Factors Associated with Family Caregiver’s Fall Preventive Behaviors for Older Adults with Low Vision

Abstract

Introduction Older adults with low vision usually have visual impairments associated with eye diseases, leading to reduced vision, decreased ability to focus, difficulty distinguishing colors, trouble adjusting to low-light conditions, and a narrowed field of vision. They also encounter difficulty perceiving depth and may have difficulty seeing peripheral images, resulting in inaccurate distance judgment, leading to accidental collisions and an increased risk of falling. In addition, older adults often experience physical degeneration, which affects their balance and movement, further increasing the risk of falls. Older adults with low vision often experience a self-care deficit, which makes them reliant on family caregivers. Therefore, family caregivers play a crucial role in reducing fall risks by assisting with physical tasks and activities of daily living and providing close supervision. They are also responsible for improving environmental safety, particularly in areas where falls have previously occurred. Encouraging older adults to engage in physical exercises and adhere to fall prevention guidelines is essential. Family caregivers who demonstrate appropriate fall preventive behaviors are vital in minimizing the risk of falls and the resulting harm to these older adults. 

Objective This study aimed to investigate the relationships among family caregivers’ fall preventive knowledge, fear of falling, experience in caring for older adults, and fall preventive behaviors in older adults with low vision. 

Design A descriptive correlational design was used in this study. The Orem’s self-care agency theory was applied as a conceptual framework. According to Orem’s theory, self-care ability refers to the capacity of an individual to provide care to someone who needs support through deliberate actions with defined goals and who can predict, adapt, and implement actions to meet the comprehensive care needs of the dependent person. The ability to care for older adults involves the caregiver’s capability to perform self-care actions, the ten power abilities, and the fundamental skills and attributes required. The ten power abilities support deliberate self-care, encouraging family caregivers to seek knowledge on self-care and develop skills using thinking and reasoning. Additionally, when family caregivers have prior experience in caring for older adults, they tend to learn, develop skills, and become more proficient in providing appropriate care. Moreover, if caregivers have a fear of falls, this can lead to better prediction of fall risks for older adults. 

Methodology Participants were family caregivers aged 18 years and older who provided direct care for older adults (aged 60 and above) with low vision who were appointed at the ophthalmic outpatient department and low vision clinic at two university-affiliated hospitals in Bangkok from August to November 2023. Participants were purposively selected based on the following inclusion criteria: 1) The caregiver must be a family member with a close relationship, living in the same household, and the primary caregiver of an older adult with low vision; 2) The caregiver must be providing care for older adults with moderate to severe dependency, as assessed by the Chula ADL Index, with a score of 9 or lower; 3) If caregivers are 60 years or older, the 6CIT score must be 7 or lower; 4) The caregiver must be fully conscious and proficient in the Thai language, including listening, reading, and writing; and 5) The caregiver must voluntarily agree to participate in the study by signing the consent form. Exclusion criteria included caregivers of older adults who were bedridden. The sample size was determined using the G*power program version 3.1.9.7 with a significance level of .05, with a power set at .80, and an effect size of 0.29, resulting in a sample size of 91 participants. The researchers increased the sample size by approximately 10% to account for incomplete data. Therefore, the study included 100 participants. Data were collected using the demographic questionnaire, the fall preventive knowledge questionnaire, the fear of falling questionnaire, and the fall prevention behavior questionnaire. The reliability of the fall knowledge assessment tool was tested using the Kuder-Richardson coefficient, which yielded a value of .82. The fear of falling questionnaire and the fall prevention behavior questionnaire had Cronbach’s alpha coefficients of .82 and .85, respectively. Data were analyzed using descriptive statistics, Pearson’s correlation coefficient and Spearman’s rank correlation coefficients. 

Results The majority of family caregivers (64%) were female, with a mean age of 44 years (SD = 12.63), and completed a bachelor’s degree (51%). The duration of care ranged from 1 to 12 years, with a mean of 4.22 years (SD = 2.95). Approximately one-fourth of caregivers had two years of experience in caring for older adults with low vision (24%). The mean score for fall preventive knowledge was 15.59 (SD = 2.47). The mean score for fear of falling was 20.29 (SD = 2.70), and the mean score for fall preventive behaviors was 67.87 (SD = 6.74). Factors significantly associated with fall preventive behaviors included fall preventive knowledge (r = .197, p < .05) and fear of falling (r = .599, p < .01). However, experience in caring for older adults was not significantly associated with fall preventive behaviors (rs = -.114, p > .05). 

Recommendation The study results highlight the importance of fall preventive behaviors among family caregivers of older adults with low vision. The results can serve as preliminary data for future research on the factors predicting fall preventive behaviors in family caregivers of older adults. Additionally, the results can contribute to developing guidelines focused on educating family caregivers about environmental modifications and promoting exercises that enhance balance to prevent falls in older adults.