Abstract
BackgroundFalls are common in people with dementia living in residential care. The ProF-Cog intervention was developed to address fall risk factors specific to this population. The aim of this study was to evaluate the safety, acceptability, and feasibility of the intervention and provide an estimate of its efficacy.MethodsThis was a cluster randomised controlled pilot study undertaken in care homes in London, UK. All permanent residents living in participating homes who were not terminally ill were invited to participate. The intervention included an assessment of falls risk factors followed by a tailored intervention which could include dementia care mapping, comprehensive geriatric assessment, occupational therapy input and twice-weekly exercise for 6 months as required to target identified risk factors. The control group received usual care without a falls risk assessment.Standing balance was the primary outcome. This and other outcome measures were collected at baseline and after 6 months. Falls were recorded for this period using incident reports. Changes were analysed using multi-level modelling. Adherence to the interventions, adverse events and trial feasibility were recorded.ResultsNine care homes enrolled in the study with a total 191 participants (51% of those eligible); five homes allocated to the intervention with 103 participants, and four homes to the usual care control group with 88 participants. The intervention was safe with only one reported fall whilst undertaking exercise. Adherence to agreed recommendations on activity and the environment was modest (21 and 45% respectively) and to exercise was poor (41%). Balance scores (score range 0–49) analysed on 100 participants decreased by a mean of 3.9 in the control and 5.1 in the intervention groups, a non-significant difference (p = 0.9). In other measures, both groups declined equally and there was no difference in falls rates (IRR = 1.59 95%, CI 0.67–3.76).ConclusionThe intervention was safe but not clinically effective. Poor adherence suggests it was not an acceptable or feasible intervention.Trial registrationISRCTN00695885. Registered 26th March 2013.
Highlights
Falls are common in people with dementia living in residential care
Interventions to prevent falls in residential care have had equivocal results with some interventions effectively reducing falls and others not [6]. One reason for this may be that some interventions tested were not adequately tailored to address the specific risk factors identified in the care home population
Our group previously investigated the risk factors associated with falls in older people with cognitive impairment living in residential care (RC) and found important risk factors for falling were slightly different to those found in community dwelling populations
Summary
Falls are common in people with dementia living in residential care. The ProF-Cog intervention was developed to address fall risk factors specific to this population. In a more in-depth analysis of risk; anti-depressant use, impaired balance (measured using postural sway), anxiety and impaired attention and concentration were independent and significant predictors of falling [5] This suggests that the profile and relative importance of the many falls risk factors differs between the older community dwelling population and the population of older people resident in care homes. Reflecting on the risk factors identified above, this would need a multifactorial intervention to include exercise to address gait and balance instability, medication modification review to address culprit medications, enriching the environment and optimising safe participation in functional activity to minimise the impact of impaired attention and orientation and to engender a personcentred approach to manage anxiety This formed the basis of the ProF-Cog intervention
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