Acceptability of and adherence to a Tai Chi exercise intervention to prevent falls among older people living with dementia.

Abstract

Exercise interventions are effective in preventing falls, however, few have involved people living with dementia and explored their experiences. The aim of this PhD thesis was to fill this gap by exploring the experiences of dyads (formed of a person living with mild-to-moderate dementia and their informal carer) taking part in a Tai Chi intervention program, including class and home-practice. Participants’ acceptability of and adherence to the Tai Chi intervention was studied alongside the Intervention Pilot Phase (3/4 weeks long) and the Randomised Controlled Trial Phase (20 weeks long) of the TAi ChI for people with demenTia (TACIT) Trial respectively, to inform how to enable their sustained participation in this exercise intervention. Participants recruited from localities in the South of England’s experiences were explored using qualitative methods. These included field notes (at both phases) to record researchers’ observations during the classes and participants (n = 10 dyads and n = 22 dyads, respectively) and instructors’ feedback at the end of each class, 2 focus groups (n = 7 dyads, 1 at each site in the Pilot Intervention Phase) and 15 dyadic interviews (in the Randomised Controlled Trial Phase). Thematic analysis was used to inductively code the field notes and transcripts, which were then deductively linked to theory. Findings suggest that a dementia friendly approach to the design of the intervention based on repetition and individualised support enacted participants’ enjoyment and mastery of Tai Chi. Dyads discovered a new common activity and valued the importance of incorporating home-practice into their routines. Facilitators of adherence to the intervention point towards participants’ enjoyment, perceived impact on well- being, social interactions with people in a similar situation and qualities of the instructor. Main adherence barriers to the intervention were difficulty following the booklet provided to support their home-practice, as well as unexpected or recurrent health problems and competing commitments. In conclusion, people living with dementia and their informal carers could benefit from getting involved in a Tai Chi exercise program. Programmes that provide opportunities for practising Tai Chi in class and at home could provide a normalised shared interest to support communication, well-being, and quality of life.