Developing an Intervention for Fall-Related Injuries in Dementia (DIFRID): an integrated, mixed-methods approach

Abstract

Background: Falls in people with dementia can result in a number of physical and psychosocial consequences. However, there is limited evidence to inform how best to deliver services to people with dementia following a fall. The aim of the DIFRID study was to determine the feasibility of developing and implementing a new intervention to improve outcomes for people with dementia with fall-related injuries; this encompasses both short-term recovery and reducing the likelihood of future falls. This paper details the development of the DIFRID intervention. Methods: The intervention was designed using an integrated, mixed-methods approach. This involved a realist synthesis of the literature and qualitative data gathered through interviews and focus groups with health and social care professionals (n = 81). An effectiveness review and further interviews and observation were also conducted and are reported elsewhere. A modified Delphi panel approach with 24 experts was then used to establish a consensus on how the findings should translate into a new intervention. After feedback from key stakeholders (n = 15) on the proposed model, the intervention was manualised and training developed. Results: We identified key components of a new intervention covering three broad areas: • Ensuring that the circumstances of rehabilitation are optimised for people with dementia • Compensating for the reduced ability of people with dementia to self-manage • Equipping the workforce with the necessary skills and information to care for this patient group Consensus was achieved on 54 of 69 statements over two rounds of the Delphi surveys. The statements were used to model the intervention and finalise the accompanying manual and protocol for a feasibility study. Stakeholder feedback was generally positive and the majority of suggested intervention components were approved. The proposed outcome was a 12-week complex multidisciplinary intervention primarily based at the patient's home. Conclusions: A new intervention has been developed to improve outcomes for people with dementia following a fall requiring healthcare attention. The feasibility of this intervention is currently being tested. Trial registration: ISRCTN41760734 (16/11/2015).

Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study

“…68 To compound this, current evidence-based guidelines and randomized controlled trials for the prevention of falls and hip fractures typically exclude people with mental and cognitive health conditions. 69,70 Although there have recently been some concerted efforts to reduce falls and hip fractures and improve their rehabilitation in people with dementia and MCI, 71 those with mental health and substance use disorders remain at risk of being overlooked. Given that older adults with substance use disorders and mental disorders appear at greatly increased risk of both falls and hip fractures, concerted efforts are required to understand and prevent these outcomes and develop better integrated models of care.…”

Expert consensus on the important chronic non-specific neck pain motor control and segmental exercise and dosage variables: An international e-Delphi study

“…Despite the sports setting being underrepresented (8.11%), there was significant expertise in CNSNP exercise prescription amongst the included participants. The round 3 response rate was lower than anticipated, however, previous interventions have been developed using much smaller sample sizes [43][44][45][46].…”

“…responses [41][42][43][44][45][46] therefore we estimated a sample size of 40 experts was required to achieve a conservative estimate of 27 round 3 responses (70% response rate) [47]. Informed consent was obtained and the rights of participants were protected.…”

An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study

“…We identified nine CMOcs, which we grouped into three themes ( Table 7). 88 Evidence relating to each of these themes is described in the following sections. At the end of this section, we provide a table indicating the intervention components suggested by the CMOcs (see Table 8).…”

“…Diagram of the search, screening, selection and extraction process. Reproduced with permission from Wheatley et al88 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.…”