Causal Effect of Caregivers' Efforts in Home Modification on Preventing Falls for Community-Dwelling Older Adults with Dementia

Background and Purpose: Older adults with dementia (OAD) have a higher risk of falls compared to their age-matched peers without dementia. Caregivers’ efforts to create a safe home environment are important for preventing falls for OAD. However, there is limited evidence about the effect of caregivers’ efforts in home modification on preventing falls for community-dwelling OAD.

Methods: The study examines the causal effect of caregivers’ efforts in home modification on preventing falls for community-dwelling OAD. Data are drawn from the 2015 and 2016 National Health and Aging Trends Study (NHATS) and 2015 National Study of Caregiving (NSOC) – two linked national surveys that provide information on the population of older adults (≥ 65 years of age) and their informal caregivers. The main outcome measure is care recipients/proxy respondents reporting in 2016 NHATS that whether care recipients have fallen down in the last 12 month (Yes or NO). The treatment variable is caregiver reporting in 2015 NSOC whether in the last year the caregiver have made the home safer by adding features or an emergency call system (Yes or NO). The covariates include care recipients’ (2015 NHATS) gender, age, education, self-rated health, self-rated balance, number of chronic diseases (except dementia), fall history in last year, cognitive function, physical capacity, depression, and caregiver depression (2015 NSOC).  Due to the self-selection problems associated with non-experimental data, we use Propensity Score Matching techniques. Covariates are used to generate the propensity score to control their influence on treatment variable and outcome variable. Matching the propensity score of care recipients who have caregivers’ efforts with who do not have, we are able to get the average treatment effect (ATE) of caregivers’ efforts in home modification on preventing falls for community-dwelling OAD. 

Results: We find that among 348 dyads of community-dwelling OAD and their primary caregivers (who provide the most hours of caring tasks), 54% of the caregivers have made efforts in home modification to make the home safer for OAD. Physical capacity, depression, and education of OAD might influence the probability that caregivers would make efforts in home modification for OAD. However, there is almost no effect of caregivers’ efforts in home modification on preventing falls for community-dwelling OAD (ATE is -0.0067, p= 0.9377).

Conclusions and Implications: This finding has limitations since we only have one self-report item reflecting on caregivers’ efforts in home modification. However, it is the first time caregivers’ efforts are captured to explore their motivations and contributions in preventing falls for community-dwelling OAD. Acknowledging more than half of the caregivers are already making efforts, we should further examine the variability of these efforts. The barriers that stop them making efforts shows that we should develop holistic fall prevention interventions to assist families in keep OAD aging-in-place. More support, information and training for caregivers to address the physical and mental health of community-dwelling OAD, especially fall prevention, are needed. It also implies the needs to integrate service for OAD and service for their caregivers in future aging care and health care system.