Dementia Care Partners' Fall Risk Management: Developing a Behavioral Framework Using Grounded Theory Approach

Background and Purpose: Community-dwelling older adults living with dementia (OLWD) experience nearly two to ten times higher fall risk than older adults without dementia (Allan et al., 2009). Despite this, evidence is limited concerning effective fall management strategies for them. Care partners (broadly defined as relatives, partners, and friends) play a critical role in managing the fall risk for community-dwelling OLWD (Zhou et al., 2020). However, it is unclear what behaviors dementia care partners adopt are relevant to fall risk management. The purpose of this study was to propose a behavioral framework of dementia care partners’ fall risk management.

Methods: The grounded theory approach was used for its suitability in developing a new framework from individual experiences (Charmaz, 2014). Participants were recruited through community-based organizations in Washington State from July 2019 to March 2020. In-depth semi-structured interviews were conducted with 14 dementia care partners. The interview protocol probed questions related to care partners’ experiences of fall risk management for community-dwelling OLWD. Data analysis included the following steps: open coding, memory (“memo”) writing, axial coding, and constant comparative process (Charmaz, 2014; Corbin & Strauss, 2014).

Results: Care partners most identified as female (n=11, 79%), non-Hispanic white (n=10, 71%), and ranged in age from 48-87. Half of the participants were spouses/partners of OLWD and the other half were adult children. All the participants were primary care partners and nine of them shared some of their care responsibilities with other care partners (hereafter referred to as “secondary care partners”). Eight domains of fall risk management behaviors were identified, including 1. functional mobility assistance, 2. assessing and addressing health conditions, 3. health promotion support, 4. safety supervision, 5. physical environment modification, 6. receiving, seeking, and coordinating care, 7. learning, and 8. self-adjustment. These behaviors were adopted across four stages of fall risk management: 1. providing support before dementia diagnosis, 2. preventing falls, 3. preparing to respond to falls, and 4. responding to falls. These behaviors can be intentionally focused on fall risk management or adopted by care partners for other reasons without the intention to affect OLWD’s fall risk. All the eight domains of fall risk management behaviors were adopted by primary care partners, while secondary care partners mainly made efforts in health promotion support, safety supervision, and physical environmental modification.

Conclusions and Implications: This study expands our knowledge of both primary and secondary care partners’ fall risk management for community-dwelling OLWD. The proposed behavioral framework indicates that dementia care partners’ fall risk management is a multi-domain, multi-stage process with multiple stakeholder. It represents different possible mechanisms through which care partners can impact OLWD’s fall-related outcomes. Once validated, this framework can be used to examine the impact of care partners on fall risk reduction for OLWD and what factors facilitate or hinder care partners’ fall risk management behaviors. This framework will inform the development of assessment tools or interventions for social workers to collaborate with interprofessional care teams and care partners to effectively manage the fall risk for OLWD.