The Long-Term Impact of Falls Among Community-Dwelling Older People with Dementia on Caregiving Difficulties: Moderation Effects of Living Arrangements

Background and Purpose: Community-dwelling older people with dementia (OPWD) experience a higher risk of falling than their age-matched peers without dementia. Falls negatively impact the health and well-being of OPWD and increase the care burden for their family/friend care partners. Little is known about the long-term impact of falls on caregiving difficulties and how such consequences differ between care partners who live with OPWD and those who do not. The study aimed to examine the longitudinal associations between falls and caregiving difficulties and if living arrangements (co-residence vs. live at different residences) moderate the associations.

Methods: The National Health and Aging Trends Study Waves 6 (T1) and 7 (T2), and the National Study of Caregiving Wave 3 (T2) provided data (n = 867 care partners for 521 community-dwelling OPWD; n=469 co-resident care partners; n=398 care partners with separate residences). Outcome variables were care-related emotional, physical, and financial difficulties. OPWD’s falls from T1-T2 were coded as: (1) continued low fall risk (0/1 fall in T1 or T2); (2) increased fall risk (0/1 fall in T1 and 2+ falls in T2); (3) continued high fall risk (2+ falls in T1 and T2); (4) decreased fall risk (2+ falls in T1 and 0/1 fall in T2). We used the multilevel generalized linear models to examine associations of OPWD’s falls from T1-T2 with T2 caregiving difficulties adjusted for covariates (care partners’ age, race/ethnicity, gender, education, relationship to OPWD, and the number of chronic conditions [0-9]). We then included an interaction term and conducted a sub-group analysis to evaluate the moderation effect of living arrangements.

Results: Continued high fall risk was significantly associated with greater care-related physical and financial difficulties for both co-resident care partners and those with separate residences. Living arrangements did not significantly moderate these relationships. Continued high fall risk was significantly associated with greater care-related emotional difficulties only for co-resident care partners. Decreased fall risk was significantly associated with greater emotional and physical difficulties only for co-resident care partners, and greater financial difficulties only for care partners with separate residences.

Conclusions and Implications: OPWD’s continued high fall risk represents a significant stressor that heightens the risk of physical and financial difficulties for care partners regardless of their living arrangements. Co-resident care partners are more likely to be impacted emotionally, as they might experience more worry, fear, and frustration when striving to ensure OPWD’s safety. The associations between decreased fall risk and caregiving difficulties indicate various efforts and sacrifices care partners may have made. Intervention programs should support care partners in fall risk management, address their emotional, physical, and financial difficulties, compensate for their sacrifices, and tailor to the needs of care dyads with different living arrangements. Future research should examine factors (i.e., activities assistance, nursing/medical care tasks, self-sacrificing behaviors, conflicts with OPWD) that may mediate associations between falls and caregiving difficulties and identify protective factors (i.e., resilience, informal support, and formal services) that may support care partners to overcome these difficulties.