Care Partner Engagement in Fall Risk Management Programs for Community-Dwelling Older People with Cognitive...

Older people with cognitive impairment (CI) are at significantly higher fall risk compared to those without CI. Their care partners' engagement is critical to facilitate their participation and adherence in fall risk management (FRM) programs. This systematic review aims to synthesize terms and measures of care partner engagement (CPE) in FRM programs for community-dwelling older people with CI, facilitators and barriers to CPE, and promising CPE enhancement strategies.

We conducted a systematic search of eight databases and included relevant literature published between 1985 and 2024 through a manual search. Guided by a conceptual framework of CPE informed by existing literature, we conducted content analysis and thematic synthesis to address our research aims. We assessed the quality of included studies using the Mixed Methods Appraisal Tool.

Thirty-two studies were included in the synthesis. There was substantial heterogeneity of CPE terms and measures. CPE facilitators and barriers were summarized under three categories: older people with CI (eg, interest, health, and functional statuses), care partners (eg, motivation, perceived burden, caring relationships), and service providers or programs (eg, supportive instructors, service disruptions). CPE enhancement strategies (eg, tailored intervention content, provision of professional and social support) were summarized, with some (eg, using a discussion tool, providing flexible schedules) showing promising effects on CPE.

Our review synthesized the common practice of CPE in FRM programs for community-dwelling older people with CI and introduced a novel conceptual framework to clarify the multidimensional nature of CPE. Our findings emphasized the urgent need to develop consistent language and validated measures for describing and assessing CPE. This review has also identified important considerations, including facilitators, barriers, and promising strategies to enhance CPE in these programs, informing the development of effective care-partner-engaged FRM programs for older people with CI.