The influence of dementia on falls, gait and rehabilitation

Booth, Victoria (2017) The influence of dementia on falls, gait and rehabilitation. PhD thesis, University of Nottingham.

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Abstract

Background

Cognitive impairment is a risk factor for falls in older adults. There is some evidence that the ability to dual-task contributes to maintaining postural stability and that cognitive impairment may impair this ability, thereby increasing falls risk. This research aims to explore physical risk factors associated with cognitive impairment and falls in older adults with mild dementia. Potential interventions for these participants will be searched for, described and theoretically modelled to develop an intervention programme to reduce their falls risk.

Methods

A cross-sectional survey described gait, dual-task cost, balance and falls risk characteristics of participants with mild dementia. Potential interventions were identified using two systematic literature reviews. A realist review explored theoretical mechanisms underpinning exercise-based interventions in older adults with dementia. An intervention programme was developed and preliminarily tested during a 6-week, small sample, non-randomised feasibility study.

Results

Older adult participants (n 69; mean age 81 years) with mild dementia (mean MoCA 21) had an increased risk of falls (1.5 median falls in previous six months; 2.48 mean physiological profile assessment [PPA] falls risk score), poor gait pattern and reduced balance. Cognition was negatively associated with gait pattern in both in simple walking and dual-task conditions. Exercise was a frequently reported intervention, with combined physical and cognitive exercise-components showing efficacy at improving gait speed (weighted mean difference [WMD] 0.08 [0.03-0.12] Z=3.65 [p≤0.001]) and balance (WMD 1.23 [0.69-1.77] Z=4.48 [p<0.001]) at a mild stage of cognitive impairment. Physiological-responses and encouragement were identifiable important mechanisms in these interventions. Findings were synthesised into a study protocol. Ten older adults (median age 84, range 69 to 89; 50% women) with mild dementia (median MoCA 21, range 16 to 26) were recruited and completed the developed intervention of combined physical and cognitive exercises. Mean differences between pre- and post-intervention assessment demonstrated improvement in falls risk, balance, and gait.

Conclusion

Mixed methods contributed to each component of development for this complex intervention. A combined physical and cognitive exercise-based programme was deliverable, feasible, and acceptable to older adults with mild dementia. A list of clinically-relevant recommendations for the content, delivery, and supervision of this intervention for an adequately powered, and randomised study, was produced.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Logan, Pip
Hood, Victoria
Masud, Tahir
Harwood, Rowan
Keywords: dementia, falls, gait, rehabilitation
Subjects: W Medicine and related subjects (NLM Classification) > WM Psychiatry
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 42040
Depositing User: Booth, Victoria
Date Deposited: 29 Aug 2017 11:16
Last Modified: 13 Oct 2017 01:07
URI: http://eprints.nottingham.ac.uk/id/eprint/42040

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