Facilitators and Barriers for Care Partners Managing Fall Risk for Community-Dwelling Older People with Dementia

Background and Purpose: Community-dwelling older people with dementia (OPWD) experience a higher risk of falling than their age-matched peers without dementia. Previous studies found that their care partners played a critical role by adopting various fall risk management (FRM) behaviors, such as providing mobility and safety assistance, health management, service coordination, and accommodation. However, little is known about what factors may shape care partners’ FRM behaviors, which hinders the development of effective strategies to engage dementia care partners in FRM. The study aims to explore facilitators to and barriers of care partner management of fall risk among community-dwelling older people with dementia.

Methods: Semi-structured, in-depth interviews were conducted with 14 primary care partners (age: 48–87; 79% women; 50% spouses/partners; 64% completed college; 21% people of color) of community-dwelling OPWD. The interviews elicited care partners’ FRM behaviors and the process of initiating, maintaining, and (dis)continuing these behaviors. Interviews were transcribed verbatim. A thematic analysis approach was utilized, and codes from the analysis were organized according to the behavioral framework of dementia care partners’ FRM (Zhou et al., 2022) and the Socio-Ecological Model for Developing and Implementing Comprehensive Dementia Care (Gitlin & Hodgson et al., 2018).

Results: Facilitators include care partners' understanding of fall risks, needs, preferences, habits, and strengths of OPWD, previous caregiving experiences, perceived benefits of different FRM behaviors, care partners’ knowledge and skills of FRM, collaborative relationship between OPWD and care partners, and being able to access services (e.g., paid caregivers, nutrition services), facilities (e.g., gym fee covered by Medicare advantage plan, senior centers, parks), and education resources (e.g., knowledgeable service providers). Barriers include OPWD’s cognitive status and behavioral and psychological symptoms (e.g., apathy, anxiety, depression), OPWD’s resistance to changes, care partners’ fatalism, denial, and under-estimation of fall risk, care partners’ physical and mental health problems, gaps in care systems (e.g., low-quality adult day care services), and structural inequalities (e.g., inability to modify the home environment in rental housing, disrupted social network due to gentrification).

Conclusions and Implications: Dementia care partners identified a range of facilitators and barriers to managing fall risk for community-dwelling older people with dementia. These findings have several important implications for developing fall prevention programs for OPWD: 1) facilitating collaborations between care partners and OPWD, 2) developing training built upon care partners’ existing knowledge and skills, 3) tailoring interventions to OPWD’s functional status, 4) adopting integrative interventions that can enhance OPWD’s and care partners’ physical and mental health simultaneously; and 5) improving care partners’ ability to identify and access suitable services and resources. Future research should further understand care partners’ perceptions of fall risk among OPWD and its impact on their FRM behaviors. Strategies that target the care system and structural inequalities are urgently needed.

References:

Zhou, Yuanjin, et al. "Development of a behavioural framework for dementia care partners’ fall risk management." BMC geriatrics 22.1 (2022): 975.

Gitlin, Laura N., and Nancy A. Hodgson. Better living with dementia: Implications for individuals, families, communities, and societies. Academic Press, 2018.