Those with Dementia have a higher risk of falling

Falling is a serious concern for the elderly.  Falling can cause a fracture which leads to a whole series of problematic health outcomes. 

What about someone who has dementia? At quick glance, it would seem that dementia and falls are not related.  Yet, the data indicates that those with dementia are at a higher risk of falling.  In fact, according to the Canadian Institute for Health Information, 15% of all Emergency Visits by seniors with dementia are fall-related (compared to only 9% of other seniors).

Why is that?

There are a number of risk factors that are exacerbated for those who have dementia. Here are a few:

Medications: some of the medications associated with dementia can have side effects which cause drowsiness, dizziness, or instability.  Antipsychotic medications sometimes have a side effect of orthostatic hypotension, which is a sudden drop in blood pressure when you stand up.

Visual Perception Changes: dementia can affect someone’s ability to process what they are seeing. Depth perception, in particular, is affected and impacts fall risk.

Spatial Judgement: dementia can impact someone’s spatial awareness and ability to judge distances making it difficult to navigate around hazards or prevent bumping into obstacles

Fatigue: many people with dementia are keen to walk incessantly, but sometimes they fail to notice when they are tired and they don’t rest when needed. 

Mobility Aids: when a walker is introduced for safety, someone with dementia may have trouble remembering how to use the walker, or remembering to use it at all.

Washroom Needs: the sudden urge to use the washroom may cause someone to rush for the bathroom, especially if help is not on the way quickly enough.

Boredom: when feeling bored, lonely, confused, uncertain, or in pain, some people with dementia tend to get up and start pacing, but it may not be safe to do so.

How can you help to prevent a fall?

There are many items to consider for fall prevention, especially among those who have dementia. Here are a few modifications or suggestions you can implement to increase safety for your loved one.

ENVIRONMENT

Someone with dementia may not be able to scan the environment and take note of risks or hazards. They may not be able to process something as risky, and they may not be thinking about safety and fall prevention. 

Aim to make the environment safer on your loved one’s behalf by:

• Decluttering
• Removing floor mats and other tripping hazards
• Keep frequently used items within arm’s reach

VISIBILITY

Since your loved one with dementia may be experiencing perception changes, try to see their environment through their eyes. 

Some recommended adjustments:

• Increase the lighting—people with dementia require brighter lighting to easily see their surroundings
• Use contrast colours to make items more visible (i.e: a beige door on a beige wall may be hard to see; paint the door a contrast colour for easier way-finding)
• Clearly mark the edges of steps

SOCIAL NEEDS

Boredom is the cause of many so-called behaviours in dementia, pacing included.  All humans have a desire to be productive and to be doing something meaningful.  Someone with dementia may be confused about what that activity should be, and in the absence of something obvious to do, they may create an activity that can be a fall risk.

To prevent this concern:

• Keep your loved ones busy with an activity that is meaningful to them. If they are content and engaged in an activity, they’ll be less likely to wander away and be at risk of falling
• Maintain social connections

PHYSICAL ACTIVITY

Someone with dementia may attempt to walk faster than their current physical ability permits, which can increase their risk of falling.  Failing to use mobility aids can add to that risk as well.

To help mitigate these risks:

• Continue strength-based exercises to maintain strength and mobility for as long as possible
• Constantly remind and demonstrate how to use mobility aids correctly until it becomes a new habit
• Provide ample opportunities to be up and walking with support when someone is present to assist, reducing the impulse to pace later.

The risk of falling increases as someone ages, but that risk accelerates when dementia is added to the mix. By identifying some of the additional risk factors faced by someone with dementia, a family can aim to mitigate those risks and put preventative safety practices in place. Protect your loved ones by following fall prevention safety guidelines!