Understanding the Theoretical Underpinning of the Exercise Component in a Falls Prevention Programme for Older Adults with Mild Dementia: A Realist Review - Work in Progress

Background: Older adults with mild dementia are at an increased risk of falls. Preventing those at risk from falling requires complex interventions involving patient tailored strength and balance challenging exercise, home... [ view full abstract ]

Background: Older adults with mild dementia are at an increased risk of falls. Preventing those at risk from falling requires complex interventions involving patient tailored strength and balance challenging exercise, home hazard assessment, visual impairment correction, medical assessment and multifactorial combinations. Evidence for these interventions in older adults with mild cognitive problems is sparse and not as conclusive as the evidence for the general community-dwelling older population. The objectives of this realist review are (i) to identify the underlying programme theory of strength and balance exercise interventions targeted at those individuals that have been identified as falling and who have a mild dementia, and (ii) to explore how and why that intervention reduces falls in that population, particularly in the context of a community setting. The rationale for using a realist review approach and an outline of the method for this work in progress will be described.

Methods: Realist review is a methodology that extends the scope of traditional narrative or systematic evidence review. Increasingly used in the evaluation of complex interventions, realist enquiry can look at the wider context of the intervention, seeking more to explain than judge if the intervention is effective by investigating why, what the underlying mechanism is, and the necessary conditions for success. In this review, key rough programme theories were articulated and defined through discussion with a stakeholder group. Six rough programme theories were outlined and are currently being tested against literature found using a comprehensive search strategy. The themes of these rough programme theories include; (i) physiological changes, (ii) enjoyment, (iii) encouraged, (iv) fearful of negative consequences, (v) empowered to achieve a goal, and (vi) influenced by social and cultural expectations or beliefs. The process of data extraction, appraisal and synthesis will lead to the refinement and production of an explanatory programme theory. The review has been registered with PROSPERO (CRD42015030169).

Discussion: As far as the authors are aware, this is the first realist literature review within falls prevention research and adds to the growing use of this methodology within healthcare. This synthesis of evidence will provide a valuable addition to the evidence base surrounding the exercise component of a falls intervention programme for older adults with mild dementia and will ultimately provide clinically relevant recommendations for improving the care of people with dementia.