Dementia and Falls

The Facts

Falls can be a real problem for people with dementia and their carers, causing real stress and distress. Older people with dementia experience 8 times more falls than those without dementia (Allan et al 2009). The annual incidence of falls in older people with dementia is 70-80% (Shaw 2007). Risk of injury, including fractures, has also been found to be higher in people with dementia compared to those without (Farrell et al 2011). As well as physical injury falls can have serious psychological consequences, such as, fear of falling, loss of confidence, self-restricted activity levels and reduced social interaction (Jensen and Padilla 2011).

Why Do People with Dementia Fall?

There are lots of different factors that can put a person with dementia at risk of falls and fractures. Of course we can all have a slip or a trip, however, there are some factors which will increase risk. These include; problems with mobility, reduced strength or balance, medication side effects, continence problems, problems with feet/footwear, poor nutrition/hydration, osteoporosis, a history of previous falls, vision problems, hearing problems, dizziness/fainting, how you interact with the environment and confusion/dementia.

People with dementia are more at risk for a number of reasons. As dementia progresses people with dementia are more likely to have problems with their mobility, strength and balance that would put them at risk. Issues such as memory impairment, disorientation and impaired judgement can also increase risk. Other risks include visual misinterpretation of the environment and postural hypotension (low blood pressure when rising). Some of the medications commonly used in the management of dementia symptoms can increase the risk of falls including antidepressants, anti-psychotics and benzodiazepines. These should be reviewed on a regular basis.

Other factors indirectly related to dementia include; a lack of physical exercise, fatigue, agitation/restlessness, discomfort/pain, thirst/hunger, a need to use the bathroom and boredom/loneliness.

What can be Done?

up and aboutIt is very important that falls are not seen as an inevitable part of getting older, nor should they be seen as an inevitable consequence of dementia. It is important that an individual’s risk factors are identified and if possible modified. This is usually done by a health or social care  professional using a multifactorial risk assessment. A personalised action plan should then be completed. General advice about how to reduce falls can be found in the Up and About booklets which can be found at the link in the useful resources section.

Special attention should be given to the environment and design for people with dementia as this has been found to reduce the risk of falls. Consideration of strategies such as contrasting colours and good lighting can help people with dementia better understand and interact with their environment and also help reduce the risk of falls. The Dementia Centre at Stirling University has a range of useful resources.

Keeping active

Physical activity is important as it has been found to be protective against falls, so should be encouraged. Exercises which improve strength and balance are particularly beneficial. Meaningful activity needs for people with dementia should also be considered to reduce the risk of falls, especially if the person’s falls may be related to their mood and how they feel. Make Every Moment Count is a useful resource for those who support people in care settings.

Team Effort

Falls prevention is often a real team effort, with a range of health professionals playing their part including; GP, Physiotherapists, Occupational therapists, Nursing, Dieticians, Podiatrists, Speech and Language therapists to name but a few. Allied Health Professional interventions can be pivotal to reducing the risk of falling, for example their specialist knowledge around diet and nutrition, physical exercise, environmental adaptation and adjustment etc. If you want to read more about their role in dementia care and treatment why not read Elaine Hunter’s previous blog on “what an allied health professional can do for you”.

Person centred care

For me good falls prevention is synonymous with good person centred care. It is about meeting the person’s needs in a range of areas and ensuring the person with dementia and their carers are at the centre of all decisions and interventions.

For more information please do not hesitate to contact me or your relevant health or social care professional or refer to the range of useful resources below. Or alternatively I would welcome your ideas on “How do we ensure that falls are not seen as an inevitable consequence of dementia?”

 

Lynn Flannigan

Lynn Flannigan
Up and About in Care Homes Deputy Project Lead
@LFlannigan

I am a physiotherapist with a special interest in dementia. I am currently seconded to the Scottish Government as part of the Up and About in Care Homes Falls Prevention Project.

 

 

References

Allan, L. M., Ballard, C. G., Rowan, E. N. & Kenny R. A. (2009), “Incidence and Prediction of Falls in Dementia: A Prospective Study in Older People”, PLoS ONE, vol. 4, no. 5.

Farrell, M. K., Rutt, R. A., Lusardi, M. M. & Williams, A. K. (2011), “Are Scores on the Physical Performance Test Useful in Determination of Risk of Future Falls in Individuals with Dementia?”, Journal of geriatric Physical Therapy, vol. 34, pp. 57-63.

Jensen, L. E. & Padilla, R. (2011), “Effectiveness of Interventions to Prevent Falls in People with Alzheimer’s Disease and related Dementias”, The American Journal of Occupational Therapy, vol. 65, no. 5, pp. 532-540.

Shaw, F. E. (2007), “Prevention of Falls in Older People with Dementia”, Journal of Neural Transmission, vol. 114, pp. 1259-1264.

 

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9 thoughts on “Dementia and Falls

  1. A good piece of information I have notice that my wife who has dementia has increasing become more unsteady on her feet I have tried to get her to take up a walking stick to no avail as she thinks it another downhill step in her illness

    • Thank you for commenting on the blog post by Lynn our physiotherapist colleague. We included some additional information on our “useful links” page, hopefully they can be of some help too. Thank you once again. Elaine

  2. Thank you so much for commenting. I would recommend an assessment by a physiotherapist for your wife who may be able to offer strategies and advice to improve her mobility and reduce her risk of falls. Lynn

  3. I have identified that my father is at a high risk of falls having had a knee replacement last year and now suffering pain in his other knee.The referral to a physiotherapist for assessment took weeks… The outcome of assessment was he had been referred to hospital for assessment,’ so wait for that.’ I am not a negative person, however I would anticipate the outcome of hospital assessment to be a referral to local physiotherapy dept. I think the information given in the blog is useful and informative. My issue is with who is expected to provide all the care, attention and expertise when the provision for care at home is so exceptionally poor for those attempting to live at home, unless they have a wide family support network or are able to independently finance their care. I fully support the concept of holistic care encompassing all allied health professionals. I enjoy reading about it, but have yet to see any evidence of it in practice. I am Not trying to be critical, but if the care and services for those with dementia are ever to be improved, there needs to be more open discussion of the frustrations and negativity which are experienced almost every day by those affected.

    • Dear Gwen,
      Thank you so much for the comments to my blog. I am glad you found the information useful and informative. I am very sorry however, to hear that you have had an experience that you felt was unsatisfactory. I am wondering if you expressed your dissatisfaction at the time? I absolutely agree that open discussion is the way forward in improving care and services for people with dementia and their carers. Without knowing the specifics of your father’s case and where you live (and therefore your local resources) I would advise you to perhaps speak to your GP, local Allied Health Professional Lead (your GP should be able to provide you with this information) or your local Alzheimer Scotland contact (or alternative if you are elsewhere in the UK). They should be able to advise and support you further.
      Kind Regards,
      Lynn

  4. “How do we ensure that falls are not seen as an inevitable consequence of dementia?”
    Possibly by moving from the more traditional medical model management of dementia. As you have quite rightly stated in your blog, there are certain medications that can increase somebody’s risk of falls.
    By helping to reduce the need for over-medication and therefore reduce this particular risk-factor through less use of the medications (particularly in inpatient settings) and more use of therapuetic activity to stave off boredom and frustration (and the possible aggression that goes hand in hand with these). In particular keeping people active which helps to build strength and confidence and enhance feelings of well-being.

    • Thank you for your most useful comments Abigail. I absolutely agree that interventions such as meaningful activity can be used to support people if they are experiencing stress and distress instead of medication. Meaningful activity is absolutely essential for physical and psychological wellbeing. The Dementia MKN has some useful resouces that those wishing to promote meanigful activity may find useful;
      http://www.knowledge.scot.nhs.uk/dementia.aspx
      Lynn

  5. Pingback: With Physiotherapy you CAN #DAW17 | Let's Talk about Dementia

  6. Pingback: With Physiotherapy you CAN #DAW17

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