Dementia and falls risk
Prevalence of neurodegenerative disorders is increasing due to changes in our population demographics. It is estimated that we have 35,000 living with Dementia and this is expected to increase significantly to 58,000, by 2021. We know that age is the most common risk factor for the disease. Prevalence is 1% between the ages of 60-64 but increases to close to 50% in people aged 85 and over.
Managing falls in Older adults with cognitive impairment and dementia
An ageing population is associated with increased risk factors. Both CI and dementia and falls related injury, challenge the healthcare team. Individuals with dementia, fall twice as often as cognitively intact people!
Cognitive Impairment is a broader term that refers to below expected performance in one or more cognitive domains, and that more commonly does not impact on the individual's ability to function (Taylor et al, 2012).
Dementia refers to progressive neurodegenerative processes affecting various areas of cognition, such as memory, language, problem solving and attention, which result in impairments in an individual's ability to perform ADL's. Alzheimer's is the most common form of dementia, followed by vascular dementia. Knowing the difference of each dementia is important with care giving.
You can’t completely prevent falls, accidents do happen. Adults over age 65, and older adults with dementia, are at a higher risk of falling, for some well known reasons. These include a higher use of prescription drugs, more night waking, shuffling and other coordination problems and weakening musculature and balance. Most falls in people with dementia are “multifactorial”, meaning that a combination of problems contributed to the fall. This makes it especially hard to eliminate falls altogether. But it’s almost always possible to identify risk factors that can be changed or risks that can be compensated for.
Dementia indicators to falls risk:
- Dementia type has been demonstrated to influence risk. Mild to Moderate Alzheimer's, Lewy body dementia, and dementia related to Parkinson's disease.
- Gait disorders are common with dementia increasing the risk of falls.
- Medications used in treatment that increase risk of syncope. (Acetylcholinesterase Inhibitor, psychotropic).
- Impaired balance associated with dementia.
- Dementia-specific falls risk factors relating to wandering, impulsivity and agitation.
- Visuo-perceptual risks due to specific types of dementia.
We will look at some risk factors in more detail below:
Risk factors with dementia
There are different personal risk factors that cause people to fall, however, people with dementia are at greater risk because they:
are more likely to experience problems with mobility, balance and muscle weakness
can have difficulties with their memory and finding their way around
can have difficulties processing what they see and reacting to situations
may take medicines that make them drowsy, dizzy or lower their blood pressure
are at greater risk of feeling depressed
may find it difficult to communicate their worries, needs or feelings
Each person will experience dementia in their own way and may experience all or none of these risk factors.
Medication: Antipsychotic, benzodiazepine and anti-depressant medications are sometimes used to treat the symptoms of dementia. These medications can increase risk of falling as they're known to cause: drowsiness, dizziness and/or a drop in blood pressure when standing up (postural hypotension).
Vision: Dementia can affect the way we perceive and process information from our eyes. This can lead to sight loss, however, eye conditions that cause sight loss, and normal ageing of the eye, can also occur alongside dementia and could be the cause of this. Loss of sight makes it more difficult to spot hazards and move around safely.
Environment: Environments that are dementia-friendly – meaning they're easy to navigate and free from hazards – can also help prevent falls. To make an environment safe:
Invest in bright bulbs and regular lighting
Add signage to doors and walkways to help patients find their way around
Use contrasting colours to make things more visible. Chairs, beds or toilet seats that are a different colour to the floor are easier to see
Thoughts and Feelings: People with dementia are at higher risk of depression, which can make you less active, and affect how well you eat, drink and sleep, leading to an increased risk of falls. Anything that makes people stressed, distressed or restless can also increase their risk of falls. Some common triggers include: being in pain, being hungry or thirsty
needing to use the bathroom, being frightened, bored or lonely.
It's important for those who support people with dementia to try to understand what triggers these feelings.
Falls Prevention in cognitive impairment and dementia:
Use of a dementia specific falls risk screening tool.
Dementia specific gait and balance training.
Future research: Research is stating that more work needs to be done to identify effective fall prevention strategies. To date interventions are focusing on the areas listed above in risk factors. With improved knowledge on fall risk factors, targeted interventions require evaluation in large RCT's.