Factors associated with falls and exercise component for older adults with mild to moderate dementia

Abstract

This study aims to investigate factors associated to falls, understanding perspectives and doses of exercise, and evaluate exercise regimes to prevent falls for older adults with dementia (OAwD). This study employed mix method study design. 1) A cross-sectional study involved 110 participants. The variables were age, gender, race, education, cognitive level (MoCA), severity of dementia (CDR), fear of falls (FES-I), functional abilities (DAD), quality of life (QoL-AD), neuropsychiatric syndromes (NPI-Q), postural stability (Mini-BESTest) and functional balance (TUG). Future risk of falls (RoF) indicated by frequency of falls. SPSS software version 26.0 analysed the data descriptively, through simple and multiple logistic regression. The factors associated to falls in OAwD were age (P=0.014; OR:1.073; 95% CI, 1.014-1.136), dementia severity (P=0.039; OR:0.886; 95% CI, 0.790-0.994), and 4 neuropsychiatric syndromes, hallucinations (P=0.04; OR:0.582; 95% CI, 0.348-0.974), anxiety (P=0.022; OR:0.574; 95% CI, 0.356-0.924), delusion (P=0.029; OR:1.494; 95% CI, 1.041-2.144), and apathy (P=0.046; OR:0.863; 95% CI, 0.746-0.997). 2) Twelve OAwD and their caregiver participated in semi-structured interview. General inductive approach suggested aerobic, strengthening, stretching, balance, group exercise, 3 times per week (x/w), 30 minutes duration, and light intensity were the important exercise component. 3) The systematic review (SR) reviewed eight poor to good quality of RCT articles suggested strengthening, gait, balance, mobility, and executive function training were beneficial in reducing RoF in OAwD. The doses were inconclusive. The findings suggested as age and severity of dementia increase, there is increase the chances to fall. While findings from the interview and SR was found to be consistence in term of strengthening and balance exercises, other exercises were also important. The suggested minimum doses of exercise were 3x/w, 30 minutes and start with light intensity. These findings have implications for the development of exercise guideline for OAwD, added value to policy makers, clinical practice and literature review.