“The Right Way at the Right Time”: Insights on the Uptake of Falls Prevention Strategies from People with Dementia and Their Caregivers

Abstract

Strong evidence exists for effective falls prevention strategies for community-dwelling older people. Understanding the translation of these strategies into practice for people with dementia has had limited research focus. People with dementia desire to have their voice heard, to engage meaningfully in the health-care decision-making process, making it a priority for researchers and practitioners to better understand how to engage them in this process. This paper reports on the qualitative aspects of a series of studies, which aimed to identify the views of people with dementia and their caregivers regarding perceptions of falls prevention and the successes and challenges of adopting falls prevention strategies. Twenty five people with dementia and their caregivers were interviewed in their homes at baseline, and 24 caregivers and 16 people with dementia were interviewed at completion of a 6-month individualized falls prevention intervention. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Five themes were identified at baseline: perceptions of falls; caregivers navigating the new and the unpredictable; recognition of decline; health services – the need for an appropriate message; and negotiating respectful relationships. At 6 months, caregivers and people with dementia decided on “what we need to know” with firm views that the information regarding falls risk reduction needed to be in “the right way … at the right time.” Rather than caregivers and people with dementia being only recipients of knowledge, they felt they were “more than just empty vessels to be filled” drawing on a “variety of resources” within their circle of influence to be able to positively “adapt to change.” The voices of people with dementia and their caregivers add an important dimension to understanding the translation of falls prevention knowledge for this population. Insights from this study will enable community care health professionals to understand that people with dementia and their caregivers can, and wish to, contribute to implementing falls prevention strategies through their resourcefulness and inclusion in the therapeutic partnership.

Falls prevention for people with dementia: a knowledge translation intervention

“…This component of the KTA framework was interpreted as factors that may prevent the uptake of falls prevention strategies, identified through interview (published elsewhere) (Meyer, Dow, Hill, Tinney, & Hill, 2016).…”

“…At 6 months, caregivers and people with dementia decided on ‘ what we need to know’ with firm views that the information regarding falls risk reduction needed to be in ‘ the right way … at the right time’. Rather than caregivers and people with dementia being only recipients of knowledge, they felt they were ‘ more than just empty vessels to be filled’ drawing on a ‘ variety of resources’ within their circle of influence to be able to positively ‘ adapt to change’ (Meyer et al., 2016).…”

“…This intervention approach ensured that there was acknowledgement of personhood and ongoing capabilities of the person with dementia, and has possibly been a factor in the high adoption of strategies. Accommodation of individual preferences for people with dementia is not common within falls prevention literature (Meyer, Hill, Dow, Synnot, & Hill, 2013), yet there is a desire from people with dementia and their caregivers to have the context of their lives acknowledged (Meyer et al., 2016). Greater uptake of strategies is more likely to occur when contextual factors are considered and the dyad is involved in the decision-making process.…”

“…Preparation and action are set for ‘doing’ with advice/education given, referrals to other services made, and follow-up of recommendations. Knowledge should be translated through the provision of choice and respectful delivery of appropriate, relevant and timely information (Meyer et al., 2013, 2016). Readiness to change behaviour regarding a specific high falls risk factor and ranking of importance were the central tenets of this study.…”

“…As in this study, health professionals should view falls prevention holistically rather than from a discipline perspective, linking with the needs and preferences of the dyad. Effective communication was highly valued by people with dementia and their caregivers (Meyer et al., 2016), with managing own health intricately tied with information received from health professionals (S. Hill, Lowe, & Ryan, 2011). Respectful service provision is highly regarded by older people, with reliable information to be provided prior to a point of crisis, to allow for informed decision-making (Dow et al., 2013).…”