Title: Developing a falls management tool for older adults with intellectual disabilities in community settings
Funder: Department of Health and Social Care

Abstract: Background Falls rates for older adults with intellectual disabilities is higher than compared to the general older adult population [Finlayson et al, 2010]. Although falls management strategies have been extensively considered in the general older population there is a paucity of evidence for older adults with intellectual disabilities [Wilgoss et al, 2010]. There is a need to develop falls prevention strategies that are specifically tailored for older adults with intellectual disabilities [Finlayson et al 2010]. The Guide to Action Tool is a multi-factorial falls management assessment that guides tailored intervention for the general older population [Robertson, 2010]. However, such tools in their current form are not be suitable for use with older adults with intellectual disabilities who have specific risk factors for falling and specific actions to reduce these risks of falling. The different risk factors for falling, different patterns of falls, different ways of delivering the actions to reduce risks and the different community settings where older people with intellectual disabilities are supported require the development of a different version of the Guide to Action Tool. Aim To systematically and rigorously revise the Guide to Action Tool (to identify risks and take action to reduce risk) to develop a version specifically for community-dwelling older adults with intellectual disabilities. Methods Development of the revised version of the Guide to Action tool for older adults with intellectual disabilities will follow the Medical Research Council Guidelines for Developing Complex Interventions [Craig, 2008] to synthesise the evidence, theory and modelling components. There will be five components of work undertaken over 24 months with older adults with intellectual disabilities, carers and clinicians included throughout. Firstly, a systematic review will be conducted to identify the specific reasons why older adults with intellectual disabilities fall. Components two and three will then involve interviews with older adults with intellectual disabilities, carers and professionals to explore their views on the design of the tool as well as any areas they feel are missing. A consensus meeting with older adults with intellectual disabilities, carers and clinical experts will then be held to determine the final tool and which actions to reduce the risk of falling are the most appropriate. The final component will be to establish the acceptability of completing the Guide to Action tool for older adults with intellectual disabilities through a proof of concept study. Anticipated Impact Co-producing the revised Guide to Action tool will enable clinicians, carers and older adults with intellectual disabilities to identify risk factors for falling and take action to reduce these risks. The immediate patient benefit will include an increase of awareness of actions to reduce the falls risk. We anticipate that the tool will reduce the rate of falls and improve the quality of life for older adults with intellectual disabilities through avoidance of hospital admissions, reducing injuries and promoting independence. Our strategies for the inclusion of adults with intellectual disabilities and their carers will provide a model for their inclusion in future research.

Lay abstract: The number of falls is higher in older adults with intellectual disabilities than that of the general older population and there is a need to develop falls prevention strategies specifically for older adults with intellectual disabilities. The Guide to Action (GtA) Tool is a falls management tool that identifies falls risk factors and supports action to reduce these risks. The GtA tool was co-produced by clinicians, care staff and researchers and is clinically used across community settings in the general older adult population. The current GtA for older adults is however not suitable for older adults with intellectual disabilities who have specific reasons why they might fall and are supported by difference services in the community. For example older adults with intellectual disabilities are more likely to have altered walking patterns in early life, resulting in increased muscle weakness in later life, are more likely to fall and sustain a head injury and more likely to fall during activities of daily living. The current version of the GtA tool is therefore not suitable for older adults with intellectual disabilities. We will co- produce, with people who have intellectual disabilities, a revised of the GtA tool to meet their needs, accounting for the different risk factors and the different settings where people are supported. Firstly, we will review the current literature to identify the specific reasons why older adults with intellectual disabilities fall and produce the first draft of the revised GtA tool. We will then carry out interviews with older adults with intellectual disabilities, carers and professionals to explore their views on the design of the tool as well as any areas they feel are missing. Thirdly, we will hold a consensus meeting with older adults with intellectual disabilities, carers and clinical experts to determine the final tool and which actions to reduce the risk of falling are the most appropriate. We will then try the tool with a small group of carers who support older adults with intellectual disabilities to ensure it can be used to facilitate actions to reduce falls risks and it is acceptable to use. Co-producing the revised GtA tool will enable clinicians, carers and older adults with intellectual disabilities to identify risk factors for falling and take action to reduce these risks. The immediate patient benefit will include an increase of awareness of actions to reduce the falls risk. We anticipate that the tool will reduce the rate of falls and improve the quality of life for older adults with intellectual disabilities through avoidance of hospital admissions, reducing injuries and promoting independence.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: NEUROLOGICAL;MENTAL HEALTH;INJURIES AND ACCIDENTS