Falls are a serious concern for older adults, especially those with cognitive impairment (CI). CI, including mild cognitive impairment and dementia, is linked to a higher risk of falls and fall-related injuries. Fall risk management (FRM) programs aim to reduce these risks, but their effectiveness for older adults with CI is uncertain. This gap in evidence highlights the need for strategies to engage care partners, such as family members or friends, in supporting older adults with CI through FRM programs.
The Power of Care Partner Engagement
Care partner engagement (CPE) is a critical aspect of FRM programs for older adults with CI. It involves care partners actively participating in various ways, such as receiving training, collaborating with healthcare teams, and ensuring access to professional services. A recent review found that involving care partners can enhance program adherence and support behavior modifications to reduce fall risks.
However, CPE in FRM programs for older adults with CI is an under-explored area. Existing reviews emphasize the involvement of care partners but lack clarity on how CPE is defined, described, or measured. This conceptual ambiguity limits our understanding of the factors that influence CPE and the potential strategies to enhance it.
A New Framework for CPE
To address this gap, this study proposes a novel framework for CPE in FRM programs. The framework identifies five key aspects of CPE: enrollment, attendance, active participation, completion, and maintenance of FRM practice. Each aspect represents a distinct role care partners play in supporting older adults with CI.
For instance, enrollment involves care partners seeking help by enrolling in FRM programs. Attendance refers to their presence at program sessions, while active participation captures their involvement in activities like recording fall incidents or modifying unsafe behaviors. Completion denotes fulfilling program requirements, and maintenance refers to sustaining the application of knowledge and skills post-intervention.
Facilitating and Barriers to CPE
The study identifies facilitators and barriers associated with each CPE component. For example, motivation is a critical driver for care partners' engagement. Support, in various forms, is also essential for sustaining their involvement. Health-related factors, such as illness or functional declines, can disrupt CPE. Additionally, service provider- or program-level factors, like program design or support received, can either facilitate or hinder CPE.
Strategies to Enhance CPE
The study also explores strategies employed in FRM programs to enhance CPE. These strategies include boosting motivation, providing multidimensional support, and facilitating goal setting and participation monitoring. However, the effectiveness of these approaches varies, and the study highlights the need for further investigation into promising mechanisms of behavior change.
Implications and Future Directions
The study's findings have several implications. First, there is a need for conceptual clarity and harmonization in defining and measuring CPE. The proposed framework provides a foundation for future research and intervention design. Second, further examination is required to understand how different factors, such as motivation, support, and comorbidity management, influence CPE. Third, the study identifies a range of promising strategies for enhancing CPE, but rigorous evaluations are needed to assess their impact.
In terms of enrollment, strategies to proactively identify and reach care partners, especially those from underserved populations, are crucial. Additionally, FRM programs should incorporate follow-up support and longitudinal engagement to promote the maintenance of FRM practices post-intervention.
Conclusion
This systematic review introduces a novel conceptual framework for CPE in FRM programs for older adults with CI. By clarifying the multidimensional nature of CPE, the study guides future inquiries and highlights the importance of care partner engagement in dementia care. The findings advance our theoretical understanding and inform the design of care-partner-engaged FRM programs, offering valuable implications for developing evidence-based strategies to foster care partner engagement.
