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Perspectives of healthcare professionals in England on falls interventions for people with dementia: a qualitative interview study
  1. Clare Burgon1,2,
  2. Janet Darby1,
  3. Kristian Pollock2,
  4. Veronika van der Wardt1,
  5. Tamsin Peach3,
  6. Lyndsay Beck4,
  7. Pip Logan1,
  8. Rowan H Harwood1,2,5
  1. 1 Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
  2. 2 School of Health Sciences, University of Nottingham, Nottingham, UK
  3. 3 Nottingham CityCare Partnership, Nottingham, UK
  4. 4 Nottinghamshire Healthcare NHS Trust, Nottingham, UK
  5. 5 Nottingham University Hospitals NHS Trust, Health Care of Older People, Nottingham, UK
  1. Correspondence to Clare Burgon; clare.burgon{at}nottingham.ac.uk

Abstract

Objective To explore the experiences of healthcare professionals working in falls prevention and memory assessment services in providing assessments and interventions for falls risk reduction in people with dementia.

Design This is a qualitative study using 19 semistructured interviews. Interviews were analysed through thematic analysis.

Setting Community-based falls and memory assessment services in the East Midlands, UK.

Participants Nurses (n=10), physiotherapists (n=5), occupational therapists (n=3) and a psychiatrist (n=1).

Results Three substantive themes were identified: challenges posed by dementia, adaptations to make falls prevention appropriate for people with dementia and organisational barriers. Patients’ poor recall, planning and increased behavioural risk associated with dementia were key problems. Healthcare professionals provided many suggestions on how to overcome these challenges, such as adapting exercise interventions by using more visual aids. Problems associated with cognitive impairment created a need for additional support, for instance longer interventions, and supervision by support workers, to enable effective intervention, yet limited resources meant this was not always achievable. Communication between mental and physical health teams could be ineffective, as services were organised as separate entities, creating a reliance on third parties to be intermediaries. Structural and organisational factors made it difficult to deliver optimal falls prevention for people living with dementia.

Conclusions Healthcare professionals experience challenges in providing falls prevention to people with dementia at the individual and organisational levels. Interventions can be adapted for people with dementia, but this requires additional resources and improved integration of services. Future research is needed to develop and test the effectiveness and cost-effectiveness of such services.

  • dementia
  • qualitative research
  • rehabilitation medicine

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Patient consent for publication Not required.

  • Contributors CB drafted the manuscript. JD undertook the analysis, in discussion with TP, supervised by KP. TP undertook the interviews, supervised by KP, and contributed to data analysis. VvdW, KP and TP designed and ran the study within which the interviews took place. LB and PL advised on study design and provided expertise on falls and memory services. RHH conceived the study, obtained funding and supervised the protocol. RHH is the principal investigator. All authors contributed to interpretation, edited the text and approved the final manuscript.

  • Funding This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Development Grant (Reference Number RP-DG-0611-10013), https://www.nihr.ac.uk/funding-and-support/. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained from the NHS National Research Ethics Service Committee, East Midlands (Reference 13/EM/1061). Information sheets were sent to potential participants and written consent was obtained before the interview. Participants were informed they could withdraw from the study at any time; however, no one did. All participants gave informed consent to participate.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are not routinely available, but interested researchers should enquire with RHH.

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