Improving Exercise Interventions for Older Adults with Dementia: A Qualitative Exploration of Physiotherapists' Knowledge, Attitudes, and Practices

Abstract

INTRODUCTION: Dementia creates significant challenges to physical activity management in older adults due to progressive cognitive and behavioural impairments. Physiotherapists serve a critical role in designing exercise interventions. However, the lack of standardized dementia-specific training compromises the efficacy of care. Despite evidence on the benefits of physical activity for older adults with dementia (OAwD), the physiotherapists’ knowledge, attitude, and practices (KAP) to meet these specific needs remains unclear. This qualitative study explores the physiotherapists’ KAP in exercise prescription, aiming to identify unmet training needs and inform targeted strategies to optimize therapeutic outcomes for OAwD. MATERIALS AND METHODS: A qualitative approach was used, employing semi structured interviews with 9 physiotherapists experienced in dementia care. Participants were selected through purposive sampling to capture diverse expertise. Data was analysed through thematic analysis uncovering patterns and insights related to KAP and its impact on care delivery. RESULTS: Four central themes emerged: Knowledge (theme 1), attitudes (theme 2), and practices (theme 3 and theme 4). Firstly, physiotherapists emphasized the importance of comprehensive assessments, utilizing tools such as the ‘Timed Up and Go test’ and ‘Montreal Cognitive Assessment’. Secondly, patience and adaptability were highlighted as essential due to cognitive decline associated with dementia. Thirdly, caregiver involvement and education were essential. Fourthly, goal oriented and functional exercises were prioritized. CONCLUSION: Physiotherapists showed a strong understanding of dementia care but highlighted the need for enhanced, specialized training. Addressing these gaps could improve exercise interventions and foster better health outcomes for OAwD.