REDUCING RISK OF FALLS FOR PEOPLE WITH DEMENTIA
People with dementia are four to five times more likely to fall than older people who do not have cognitive impairment. People with dementia fall more often than cognitively healthy older adults, but their risk factors are not well understood.
Teepa Snow has created a one-hour program on reducing falls for the dementia patient. This program is appropriate as part of your continuing education under the NH requirement for annual on-going Dementia Care Training.
For people living with dementia, this could lead to muscle atrophy and increase the risk for falls, potentially leading to avoidable hospitalization. Staff must remain vigilant while trying to reduce the number of falls.
Dementia care expert Teepa Snow discussed:
- Risk factors for falling in people living with dementia
- Best practices and practical interventions to reduce falls
- Strategies to help increase mobility in people living with dementia
This presentation will advise caregivers on promoting regular physical activity and movement to maintain strength and balance which does decrease the risk of falling. Teepa will demonstrate how you can make movement and mobility part of everyone’s daily routine, as well as provide exercise programs that promote balance, stability and endurance: lifting weights, tai chi, chair exercises, or walking programs.
For those patients who do fall, the risk of sustaining a fracture is three times higher than for cognitively well people. Also, those who fall are five times more likely to be hospitalized or live in a long-term care setting than older adults with dementia who do not fall. People with Parkinson’s disease, vascular and Lewy body dementia are more prone to mobility disturbances.
In June the experts at C & V Senior Care will address this, and take the topic a step further, as we discuss reducing hospital admissions for this population through fall reduction.
Registration available now:
Those who fall are more likely to have long term consequences such as hospitalization, disability, or death. People with Parkinson’s disease, vascular and Lewy body dementia are more prone to mobility disturbances. (Fiona Shaw, 2003) Incorporating evidenced based assessments and increasing awareness and understanding of the modifiable risk factors can contribute to decreased falls in client populations.
- Recognize the risk factors associated with falls.
- Increase knowledge of evidenced based tests for fall risk assessment.
- Employ fall prevention strategies with Dementia clients to reduce unnecessary hospitalizations.
Tips on Reducing Falls in Dementia Patients
The person with dementia may experience changes that increase their risk of falling.
Changes may occur in:
- insight, which affects judgment and the ability to reason
- recognition of sensory input, such as sight, sound, touch
- communication: ability to understand and express needs
- coordination of movement: the brain’s inability to communicate with the muscles and carry out day-today functions despite having the physical ability
- interpretation of their environment, causing illusions and misperceptions e.g., depth, light intensity, color, pattern, temperature
- retention of information: loss of memory, difficulty with new learning
- initiation of tasks, leading to immobility
Things to consider when a person falls:
- Is there a reversible cause or is it related to another medical condition?
- Is the person taking multiple medications?
- Is the person experiencing medication side-effects or interactions?
- Are medications being taken as prescribed?
- Does the person have changes in vision?
- Has the person’s mobility changed?
- Is the person restless?
- Is the person fatigued?
- Is the person in pain but unable to recognize or communicate their discomfort?
How the caregiver communicates with the person they are assisting is an important factor in reducing the risk of falls for people with dementia.
- obtain the person’s attention: reduce distractions, gain eye contact
- watch for non-verbal cues from the person to help understand their actions and reactions
- be mindful of your approach: remain calm and watch your facial expression and gestures
- give thought to how instructions are given: use short, simple sentences; suggest one step at a time; use cue; allow time; encourage the person
Protective Considerations in the External Environment
- Ensure Adequate Lighting
- Increase lighting
- Reduce glare
- Limit shadows
Lighting and Visual Suggestions:
- Use night lights in the bedroom and hallway.
- Turn lamps on in dimly lit rooms.
- Purchase glow-in-the dark light switches.
- Utilize high wattage/low energy bulbs.
- Install lights in dark closets.
- Close drapes and use additional lighting at night.
- Open drapes during the day.
- Keep entrances and outside walkways well lit.
- Install outdoor motion-sensor light.
- Provide Visual Contrast
- Use obvious contrast in color to define objects from the background.
- Use solid colors with no pattern to decrease confusion.
- Avoid black surfaces, which may be misinterpreted as being a black hole.
- Remove anything in the pathway that could cause the person to trip.
- Remove scatter mats or secure mats with double sided tape.
- Replace uneven, damaged flooring.
- Replace rippled carpets.
- Avoid waxing floors.
- Ensure doorsills are no more than one inch high.
- Clean up spills immediately.
- Tie up or secure extension cords.
- Remove light, unstable or low pieces of furniture.
- Keep furnishings in consistent places.
- Use simple furniture arrangement.
- Keep pathways and the driveway level, in good
- repair, free of clutter and clear of ice and snow.
- Paint outside stairs with a mixture of paint and sand.
- Paint step edges a contrasting color.
- Keep important items in consistent, visible, easy-to-reach places.
- Use a firm mattress.
- Lower bed height.
- Use adaptive equipment.
- Keep glasses and keys in consistent places.
- Label cupboards with the name of the contents.
- Install railings on the stairs and in hallways.
- Keep mobility aids close by.
- Place frequently used kitchen items within easy reach.
- Relocate the bedroom to the main floor near a bathroom.
- Have important items by the bedside.
- Have an emergency plan.
- Place emergency numbers by the phone.
- Keep a cell phone handy at all times.
- Consider purchasing a fall alert device, e.g., Lifeline.
- Register with MedicAlert® Safely Home®.
Increase Bathroom Safety
- Use a non-slip bath mat.
- Utilize a hand-held shower.
- Use a bath chair or bath bench.
- Install a raised toilet seat.
- Secure appropriately-placed grab bars by the tub and toilet.
- Lower water heater temperature to 48 degrees Celsius or less.
- Place night lights in the bathroom and the hallway to the bathroom.
- Have an accessible emergency system close by e.g. Lifeline, pull cord.
- Light the area adequately.
Ensure Safe Footwear
- Check fit regularly.
- Buy shoes with Velcro® closures.
- Check soles for wear.
- Avoid walking indoors in socks or slippers.
- Avoid extra-thick soles.
- Purchase shoes with a good tread.
- Ensure outdoor footwear is appropriate for the weather.
Reduce Noise Level
- Reduce busyness in the living space.
- Avoid sudden, loud noises.
Scholarly Articles on Dementia and Fall Prevention:
- Gait and cognition: a complementary approach to understanding brain function and the risk of falling – AGS, Geriatric Health Care Professionals
- Functional mobility limitations and falls in assisted living residents with dementia: physical performance assessment and quantitative gait analysis– APTA, Geriatric Physical Therapy
- Reducing Risk of Falls for People with Dementia– Alzheimer’s Society Canada
- Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review – NIH
- Falls, Wandering and Physical Therapy – Alzheimer’s Association
As these data show, fall prevention is essential; however, this endeavor is challenging, as there is a lack of compelling evidence that any one intervention will reliably decrease the incidence of falls. This is because many falls have multiple etiologies, requiring consideration of multiple physical, cognitive, and environmental factors.
Reducing the risk of falls and fall-related injuries requires a comprehensive approach that focuses on identifying the myriad conditions that predispose to falls and addressing each resident’s identified risk factors; this needs to start on each patient’s first day of care. In addition, when a fall occurs, systemic improvement depends on conducting a thorough root cause analysis of the fall, which includes tracking trends (eg, when, where, and how the fall occurred), the number of falls, and whether any family members or staff members were present.