Adapting an emergency department fall prevention intervention for persons living with dementia through patient, caregiver, and expert interviews

Study objective Although falls are up to three times more common in persons living with dementia (PLWD), limited fall prevention interventions exist for this population. Adapting promising interventions, such as the GAPcare intervention, which reduced fall-related ED visits by 66% and did not prolong ED length of stay, may address this need. In GAPcare patients receive pharmacy and physical therapy (PT) consultation to reduce modifiable risk factors for falls prior to ED discharge. In this qualitative descriptive study, we conducted semi-structured interviews with PLWD who recently visited the ED, their caregivers, and national experts in dementia care or ED operations to elicit perspectives on how GAPcare should be adapted for PLWD. Interviews were conducted in English and Spanish. We analyzed interviews using rapid qualitative analysis guided by Castro's framework for adapting prevention interventions. We interviewed 7 patients, 2 caregivers, and 15 experts (5 physicians, 3 nurses, 3 PTs, 3 pharmacists, 1 PhD scientist). Participants strongly supported improved ED falls care for PLWD. They also indicated that tailoring at multiple levels (patient and caregiver, ED, and external factors, e.g., insurance status) would be required to support the complexities in PLWDs' circumstances (e.g., living arrangements, income) and cognitive abilities. Participants suggested training of ED staff in dementia care and caregiver support. PLWD, caregivers, and experts in dementia care and ED operations are supportive of adapting our existing GAPcare intervention for PLWD. Early feedback from relevant informants guided GAPcareAD intervention refinement and fit with ED workflows.