Maintaining independence at home after a fall: a process evaluation of the MAINTAIN multicomponent intervention for people living with dementia.

Background: People with dementia who have a fall can experience both physical and psychological effects, often leading to diminished independence. Falls impose economic costs on the healthcare system. Despite elevated fall risks in dementia populations, evidence supporting effective home-based interventions remains limited.

Methods: Multiple-methods process evaluation within a pilot cluster randomised controlled trial informed by a realist approach. Settings included six UK sites/clusters (three intervention, three control). Fidelity checks on routine data collection and fidelity observations of intervention sessions, multidisciplinary team meetings and supervision sessions were undertaken. Semi-structured interviews were conducted with people with dementia, caregivers and intervention therapists.

Results: The MAINTAIN intervention demonstrated high fidelity in home assessments and intervention delivery, with participants receiving a mean of 15 of the 22 available sessions with a range of 5-25 sessions. Qualitative findings revealed that regular home visits increased engagement and motivation. Multidisciplinary team support enhanced therapists' confidence, particularly with complex cases. While most participants achieved their functional goals and reported improved confidence, challenges included geographical disparities in service delivery, carer burden and varying effectiveness of referral pathways. Therapists' attitudes towards advanced dementia influenced intervention delivery. The paired approach, involving both the person living with dementia and their carer, supported activity engagement but occasionally added extra responsibilities for caregivers.

Conclusions: MAINTAIN was both feasible and acceptable. Future studies should consider standardising multidisciplinary support, incorporating targeted falls-related anxiety support and establishing sustainable post-intervention maintenance strategies. Protocol adaptations, such as video consultations, showed promise in addressing workforce constraints.