The balanced mind: preventing falls in dementia

Award Number
RP-DG-0611-10013
Programme
Programme Grants for Applied Research
Status / Stage
Completed
Dates
24 May 2024 -
24 May 2024
Duration (calculated)
00 years 00 months
Funder(s)
NIHR
Funding Amount
£97,346.00
Funder/Grant study page
NIHR
Contracted Centre
Nottingham University Hospitals NHS Trust
Contracted Centre Webpage
Principal Investigator
Professor Rowan Harwood
PI Contact
Rowan.Harwood@nottingham.ac.uk
WHO Catergories
Development of novel therapies
Risk reduction intervention
Disease Type
Mild Dementia

CPEC Review Info
Reference ID61
ResearcherReside Team
Published12/06/2023

Data

Award NumberRP-DG-0611-10013
Status / StageCompleted
Start Date20240524
End Date20240524
Duration (calculated) 00 years 00 months
Funder/Grant study pageNIHR
Contracted CentreNottingham University Hospitals NHS Trust
Contracted Centre Webpage
Funding Amount£97,346.00

Abstract

We propose 4 elements to the PDG Surveys of conventional and neuropsychological falls risk factors in people attending memory clinics and people seen by falls services Falls prevention intervention development Initial feasibility testing of delivery of the intervention Preparation of application for PGfAR. 1. Surveys of falls risk factors Many patients seen in regular falls services have mild dementia or mild cognitive impairment (often undiagnosed), and many patients attending memory clinics have fallen or are at risk of doing so. We will therefore study both groups. This work will investigate the prevalence of risk factors, and also determine the feasibility, tolerability and best location for the testing procedure in this population. This will demonstrate that both conventional and neuro-psychological impairments are present in our study populations, and can be measured. We will recruit two populations a) 50 people over 65 with newly diagnosed mild or early dementia or MCI (defined by performance on 2 pen-and-paper cognitive tests, >20 on the Mini-Mental State Examination, b) 50 people over 65 seen by falls services with similar levels of cognitive impairment and physical ability. Potential participants will be approached and invited by clinic staff, who may be supported by PPI volunteers. The St Francis Hospital memory clinic makes especial attempts to make people feel at ease, including an Alzheimer café run in conjunction with the Alzheimer s Society. Community Falls Service patients are seen at home. In both groups, those expressing initial interest will be approached and screened by a researcher or Mental Health Research Network research nurse, given a Participant Information Sheet, and invited to take part. Potential participants without mental capacity to consent to participate will be excluded (we anticipate that most will have capacity to give their own consent at this stage of the disease). Those participants agreeing to the initial invitation will be invited to return to a clinic, the day hospital or a dedicated research space in the hospital, where consent will be obtained by a researcher and demographic, cognitive and health variables will be collected, and gait assessment carried out. Carers will be recruited to act as informants. PPI consultation indicated a preference for research interviews to be undertaken at home. However, assessing gait speed in particular may be difficult in this setting. We will ask participants where they would have preferred to be assessed. This will inform the design of the randomised controlled trial that we will conduct in the subsequent PGfAR. Where clinic attendance proves impossible, we will offer home visits, and monitor completion rates of the tests. Measurement: To minimise burden, we will extract as much data as possible from clinical assessments if they have been performed at a recently. The researcher will record (using an informant to corroborate, if necessary) Background: demographic, medical history and health status, drugs. Established falls risk factors, including: previous falls history; extrapyramidal motor signs; physiological profile (vision, proprioception, sway, leg strength, reaction time); postural blood pressure. Neuro-psychological tests: We will perform a battery of different pen and paper neuro-psychological tests, including, and subject to participant tolerance and fatigue, tests of: – visuospatial ability (Rey copy (Rey, 1959)) – executive abilities (Trail Making (Delis, 2001); BADS Key Search and Rule shift (Wilson1996)) – attention (TEA elevator counting and visual search (Robertson, 1994)) – working memory (digit span, non-verbal span (Wechsler, 2009)). We will assess gait, and measure dual task deficit in gait speed (whilst performing serial 3s mental arithmetic).

Plain English Summary

The Ministerial Advisory Group for Dementia Research identified falls as a priority. Falls cause injury, threaten independence and are expensive to the patient and society. We ultimately aim to develop and test a new approach to preventing falls in people with dementia. The research will be conducted in memory clinics, falls services, and patients own homes. It will focus on people with early dementia, when the potential to respond to intervention is greatest. Dementia causes loss of memory and other mental functions including reasoning, awareness of space, and decision making. Falls risk is high in people with dementia, but national clinical guidelines make no treatment recommendations for this group. Usual interventions are widely believed to be ineffective, either because dementia-specific risk factors are operating, or approaches to reducing conventional risk factors take insufficient account of the different learning needs of people with dementia. Recent work suggests that impairments in judgement and decision making ( executive function ) are important, and that these might be amenable to intervention. We will develop a risk assessment and treatment programme, described in a manual, which can identify, and take account of, memory and other cognitive problems. In the PDG, we will measure conventional and falls-specific cognitive impairments amongst patients attending memory clinics and falls services. We will design interventions based on the literature, practitioner experience, and neuro-psychological expertise. In a subsequent PGfAR, we will further develop and test the feasibility of the interventions through use in practice, and information from interviews with people with dementia and their carers. We have used this approach previously in developing a falls prevention programme for use in care homes. We will then evaluate clinical and cost effectiveness in a randomised controlled trial, with rate of falling, disability and quality of life, as outcome measures. The main ethical issues are: researching people who are vulnerable; potential restrictions to lifestyle introduced by the intervention, and identifying new dementia diagnoses among falls patients. We have experience in including participants with dementia in research. We will explicitly address the issue of restriction through qualitative work with patients and carers. The multidisciplinary research team includes doctors, therapists and nurses with expertise in falls and dementia, and who are experienced in clinical trials, interview-based research and intervention development, a neuropsychologist, statistician, carer of a person with dementia who has experience of patient and public involvement in research, and a service manager. The group has an excellent track record delivering research for complex problems, leading to changes in clinical care. If successful, the findings will help reduce falls and fractures amongst people with dementia, avoiding the disability, distress and cost that they cause. It would also help identify people with undiagnosed memory problems who present with falls.