Greene Leanne, Allan Louise M, Bingham Alison, Sharma Ashima, Whale Bethany, Barber Robert, Fox Christopher, Goodwin Victoria A, Gordon Adam Lee, Hall Abigail J, Harwood Rowan H, Hulme Claire, Jackson Thomas Andrew, Litherland Rachel, Parry Steve W, Ukoumunne Obi, Morgan-Trimmer Sarah
University of Exeter Medical School, CTU, College House St. Luke's Campus, Exeter, Devon EX1 2LT, UK.
University of Exeter Medical School, Exeter, Devon, UK.
Age Ageing. 2025 Aug 29;54(9). doi: 10.1093/ageing/afaf245.
People with dementia who have a fall can experience both physical and psychological effects, often leading to diminished independence. Falls impose economic costs on the healthcare system. Despite elevated fall risks in dementia populations, evidence supporting effective home-based interventions remains limited.
Multiple-methods process evaluation within a pilot cluster randomised controlled trial informed by a realist approach. Settings included six UK sites/clusters (three intervention, three control). Fidelity checks on routine data collection and fidelity observations of intervention sessions, multidisciplinary team meetings and supervision sessions were undertaken. Semi-structured interviews were conducted with people with dementia, caregivers and intervention therapists.
The MAINTAIN intervention demonstrated high fidelity in home assessments and intervention delivery, with participants receiving a mean of 15 of the 22 available sessions with a range of 5-25 sessions. Qualitative findings revealed that regular home visits increased engagement and motivation. Multidisciplinary team support enhanced therapists' confidence, particularly with complex cases. While most participants achieved their functional goals and reported improved confidence, challenges included geographical disparities in service delivery, carer burden and varying effectiveness of referral pathways. Therapists' attitudes towards advanced dementia influenced intervention delivery. The paired approach, involving both the person living with dementia and their carer, supported activity engagement but occasionally added extra responsibilities for caregivers.
MAINTAIN was both feasible and acceptable. Future studies should consider standardising multidisciplinary support, incorporating targeted falls-related anxiety support and establishing sustainable post-intervention maintenance strategies. Protocol adaptations, such as video consultations, showed promise in addressing workforce constraints.
患有痴呆症的人跌倒后可能会产生身体和心理影响，常常导致独立性下降。跌倒给医疗保健系统带来经济成本。尽管痴呆症患者群体的跌倒风险较高，但支持有效的家庭干预措施的证据仍然有限。
在一项以现实主义方法为指导的试点整群随机对照试验中进行多方法过程评估。研究地点包括英国的六个地点/群组（三个干预组，三个对照组）。对常规数据收集进行保真度检查，并对干预课程、多学科团队会议和监督会议进行保真度观察。对痴呆症患者、护理人员和干预治疗师进行了半结构化访谈。
MAINTAIN干预措施在家庭评估和干预实施方面表现出高保真度，参与者平均接受了22次可用课程中的15次，范围为5 - 25次。定性研究结果表明，定期家访增加了参与度和积极性。多学科团队的支持增强了治疗师的信心，尤其是对于复杂病例。虽然大多数参与者实现了他们的功能目标并报告信心有所提高，但挑战包括服务提供方面的地理差异、护理人员负担以及转诊途径的不同有效性。治疗师对晚期痴呆症的态度影响了干预实施。涉及痴呆症患者及其护理人员的配对方法支持了活动参与，但偶尔会给护理人员增加额外的责任。
MAINTAIN既可行又可接受。未来的研究应考虑对多学科支持进行标准化，纳入针对性的跌倒相关焦虑支持，并建立可持续的干预后维持策略。协议调整，如视频咨询，在解决劳动力限制方面显示出前景。
