None listed
Conditions
Brief summary
Seventy to eighty-five percent of people with cognitive impairment fall each year. This alarming rate is twice that seen in cognitively normal older people. In addition, people with cognitive impairment and dementia are at increased risk of serious injury and have a poorer prognosis following a fall. Falling in older age can markedly change an individual’s health trajectory, having debilitating and isolating consequences. Falls can start a downward spiral of immobility, reduced confidence and incapacity leading to institutionalization, and can be a cause of premature death. Typically, fall studies conducted with community-residing people exclude those with cognitive impairment. Thus little is known about how to best conduct falls prevention in this population. This project will refine, trial and pilot a program that integrates the known evidence for falls prevention for environmental adaptation along with a dementia-specific approach to safe activity engagement in fall risk situations. Assessment of functional abilities and functional cognition will be conducted using Allen’s Cognitive Disability Model of practice. This will frame the intervention which will utilise the older person’s personal and environmental resources to make adaptations to the environment and behaviours that will significantly reduce their risk of falling.
Interventions
The i-FOCIS intervention will encompass:
1. Assessing functional cognition to determine personal resources; fall risk factors using evidence–based protocol; and, daily routines and preferred activities by interview.
2. Based on the assessment, developing tailored and prioritized intervention goals:
a. Identifying and modifying environmental risk factors and simplifying environmental press to match cognitive abilities.
b. Providing exercise and functional tasks matched to capacity that will im
The i-FOCIS intervention will encompass: 1. Assessing functional cognition to determine personal resources; fall risk factors using evidence–based protocol; and, daily routines and preferred activities by interview. 2. Based on the assessment, developing tailored and prioritized intervention goals: a. Identifying and modifying environmental risk factors and simplifying environmental press to match cognitive abilities. b. Providing exercise and functional tasks matched to capacity that will improve balance and increase lower limb strength. c. Developing personal strategies to address safety and behavioral risk factors by focusing on meaningful activity that is associated with a high risk of falling for the individual (e.g., task analysis and simplification). d. Training for caregiver in the above problem solving strategies and generic principles of risk reduction, and in specific communication strategies to facilitate management of the person and environment and ongoing engagement in falls prevention. The planned program is four occupational therapy visits of 1-2hours duration and 4 physiotherapy visits of 1-1.5 hours duration, plus three follow up phone calls. The sessions will finish in the 12th week and be more frequent over the first 6 weeks.
Sponsors
Prince of Wales Medical Research Institute
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Diagnosed with dementia Have a main caregiver who has a ninimum of 3.5 hours face to face weekly contact
Exclusion criteria
Diagnosed delerium Severe psychiatric disorder Parkinson's Disease Living in a nursing home or hostel
Outcome results
None listed