University of Newcastle upon Tyne
Is it possible to develop a complex intervention to improve the outcome of fall-related injuries in people with dementia? (DIFRID)
Alzheimer's disease & other dementias
Fall related injuries are a significant cause of morbidity and mortality in people with dementia (PWD). There is presently little evidence to guide the management of such injuries, and yet there are potentially substantial benefits to be gained if the outcome of these injuries could be improved. This 21 month study aims to provide the evidence needed for the design of an appropriate healthcare intervention for such PWD and to assess the feasibility of delivery in the clinical setting. Work Package 1: Systematic Literature review Strategy for reviewing literature: review of bibliographic source, existing investigator reference databases, grey literature and key references as identified from experts in the field to identify studies examining: the health and social care needs of PWD with fall related injuries, outcomes of importance to patients/carers and evidence on the relative effectiveness of interventions. Methods of systematic review will be based on those of the Cochrane Collaboration and realist synthesis. Work package 2: Understanding current practice Design: prospective observational study over 6 months with qualitative study Settings: 3 UK sites (Newcastle, Stockton, Norwich) each including 3 settings: primary care consultations, paramedic attendances and Emergency department (ED) attendances. Target population: PWD presenting with fall related injuries in each setting at each site. Health technology assessed: Procedure for ascertaining person has a diagnosis of dementia, estimation of number of PWD presenting in each setting, identification of services they are directed to after the fall. In each site a subgroup of 20 PWD and their carers will keep a diary of service usage for 3 months, to describe the type and quantity of care accessed and care pathways followed by such individuals. Qualitative interviews to explore their perceptions of what their care needs were, whether they were met, what might have been improved and what outcomes were important to them. Qualitative interviews of care professionals they encounter, to identify their perceptions of the health and social care needs of PWD, ideas for service improvement, barriers and facilitators to change. Work package 3: Intervention development and validation Design: Convening of an expert panel with qualitative study Health technology assessed: the panel will review the results of WP1 and 2; assess the feasibility and appropriate setting for recruiting participants to receive the intervention, assess and prioritise specific elements to be combined in a complex health care intervention, identify the most appropriate setting and professionals required for delivery of the intervention, training needs, identify and prioritise outcomes to be measured. Qualitative study: exploration of acceptability of proposed intervention with a range of stakeholders including those identified in WP2. Work package 4: Pilot implementation Design: Rehearsal of intervention with process evaluation Settings: as WP2 Target population: 15 PWD with a fall related injury in each site Health technology assessed: feasibility of participant recruitment, fidelity of delivery of the intervention, feasibility of outcome measurement. Qualitative study: assessment of factors influencing the acceptability and implementation of the intervention. Final output: Description of a validated complex intervention with accompanying training materials for its delivery and measurement of outcomes.