3140 Maintaining independence in people with dementia who have had a fall: a pilot cluster randomised controlled trial (MAINTAIN)

Abstract Background Falls in people with dementia often result in physical and psychological impacts, reducing independence and increasing healthcare costs. Falls place a significant economic burden on the healthcare system. Although individuals with dementia face a heightened risk of falling, there is limited evidence supporting effective home-based interventions for this population. Methods A mixed-methods process evaluation was embedded within a pilot cluster randomised controlled trial, guided by a realist framework. The evaluation was conducted across six UK sites (three intervention, three control). It included fidelity checks of routine data collection, observation of intervention sessions, multidisciplinary team (MDT) meetings, and therapist supervision. Semi-structured interviews were conducted with people with dementia, caregivers, and therapists. Results High fidelity was achieved in home assessments and intervention delivery, with participants completing an average of 15 out of 22 planned sessions. Regular home visits enhanced engagement and motivation, while MDT support boosted therapist confidence in managing complex cases. Most participants met their functional goals and reported improved confidence. However, challenges included geographical and capacity variability in service delivery and inconsistent referral pathways. Therapists’ attitudes toward advanced dementia influenced intervention delivery. The dyadic approach supported activity engagement but occasionally increased caregiver responsibilities. Conclusions The Maintain intervention was feasible and acceptable, with preliminary evidence of improved daily living activities and quality of life. A future trial should focus on standardising MDT support, addressing falls-related anxiety, and developing sustainable post-intervention strategies. Protocol adaptations, such as video consultations, demonstrated potential to mitigate workforce challenges.