(Withdrawn) "Not Just Tools": How Do Falls in Community-Dwelling Older Adults Living with Dementia Impact the Health of Their Care Partners?

Background and Purpose: Community-dwelling older adults living with dementia (OLWD) experience a higher risk of falling compared to their age-matched peers without dementia. Falls negatively impact not only the health and well-being of OLWD but also their care partners (i.e., family, friends). Limited studies have examined care partners’ responses to OLWD’s falls. Little is known about how OLWD’s falls impact their care partners’ health and well-being. The aim of the study was to examine care partners' responses to falls among community-dwelling OLWD and explore possible mechanisms through which OLWD’s falls might impact care partners' health and well-being as a foundation for mitigation.

Methods: This was a qualitative secondary analysis using one original dataset from a primary study that focused on examining care partners’ experiences of OLWD’s health crises that resulted in hospitalization or emergency room visits. The primary study recruited 100 care partners of community-dwelling OLWD via Electronic Medical Records at two local hospitals and offered participation using mailed and follow-up phone invitations. Interviews were transcribed verbatim. Through preliminary analysis, we observed that 59 dementia care partners (age 33 to 88, mean: 63) reported the impact of falls among OLWD (age 64 to 96, mean: 82) on care partners themselves. We conduct a supplementary analysis of this phenomenon in this sub-sample, comprised predominantly of women (70%; 30% men), Non-Hispanic Whites (78%; 14% Asians, 7% Black/African American, 3% American Indian or Alaska Natives, 2% Hispanics), OLWD’s adult children (51%, 37% spouses, 12% others), and college-educated individuals (63% had a college degree). The majority (88%) viewed themselves as primary support persons. A grounded theory approach was utilized for the analysis.

Results: We found that care partners’ perceptions of OLWD’s falls (a lack of clarity about OLWD’s fall risk, traumatic experiences of OLWD’s falls, and confusion about falls-related care needs) influence their psycho-emotional health (worry, fear, anger, and frustration) and fall risk management behaviors (engaging informal care networks, collaborating and negotiating with formal care providers, negotiating with OLWD about fall risk and autonomy, modifying the physical environment, and self-sacrificing). Although these behaviors might reduce OLWD’s fall risk, they added significant care responsibilities, which might negatively impact care partners’ health and well-being over time.

Conclusions and Implications: Findings suggest that care partners should not just be utilized as tools for reducing OLWD’s fall risk and 'picking up the piece' when OLWD fall. Mitigating the negative impact of OLWD’s falls on care partners should be incorporated into developing care plans to address OLWD’s falls. Such an approach should address care partners’ perception of OLWD’s falls, their psycho-emotional health, and fall risk management behaviors, which requires the engagement of interprofessional health and community service providers. Social workers can play essential roles in coordinating interprofessional teams to support care partners to acquire new skills/tools, cope with emotional challenges, resolve care network conflicts, manage increased responsibilities, and mitigate self-sacrificing behaviors. Other clinicians (such as physicians, nurses, and occupational/physical therapists) all play important roles in addressing care partners’ perceptions of OLWD’s falls and providing training in fall risk management.