Developing and validating a behavioral framework for dementia care partners' fall risk management

Abstract

Older adults living with dementia (OLWD) experience nearly two to ten times higher fall risk than older adults without dementia. Despite this, evidence is limited concerning effective fall management strategies for them. Care partners (broadly defined as relatives, partners, and friends) play a critical role in managing the fall risk for community-dwelling OLWD. However, it is unclear what behaviors dementia care partners adopt are relevant to fall risk management (FRM) and how these behaviors are associated with fall-related outcomes for OLWD. This dissertation utilizes an exploratory sequential mixed method study design to develop and validate a behavioral framework for dementia care partners' FRM. This first paper proposes a behavioral framework for dementia care partners’ FRM using a grounded theory approach and semi-structured, in-depth interviews with 14 care partners of community-dwelling OLWD. This paper makes a distinctive contribution by identifying eight domains of dementia care partners’ FRM behaviors (1. functional mobility assistance, 2. assessing and addressing health conditions, 3. health promotions support, 4. safety supervision, 5. physical environment modification, 6. receiving, seeking, and coordinating care, 7. learning, and 8. self-adjustment) across four stages of FRM (1. providing support before dementia diagnosis, 2. preventing falls, 3. preparing to respond to falls, and 4. responding to falls). The second paper validates this behavioral framework by using two linked national surveys, the National Health and Aging Trends Study (NHATS) 2015 and the National Study of Caregiving (NSOC) 2015, to examine the prevalence and dimensionality of care partners’ FRM and to compare the differences between primary and secondary care partners. The exploratory factor analysis (EFA) approach under the item response theory paradigm is utilized to examine the dimensionality of FRM behaviors. EFA results illustrate the complexity of two domains of FRM behaviors that emerge from the first paper: receiving, seeking, and coordinating care, and assessing and addressing health conditions. These discrepancies illustrate the need to explore different mechanisms, facilitators, and barriers for care partners navigating multiple care systems and service providers and addressing different types of health conditions for managing OLWD’s fall risk. Furthermore, this study identifies similarities and differences between primary and secondary care partners that may inform the development of different strategies to engage care partners based on their caring roles. Informed by this validated framework, the third paper focuses on assessing fall risk reduction for community-dwelling OLWD associated with receipt of FRM support from their care partners utilizing longitudinal data NHATS 2015-2016 and the linked care partner data NSOC 2015. Study findings from this paper highlight the importance of care partners’ medication management, wound care, learning behaviors, accessing formal social care, and physical environment modifications in potentially reducing the risk of falling for community-dwelling OLWD. The study also found that certain FRM behaviors, including functional mobility assistance, health promotion support, and medication management might be associated with a higher risk of falling for OLWD. Overall, the findings from this dissertation yield contribution to both practice and health and social behavior science inquiries. The dissertation addresses the need for a behavioral framework to understand care partners’ FRM and assess the contributions and limitations of care partners’ efforts. Future interventions can be developed by applying this framework to engage dementia care partners.