Table 2 Eight domains of dementia care partners’ fall risk management behaviours

Functional mobility assistance

Physically or verbally assist older adults with dementia to move around in the environment in order to participate in the activities of daily living safely [39]

Standing assistance

6

1

0

“She has a hard time operating her foot then she will hang on to something or she will hang on to me. But no cane. (Tracy)”

“(After my wife fell), I first make sure she was all right and got her back to her feet.” (James)

Walking assistance

7

1

0

“I would just put my hand on her arm. I would just hold on to her a lot when we are walking outside.” (Teresa)

Toileting assistance

2

0

0

“It was riskier as she tried to lean on the toilet and fall off. I’ve come to the door and ask her: Do you need my help? She could make the attempt and I took over when she needed it.” (Marissa)

Shower/bath assistance

1

1

0

“It was really hard to get her into the bathtub without her falling or I falling. I had to have a strategy planned around how my body would work to help her body work.” (Marissa)

Hazard reminder

4

0

0

“When he’s walking up to church or walking up to the doctor’s, I would say, ‘there’s the curb, be careful, pick your feet up.’” (Jane)

Mobility restraint

3

0

0

“If she goes walking out for any distance, I wouldn't allow her to do that by herself.” (Tracy)

Assessing and addressing health conditions

Assess and address older adults with dementia’s mental and physical health conditions directly

Assess physical and mental health conditions

12

7

0

“I look at my mom, and I see she's getting weaker. As she walks, she's not picking up her feet. She just doesn't have much strength or energy.” (Catherine)

Address physical and mental health conditions

5

3

0

“I think that fall was because of the UTI.…. The urologist gave us antibiotics. But then we went back in 10 days, and she still had it and so then she gave mama more antibiotics and that cleaned it up.” (Monica)

Medication management

2

10

2

“I had to figure it (the side effect of medication) out by watching her reactions…. there was something about it that seemed to make her a little loopier. I just told the doctor either you prescribe her something else, or I'll just take her off of it.” (Marissa)

Health promotion support

Care partners enable older adults living with dementia to increase control and improve their health [40]

Health and risk communication

12

1

0

“I just told her I said we don't get any exercise. Let's go get some exercise. I said we both had diabetes. You know, it will help your Alzheimer's. It will help with our diabetes. I said, look, let's go do it (a balance exercise program). And she said, she thought about it. Next day, she says I'm ready. Let's go.” (Marshall)

Enhance activity engagement

5

7

5

“Our sons will come and stay with him. They do a lot of playing. They like to play poker together. (Leila)”

“We go up and down the stairs so that she can get the dogs food. She has to feed the dog. That's her job. I gave her that job. I hope it gives her a sense of responsibility.” (Marshall)

Exercise support

3

7

4

“I just give her instructions as to how to do them if it’s a new one. If it’s a new exercise, I show her how to do it.” (James)

Diet support

2

14

5

“I try to keep her nutrition. It is not likely to stop her eating things that you think is not nutritious, but you can provide you more food with more nutrition.” (Tracy)

Improve and maintain self-efficacy

3

2

1

“She used to work around the house, and you know, the yard and she feels like she's useless now. And I said, no, you're far from useless because you have a full-time job. That is not to fall.” (Monica)

Improve help-seeking behaviours

2

1

0

“I told my wife: knowing what your limits are is extremely important. Don’t be macho about oh, I can still do that or whatever. And don’t be embarrassed to ask others to help you.” (Glenn)

Safety supervision

Being able, ready, and willing to perform intentional acts to reduce injury risk to a less capable person [41]

Pay close attention

8

1

0

“When we're walking, he walks really good, but I just have to make sure I keep him in sight.” (Emma)

Regularly check in

2

0

2

“(When I left the house), I often call her to check on her. She could fall and nobody be able to be here for the doors locked and just not eating properly.” (Tracy)

Be present

5

1

5

“Well, I think the most important thing that I did all around to manage fall risk for my mom was to be there for her, make her happy and make her feel safe.” (Marissa)

Modification of the physical environment

Modify the physical aspect of the environment that OLWD interact with

Home safety assessment, modification, and organizing

12

2

4

“I just keep things picked up. I would not want to see papers on the floor or anything like that. That would be a trip hazard. And sometimes when he likely finishes the newspaper, he drops it on the floor. I picked it up so that it won't be a danger.” (Leila)

Ensure footwear safety

2

0

0

“(My husband) has fallen when he was hiking, and the soles came off of this shoe…. We had to have all their soles replaced.” (Emma)

Support use of mobility assistive devices

6

2

3

“I know there's a risk of falling so I do encourage him to use his walker.” (Leila)

Support use of monitoring technology

4

0

0

“I also have a medical alert on her so that if I don’t happen to be right where she is at the time, she will get medical attention immediately.” (James)

Receiving, seeking, and coordinating care

Receive, seek, and coordinate formal and informal care and services

Use of informal care

6

4

4

“Like on Saturday, I went to the conference the whole day. I left at 8:30, and our neighbour came over at 10. One of my girlfriends came over at 11:30; and my other girlfriends came over at 1:00. And then our neighbour came back over at 2:30. For every hour, someone came over to stay with my mom.” (Monica)

Hire and coordinate with paid caregivers

0

2

0

“I have a caregiver that comes on Mondays and Wednesdays for from about 9:30 until 1:00, okay, he takes him out for a walk… and he helps with his toilet.” (Emma)

Use of social and health services

8

13

2

“These things got scary for her to be walking down the street. I got her a new assessment that gave her hours in the adult day care centre. I could pick her up after I am done working.” (Shannon)

Communicate with other care partners and professionals

4

0

1

“I finally got my mom convinced to remove the rugs that, 'You have to compromise, mom (the secondary care partner). You can’t just have the house like you want it. We have to make it safe. Not just for dad (OLWD), but for you too.'” (Veronica)

Learning

Gain information, knowledge, and skills from past experience and the outside world about fall risk management for OLWD [32]

Learn from professional care providers

8

6

1

“We had an occupational therapist and a physical therapist come here to the house. …They taught me exercises to do with her, because they would come like once or twice a week.” (Monica)

Learn from care partners’ life experiences

8

4

0

“With my car accident, when I finally graduated from the wheelchair, I was falling. Every single day, probably 15 times a day. I had to learn how to mitigate. That’s how I learned how to fall so I taught my mom how to do that when she fell.” (Marissa)

Learn from older adults living with dementia

6

2

0

“We were walking along, and I said, oh, I wanted to tell you about the program on TV tonight. He said, wait a minute, I can't do two things at once. So, I learned to be careful if he's concentrating on something and not to try to interrupt him.” (Leila)

Learn from social network

6

5

0

“The biggest thing for the support group is talking to people who have had gone through it with their parents. They tell me different strategies that they use to help prevent falls.” (Marissa)

Learn online and media

3

1

0

“I started to do research online of all the different providers of these fall alerts, trying to figure out, who does have reliable phone service when somebody falls in this particular location.” (Tracy)

Self-adjustment

Care partners change their arrangements of living, sleeping, working, and social and physical activities in response to the fall risk of older adults with dementia

Change living arrangement

0

4

0

“That's scary, if there was a problem, she couldn't call 911. If she couldn't figure out the phone, we realized that it was not safe for her to be alone all the time. So, we moved her in with me.” (Teresa)

Change sleeping arrangement

1

0

0

“She just lost her balance. So I thought, okay, I better come in the house. So I slept on her bedroom floor.” (Monica)

Reduce working time

1

1

0

“For the recent cancer diagnosis, he was so distracted; something took over his mind, so he might not pay much attention to his body… I stopped working because my husband needed me here 24 seven.” (Betty)

Avoid social activities

0

5

0

“I had nobody on Sunday before. I used to be very active in my church. Now I cannot go to church.” (Shannon)

Adapt walking behaviours

4

0

0

“I remember in my mind; you don't want to say hurry up. I don't want her to feel anxious. If she does, she's gonna fall.” (Marshall)