▪ What is already known about the problem that the project will address?
People with dementia fall over up to ten times more often than people who do not have dementia. When they fall over, they are more likely to hurt themselves. They are less likely to recover than people without dementia. After a fall people with dementia may need a lot more help and they, and their carer, may have a poorer quality of life.
In a previous study funded by the National Institute of Health Research, we carried out a number of projects to help us design a new package of care (intervention) to help people with dementia recover from a fall. We first studied what is currently happening to people when they fall and we found that most people are not offered any extra help or treatment. We looked at the published studies on this problem and found that there was very little research in this area and that no effective interventions have been developed so far. We carried out interviews with professionals, people with dementia and their carers to find out how they thought people should be supported after a fall. We looked at other studies and reports to find ideas for how we should help people with dementia who fall. We developed a theory as to how to help people with dementia after a fall and then brought together a panel of experts to design a new intervention. Finally, we tested the intervention with 11 people with dementia who had had a fall. The intervention was well received by the people with dementia and they found it helpful. The professionals enjoyed delivering the intervention and thought it was more helpful than what they were previously doing. We found out that it would be helpful to improve the intervention by increasing involvement of doctors who care for older people (Geriatricians) and also by providing more support and training for carers. We will make these improvements in the new study.
▪ What do we hope to find out?
We now wish to take the next step in showing that our intervention is effective by carrying out a pilot randomised controlled trial. In a pilot randomised controlled trial we test all the procedures for a full trial of the intervention in a mini version of the trial with fewer people. This is to find out whether a full trial is likely to be successful. If this study is successful we will apply for funding to carry out a full randomised controlled trial in a larger group of people. A full randomised controlled trial will be done to find out whether the intervention is effective in helping people with dementia maintain their independence after a fall, and how, and whether the intervention is good value for money.
▪ How the results of our study could benefit the lives of people affected by dementia today or in the future?
If we can help people with dementia maintain their independence after a fall we will improve their quality of life and reduce the difficulties faced by their carers. We may be able to reduce the number of falls they have in the future. We may be able to prevent hospital admissions and people having to go into a care home. We may be able to save money for carers, social services and the National Health Service.
▪ How does our project complement national/international research in the area?
There have been three other international trials aimed at preventing falls in people with dementia and one of them showed some potential benefits. However, none of them have been aimed at people with dementia who have already had a fall, which are a higher risk group. One trial in the UK aimed to reduce falls in people with mild memory difficulties who had had a fall but did not show any benefits. However, the intervention in this trial was not adapted for people with dementia and did not aim to help them maintain their independence. Our study will be different from these other studies because it will be aimed at people who have already had a fall and will use an intervention specially adapted for people with dementia. We will aim to help people maintain their independence after a fall.