Keeping steady – thinking about falls and dementia

Even though we don’t like to think about it – having a fall can have serious outcomes including injury, disability and ending up in hospital. 

People living with dementia can have a higher chance of falling. This is because dementia can affect:

• Balance and the ways movements are coordinated 

• Being able to respond quickly to changes in the environment

• Being able to find your way around and stick with safe routes

• Vision and perceiving other senses

• Doing more than one thing at a time

Some medications or other health conditions you might have can also affect being able to move around safely.

Falls are such a big issue worldwide – that last year a global guideline was published in preventing falls and supporting people who fall. This recommends health teams take an approach to falls that is person-centred and has these characteristics:

Predictive – Considers a person’s risk of falling given their situation

Preventative – Focuses on preventing falls and preventing serious injuries from falls while making sure people are still staying mobile and involved.

Personalised – responds to a person’s specific risk factors and health information to develop a plan just for them.

Participatory – develops goals in relation to mobility and falls in partnership with the person and their supporters – and considers their values, resources and care partners.

To understand some of your own risks, there are falls risk checklists. Here is a very detailed one from Queensland Health in Australia 

When you look at your own environment at home and in the community, you may be able to make things safer and prevent falls or reduce the risks of them happening.  At home you could consider:

• Keeping clear paths as you walk around at home (so you are not dodging furniture or things on the floor)

• Removing or taping down rugs

• Watching out for wires and cords

• Keeping stairs clear and well lit, and use handrails

• Checking if your floor or surfaces are slippery -  Think particularly about your bathrooms

• Thinking about having lights to help if you get up at night

• If you are missing changes in surfaces or steps, you might want to use contrast tape on the edge.

• Thinking about how you might get help if you do fall (phones, personal alarms).

In the community, you might think about 

• Keeping an eye on how safe your footpaths (sidewalks) are – and report unsafe areas.

• Using handrails, particularly when using public transport (buses, trains) or stairs, and don’t feel you have to rush.

• Wearing shoes that are comfortable, secure and have good grip.

• Carrying things in a way that doesn’t make you feel unstable 

• Considering and plan for the weather

• Making sure you are wearing the correct glasses (including sunglasses), and using mobility devices (walking cane, frames etc) if you use them.

• Talking to your health team about any near misses, trips or worries about falling.

There is a lot of research about falls and the following recommendations have strong research support

• Getting a range of professionals involved to work on different aspects of falls issues is effective (e.g. doctors, physiotherapists, occupational therapists).

• People should be encouraged to talk about their falls or near-falls with their doctor to manage risks.

• Looking at falls should consider mobility (balance, walking pattern, muscle strength, mobility devices, anxiety about falling); sensory issues (dizziness, vision, hearing), activities of daily living, cognitive issues, medical conditions, nutrition and medication. The home and community environment also needs to be considered.

• Individualised exercise programs can be effective.

• Modifying the environment to reduce hazards can be effective.

• Making sure worry about falls does not stop someone from staying involved in their communities and activities is important.

If you want to read more about falls and dementia, here are some resources:

• NHS falls and dementia

• Falls in hospital (aimed towards care partners, NSW health)

• A self screening falls tool (not specifically for people living with dementia, Active Ageing Australia)

• Falls hazards in the home, NHS; and NIH (USA)

• Ways to prevent falls in your community (National Council on Aging, USA).
  

If you are interested in working on improving environmental design, you may consider joining DAI’s Environmental Design SIG: /get-involved/special-interest-groups/ed-sig