenges, such as adapting exercise interventions by using more visual aids. Problems associated with cognitive impairment created a need for additional support, for instance longer interventions, and supervision by support workers, to enable effective intervention, yet limited resources meant this was not always achievable. Communication between mental and physical health teams could be ineffective, as services were organised as separate entities, creating a reliance on third parties to be intermediaries. Structural and organisational factors made it difficult to deliver optimal falls prevention for people living with dementia.ConclusionsHealthcare professionals experience challenges in providing falls prevention to people with dementia at the individual and organisational levels. Interventions can be adapted for people with dementia, but this requires additional resources and improved integration of services. Future research is needed to develop and test the effectiveness and cost-effectiveness of such services.

“Falling through the cracks”; Stakeholders' views around the concept and diagnosis of mild cognitive impairment and their understanding of dementia prevention

“…Our first theme highlights the liminal position of people with memory concerns-between illness and normality reflecting previous work, 5 individuals' interests and needs, especially for individuals with memory concerns, has been recommended elsewhere. 7,9,21 We recruited participants from a broad range of organisations that provide care to people living with SCD and MCI, including NHS and third sector organisations thereby maximising diversity and encompassing a wider range of professional expertise. We only included professionals who often worked with people with memory concerns.…”

“…The importance of tailoring advice and activities to the individual in order for an intervention to be effective and acceptable for individuals with memory concerns was a clear message by our study participants. Tailoring interventions to individuals' interests and needs, especially for individuals with memory concerns, has been recommended elsewhere 7,9,21 …”

The perspectives of healthcare practitioners on fall risk factors in older adults

“…One of the key strategies for compiling a list of relevant ICF codes involves determining the perspectives of HCPs on fall risk factors in older adults. Practitioners have an important role to play in identifying fall risk (Liddle et al 2018 ), yet their perspectives are not routinely included in research on the topic (Burgon et al 2019 ). Currently, no universal tool exists for HCPs to comprehensively document fall risk factors in older adults, and this possibly contributes to the ineffective management of the problem (De Clercq, Naude & Bornman 2020 ).…”

“…Based on their clinical experience, HCPs could offer new insights into the current knowledge on fall risk factors in older adults, thereby identifying potential risk factors not previously documented. Healthcare practitioners are also able to influence patients’ opinions on falls and to reduce fall risk (Burgon et al 2019 ). Obtaining qualitative data on their perspectives on fall risk factors in older adults and linking these factors to the ICF as a universal framework could give insight into the clinical manifestation of fall risk in this population.…”

Accessing community dementia care services in Ireland: Emotional barriers for caregivers

“…Despite their effect on caregiver's motivation to engage with CBS, little is known about the emotional barriers, mental limitations created by one's own self that prevents open communication of thoughts and feelings (Kuttappa, 2020), and their effect on a caregivers' decisions to engage or not engage with CBS (Morgan et al, 2002;Stirling et al, 2010;Taylor et al, 2016). Similarly, professional healthcare providers (PHPs) play a significant role in influencing patients' opinions on healthcare based interventions (Burgon et al, 2019;Dening et al, 2019), but little research has been done on PHP awareness of internal emotional barriers of caregivers' in relation to CBS use.…”