Article

This series of articles for rehabilitation in practice aims to cover a knowledge
element of the rehabilitation medicine curriculum. Nevertheless, they are
intended to be of interest to a multidisciplinary audience.
The competency
addressed in this article is an understanding of how to develop an intervention
for people with mild cognitive impairment and dementia to promote their
independence, stability, and physical activity. INTRODUCTION: Older adults with
dementia are at a high risk of falls. Standard interventions have not been shown
to be effective in this patient population potentially due to poor consideration
of dementia-specific risk factors. An intervention is required that addresses the
particular needs of older people with dementia in a community setting. METHODS:
We followed guidelines for the development of an intervention, which recommend a
structured approach considering theory, evidence and practical issues. The
process used 15 information sources. Data from literature reviews, clinician
workshops, expert opinion meetings, patient-relative interviews, focus groups
with people with dementia and clinicians, a cross-sectional survey of risk
factors, a pre-post intervention study and case studies were included. Data were
synthesized using triangulation to produce an intervention suitable for
feasibility testing. Practical consideration of how an intervention could be
delivered and implemented were considered from the outset. RESULTS: Elements of
the intervention included individually tailored, dementia-appropriate, balance,
strength and dual-task exercises, functional training, and activities aimed at
improving environmental access, delivered using a motivational approach to
support adherence and long-term continuation of activity.
We focussed on
promoting safe activity rather than risk or prevention of falls. CONCLUSION: We
used a systematic process to develop a dementia-specific intervention to promote
activity and independence while reducing falls risk in older adults with mild dementia.

Langue : ANGLAIS