Falls are a common and expensive problem, especially in persons with dementia (PwD). Annual fall rates in PwD can be as high as 90%. Injurious falls are a frequent reason people are unable to stay in their homes, significantly increasing the costs of care to the family and society. Fallers usually do not understand the cause of their fall and often repeat the same behavior; the single best predictor of fall risk is a previous fall. Our research has demonstrated that falls prevention (FP) requires behavior change and learning to recognize one's own personal fall risks. Most FP efforts do not focus on changing the underlying behavior. FallsTalk is an evidence-based FP intervention, recognized as meeting highest tier federal criteria. Falls are treated as an opportunity to understand fall threats and initiate behavior change. This individualized approach significantly increases new FP behaviors, improves recognition of fall threats and reduces falls. We propose to use the caregiver (CG)-PwD dyad as a building block. The CG will be trained to conduct positive daily interactions and participate in weekly interviews. Using guided CG supports provides a unique opportunity to empower both CG and PwD. To test this innovative approach, we will develop prototype resources to assist CGs and study personnel in working with PwD in their home and then evaluate the efficacy of this model and feasibility of the new approach. Our hypothesis is that the FallsTalk Caregiver Resource System (FT-CG) can create a constructive post-fall experience, resulting in the outcomes required to reduce falls. Phase 1 Aims are to translate the current intervention for use with CGs by: 1) developing a prototype; 2) conducting a preliminary study and 3) gathering falls data. The prototype FT-CG system will include: CG training software with embedded videos, for learning methodology; CG tools to conduct and record daily and weekly interactions; and Interventionist software to structure the behavioral intervention components for PwD and CGs. Dyads will be recruited from 45 support groups in two large counties with the assistance of the Washington chapter of the Alzheimer's Association. Sixty dyads will be randomly assigned to study group; Experimental dyads will receive the FT-CG intervention, while Control dyads receive an outcomes measurement visit only. Outcomes will include currently unavailable information about falls by PwD in home, rather than long term care, settings. Feasibility will be determined by evaluating FT-CG preliminary outcomes and comparing those with benchmark data from previous research. Phase 2 will create and test new FT-CG resources which: may eliminate the need for a third person to work with the CG; will incorporate components for professional CG; add Interventionist training software and evaluate potential self-administration tools for persons with mild cognitive impairment. FT-CG will offer an urgently needed FP intervention for PwD. The benefits of sustaining in-home living for PwD by preventing falls will benefit all stakeholders for this large, high-risk population.
Public Health Relevance Statement: Falls are a common and expensive problem, especially in persons with dementia (PwD). FallsTalk is an evidence-based fall prevention intervention which will be translated to incorporate a caregiver (CG) and provide a unique opportunity to empower both CG and PwD. Development of the FallsTalk Caregiver Resource System will address a frequent reason people that PwD are unable to stay in their homes, reducing family and public health costs.
Project Terms: Address; Alzheimer's Disease; attentional control; Award; Balance training; Behavior; behavior change; Behavior Therapy; behavioral outcome; Benchmarking; care costs; caregiver education; caregiver interventions; Caregiver support; Caregivers; Caring; Communities; Computer software; Computers; Control Groups; County; Custom; Data; Dementia; Dementia caregivers; Development; disability; E-learning; Economics; Elderly; Elements; Enrollment; Environment; evidence base; Expenditure; experience; experimental group; Failure; Fall injury; Fall prevention; fall risk; falls; Family; Family health status; follow-up; Health Care Costs; high risk population; Home environment; Hospital Costs; Human Resources; improved; Individual; innovation; Intervention; Interview; Learning; Long-Term Care; Measurement; Measures; Medicare; meetings; memory recall; Methodology; mild cognitive impairment; Modeling; Monitor; Multimedia; novel strategies; Outcome; Outcome Measure; personalized approach; Persons; Phase; Preventive Intervention; Protocol Compliance; prototype; Public Health; Quality of life; Randomized; recruit; Reporting; Reproducibility; Research; Resources; response; Risk Behaviors; Self Administration; Self Efficacy; Shapes; Short-Term Memory; Societies; Source; strength training; Structure; success; Support Groups; System; Telemedicine; Testing; Time; tool; Training; Translating; Translational Research; usability; Visit; Washington; Work
