Developing a sustainable research programme to prevent falls and promote physical activity among older people with dementia.
Award TypeCareer Development Fellowship
Status / StageCompleted
Dates1 January 2016 -
31 December 2018
Duration (calculated)02 years 11 months
Funder/Grant study pageNIHR
Contracted CentreBournemouth University
Contracted Centre Webpage
Principal InvestigatorDr Samuel Nyman
WHO CatergoriesRisk reduction intervention
Disease TypeDementia (Unspecified)
CPEC Review Info
|Status / Stage
|02 years 11 months
|Funder/Grant study page
|Contracted Centre Webpage
This study will be a phase 2 randomised controlled trial (RCT) to test the effectiveness of Tai Chi to improve postural balance among community-dwelling PWD, and the feasibility of conducting a phase 3 trial. If the results of this study are favourable, then the subsequent study will be a multi-site, phase 3 trial to test the effect of the intervention on preventing falls and associated hospital admissions. Background Falls are the leading cause for A&E presentation in adults aged 65+ , and people with dementia (PWD) are twice at risk of falling and twice at risk of sustaining a fall-related injury [8,9]. There is thus a pressing need to reduce the risk of admission of PWD to A&E due to fall-related injury. Existing systematic reviews report robust evidence for exercise-based interventions to prevent falls among community-dwelling older people , but the few studies with PWD have shown mixed findings. Tai Chi exercise has been successfully adapted for people with dementia by an American research team. While Tai Chi has been shown to prevent falls, at present, no study has been conducted in the UK, and no study has used a RCT design targeting PWD.CHAR(13) + CHAR(10)This will be the first UK study to test the benefit of Tai Chi exercise for improving balance and preventing falls among PWD. CHAR(13) + CHAR(10)AimsThe overarching research question is, ‘Can a Tai Chi exercise intervention prevent falls among community-dwelling older PWD?’ This phase 2 trial will test the effectiveness of the intervention on improving postural balance, and the subsequent phase 3 trial will test the effectiveness of the intervention on rate of falls and associated hospital admissions. Plan of investigationThe intervention will comprise three components: (1) Tai Chi classes delivered for 20 weeks, (2) carer-led, home-based Tai Chi exercises, and (3) a behaviour change component to enhance adherence to the intervention.  Pre-trial phaseThe protocol for baseline data collection and intervention delivery will be refined through testing with 14 dyads (PWD and their carer) over four weeks. Qualitative data will be captured. Phase 2 RCT 150 PWD and their carers will be recruited from memory clinics and randomised to either an intervention (n=75) or control group (n=75). Baseline measures will be repeated at a six-month post-baseline follow-up, with dynamic balance (timed up and go test) as the primary outcome. Secondary outcome measures will be static balance, fear of falls, daily functioning, mood, agitated behaviour, cognitive functioning, and carer burden. The process evaluation will collect qualitative data through observation of the Tai Chi classes and interviews. Falls experienced, class attendance, and adherence to home-based Tai Chi exercises will be recorded weekly throughout the six month period. Health economics data will also be collected to determine the cost-effectiveness of the intervention in relation to health care service use. Summary of potential benefits to patients and the NHS The intervention is anticipated to benefit PWD by reducing their risk of unwanted hospital stays and admission to a care home. Carers of PWD will benefit by avoiding the stress and increased workload of caring for someone with PWD with a fall-related injury. The NHS will benefit through a reduction in the number of A&E attendances among PWD with a fall-related injury. This will provide cost savings and relieve much needed pressure on UK A&E departments.
This study will contribute to a developing programme of research to identify the most appropriate and effective approaches for preventing falls and promoting physical activity among people with dementia (PWD).