Falls Prevention Behaviors by Family Caregiver-Person Living with Dementia Dyads and Falls

TL;DR

A multimedia intervention helped caregivers of dementia patients adopt behaviors to prevent falls, with most falls linked to new challenges or health changes.

Contribution

Demonstrates that stimulating caregiver-led fall prevention behaviors can reduce falls in dementia patients over time.

Findings

Caregivers reported 435 fall prevention behaviors over 371 weeks, with most falls linked to new obstacles or health changes.

A booster session could help sustain fall prevention behaviors as dementia progresses.

Most falls or near falls led to 1-4 prevention actions, reducing subsequent incidents.

Abstract

We previously reported the successful use of the FallScape-D computer-tailored multimedia falls-prevention intervention (FallScape-D) for family caregivers of persons living with dementia (PLWD). We enumerated caregiver-reported falls prevention behaviors (FPBs) during the 4-6 week intervention. This study enrolled a small intentionally-varied PLWD-caregiver dyad cohort, delivered Fallscape-D, and followed dyads for up to one year.

Eleven family caregivers (6 female; mean(SD) age=65.6(12.8)) delivered FallScape-D, consisting of daily caregiver presentation of brief (< 90s.) individually-relevant stories to the PLWD (5female; age=78.2(5.3); MMSE12-29). Caregivers utilized an on-line daily log to report falls, injury falls, near falls (NFs), FPBs, and other events/issues encountered. A case series approach explored patterns of caregiver-reported FPBs and PLWD falls.

Caregivers logged 371 weeks (13-52) of daily reporting, 435 FPBs (12-106) and 14 PLWD falls. The first four weeks, 154 FPBs were reported (average=14(8)). Months 2 + 3 (9 weeks) yielded 148 FPBs (average=13(13). Months 3-6, 6-9, 9-12 (13 weeks each) yielded 81 FPBs (average=12(8), 29 FPBs (average=6(7) and 23 FPBs (average=5(5) respectively. Most falls or NFs, stimulated 1-4 FPBs, reducing or eliminating subsequent NFs. Six falls were caused indirectly (e.g. extraneous party created obstacle-3, caregiver extended absence-2, unrelated hospitalization-1). Eight falls related to health issues or dementia progression occurred 3+ months later.

Family caregivers generated falls prevention ideas and encouraged PLWD falls prevention measures. A booster session may have prevented falls that occurred months after FallScape-D by inspiring FPBs matching changed circumstances. We conclude that stimulating FPBs is a viable strategy to prevent falls in PLWD.