Dementia Care Research and Psychosocial Factors

Area of Science:

• Gerontology
• Geriatric Medicine
• Public Health

Background:

• Aged residential care (ARC) residents exhibit a 2-4 times higher fall risk compared to community-dwelling older adults.
• Dementia and physical impairments significantly increase fall risk in ARC settings.
• Current falls prevention strategies in ARC often involve restricting ambulatory activity, despite unclear evidence on its link to falls rates.

Purpose of the Study:

• To investigate the relationship between ambulatory activity and falls rate in ARC residents.
• To explore the influence of physical capacity and cognitive impairment on this relationship.
• To inform falls prevention strategies by examining the risk-reward balance of physical activity.

Main Methods:

• Utilized data from 281 ARC residents in the Staying Upright randomized controlled trial.
• Assessed daily step count using accelerometers and monitored falls over an average of 581 days.
• Classified physical capacity as Moderate or Low and analyzed associations using quasi-Poisson generalized linear models.

Main Results:

• Lower physical capacity was associated with higher falls rates (p=0.001).
• Increased daily step count correlated with a higher falls rate (p=0.046), particularly in residents with moderate physical capacity.
• Cognitive impairment was not found to be associated with step count or falls rate.

Conclusions:

• Residents with moderate physical capacity can increase their falls-free steps with minimal increase in injury risk.
• Low-capacity residents have a higher baseline fall risk but are less affected by changes in activity levels.
• Findings challenge the restriction of ambulatory activity in aged care and suggest the need for personalized interventions.