Attitudes of older people with mild dementia and mild cognitive impairment and their relatives about falls risk and prevention: A qualitative study

Abstract

ObjectiveTo explore the perceptions of older people with mild dementia and mild cognitive impairment, and their family carers, about falling, falls risk and the acceptability of falls prevention interventions.DesignQualitative study involving thematic analysis of semi-structured interviews with patient and relative dyads.Participants and setting20 patient/ relative dyads recruited from Memory Assessment Services and Falls Prevention Services in the United Kingdom.ResultsThe findings are presented under four key themes: attitudes to falls, attitudes to falls prevention interventions, barriers and facilitators, and the role of relatives. Participants’ attitudes to falls interventions were varied and sometimes conflicting. Some worried about falls, but many resisted identifying themselves as potential ‘fallers’, even despite having fallen, and rejected the idea of needing the help that structured interventions signify. Participants preferred to focus on coping in the present rather than anticipating, and preparing for, an uncertain future. Falls prevention interventions were acknowledged to be valuable in principle and if required in the future but often felt to be not necessary or appropriate at present.ConclusionsThis study of how persons with cognitive impairment, and their relatives, view falls risk and prevention mirror findings relating to the wider population of older persons without dementia. Participants did not generally see falls prevention interventions as currently relevant to themselves. The challenge for clinicians is how to present interventions with understanding and respect for the older person’s identity. They must identify and address goals that patients and relatives value. Simplistic or paternalistic approaches will likely fail. Individualised interventions which focus on maintaining independence and preserving quality of life are more likely to be acceptable by supporting a positive self-image for patients and their relatives.

External Validation of the ‘PHYT in Dementia’, a Theoretical Model Promoting Physical Activity in People with Dementia

“…However, in line with previous research recognising the role of carer in the advanced stages of dementia [47], we found that the person might lack the insight/capacity needed to develop and sustain intrinsic motivation, or they might forget that they are intrinsically motivated to change behaviour. As external motivation becomes pivotal [48], the level of commitment that the significant others have in supporting the person with dementia is essential. Previous studies [26][27][28] found that carers might be risk-averse and as a result, adopt gate-keeping behaviours to physical activity.…”

The impact of early psychosocial intervention on self‐efficacy of care recipient/carer dyads living with early‐stage dementia—A mixed‐methods study

“…A lack of insight into deficits may have had moderating effects on the care recipients’ self‐reported self‐efficacy (Dawson, Powers, Krestar, Yarry, & Judge, ). Preparing for increasing care needs requires the person with dementia to consider and plan for future incapacity, a concept some would prefer to ignore (Mak & Sörensen, ; Peach et al., ). The stigma associated with dementia results in poor adjustment to the disease and subsequent reduction in self‐efficacy (Martin, Turner, Wallace, & Choudhry, ).…”

“…A lack of insight into deficits may have had moderating effects on the care recipients' selfreported self-efficacy (Dawson, Powers, Krestar, Yarry, & Judge, 2012). Preparing for increasing care needs requires the person with dementia to consider and plan for future incapacity, a concept some would prefer to ignore (Mak & S€ orensen, 2012;Peach et al, 2017).…”

A development study and randomised feasibility trial of a tailored intervention to improve activity and reduce falls in older adults with mild cognitive impairment and mild dementia

“…The intervention was developed by a multi-disciplinary team of physiotherapists, occupational therapists, doctors, nurses, psychologists, and patient and public representatives, using the principles of co-production. This was informed by findings from three literature reviews [ 92 – 94 ], clinician, health psychology and neuropsychological expertise ascertained by interview and during workshops, focus group discussions held with patients, carers, and clinicians, and the views of patients and their carers from a prior interview study [ 62 ]. Ten patients were treated in a 6-week ‘proof of concept’ study as part of the intervention development, in which intermediate outcomes were measured and field notes were thematically analysed.…”

“…behaviour change wheel [ 58 ]) in the context of dementia is unknown, but provides a framework for further investigation. Barriers to sustaining a moderate to vigorous exercise programme include not perceiving oneself as being at risk from falls; perceived lack of relevance of exercise or other interventions; and focus on priorities such as maintaining independence, or family, social or domestic concerns [ 62 – 64 ]. Barriers to long-term adherence include forgetfulness, medical co-morbidities, planning problems and practical support.…”