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

Abstract

Older adults with cognitive impairment are at high risk of experiencing falls. Although no specific fall prevention guidelines presently exist for this population, exercise programmes to prevent falls are recommended. Limited literature exploring what older adults with mild to moderate cognitive impairment think about or how they make sense of the need for such programmes exists. This study explored the perspectives of older adults with mild to moderate cognitive impairment and their caregivers about exercise and physical activity in the context of fall prevention. Underpinned by Interpretive Phenomenological Analysis, qualitative semi-structured interviews were undertaken with nine community-dwelling adults (>65 years) with mild to moderate cognitive impairment and their caregivers (N = 6). Three themes of acceptance, denial, and accommodation were identified. The fluctuating concept of ‘self’ appeared to influence individual decisions to exercise or be physically active and what sort of physical activity to undertake more than any practical barriers. We suggest that healthcare professionals emphasise the concept of personhood, listening to and reinforcing biographic narratives of older adults living with cognitive impairment to foster a sense of autonomy, and shared decision-making while emphasising fall prevention activities that older adults with cognitive impairment might like to engage with.

The Experiences of Older Adults with Dementia of “Balance Wise”—An Individual or Group-Delivered Exercise Programme: A Qualitative Study

“…In our previous qualitative study [21], we found that older adults with mild to moderate cognitive impairment and their care partners had complex and changing perceptions about exercise and physical activity. The people we interviewed seemed to fluctuate between states of acceptance, denial, and accommodation, and each state would impact participants' decisions to exercise or be physically active and what sort of physical activity they wished to engage in.…”

“…Our previous qualitative study identified three dispositions where people with mild-to-moderate cognitive impairment appeared to fluctuate between-acceptance, denial, and accommodation. Each of these states appeared to self-impact, in the moment, an individual's decision to exercise or be physically active and what sort of physical activity to engage in [21]. This apparent fluctuating nature of the early stages of dementia may be one reason people may not be inclined to participate in studies or activity programmes.…”

“…The OEP has been reported as a safe and acceptable exercise programme in older adults with cognitive impairment [25]. We modified these programmes addressing considerations identified in our qualitative study [21], namely, to shorten session duration and keep exercise intensity low to accommodate for fatigue and limited concentration spans; to include exercises that challenged cognitive function and visual input and involved complex motor tasks used in everyday life; and to ensure that all exercises chosen were fun and enjoyable to do. Participants could choose to have a home-and individual-based exercise programme or attend a group-based exercise programme.…”