Attitudes of older people with mild dementia and mild cognitive impairment and their relatives about falls risk and prevention: a qualitative study

Objective: To explore the perceptions of older people with mild dementia and mild cognitive impairment, and their family carers, about falling, falls risk and the acceptability of falls prevention interventions. Design: Qualitative study involving thematic analysis of semi-structured interviews with patient and relative dyads. Participants and setting: 20 patient/ relative dyads recruited from Memory Assessment Services and Falls Prevention Services in the United Kingdom. Results: The findings are presented under four key themes: attitudes to falls, attitudes to falls prevention interventions, barriers and facilitators, and the role of relatives. Participants' attitudes to falls interventions were varied and sometimes conflicting. Some worried about falls, but many resisted identifying themselves as potential 'fallers', even despite having fallen, and rejected the idea of needing the help that structured interventions signify. Participants preferred to focus on coping in the present rather than anticipating, and preparing for, an uncertain future. Falls prevention interventions were acknowledged to be valuable in principle and if required in the future but often felt to be not necessary or appropriate at present. Conclusions: This study of how persons with cognitive impairment, and their relatives, view falls risk and prevention mirror findings relating to the wider population of older persons without dementia. Participants did not generally see falls prevention interventions as currently relevant to themselves. The challenge for clinicians is how to present interventions with understanding and respect for the older person's identity. They must identify and address goals that patients and relatives value. Simplistic or paternalistic approaches will likely fail. Individualised interventions which focus on maintaining independence and preserving quality of life are more likely to be acceptable by supporting a positive self-image for patients and their relatives