The statistics around falls are staggering. The Centers for Disease Control reports that 10,000 Americans turn 65 daily, and one in four adults experience a fall daily. Statistics also tell us that people with dementia are four to five times more likely to fall than older people who do not have cognitive impairment.
Now consider this: more than 20 percent of older adults who fall sustain serious injuries, and 800,000 people require hospitalization after a fall. What does this tell us? Fall prevention is key to protecting the health, safety, and life longevity of your loved one, especially if they are living with Alzheimer’s disease or any other form of dementia.
Here are eight tips to help caregivers and families understand what increases the risk of dementia-related falls and how to prevent them:
Tip #1: Consider the physical and cognitive changes that make someone living with dementia more prone to falling:
Jane Yousey is a registered and licensed occupational therapist and the manager of organizational learning and development at FirstLight Home Care. She reminds caregivers and families that people with dementia are at a higher risk of falling as their brains’ visual processing and coordination areas may no longer be working correctly.
“Dementia changes how the brain processes what someone sees. Think of how critical this ability is when climbing steps or stepping off a curb. As dementia progresses, it impairs coordination of movements, so walking, moving smoothly, and transferring safely is compromised,” Yousey says.
“Additionally, changes with aging in general can cause slower reflexes and diminished strength, which make it more difficult to catch oneself and recover during or after a misstep.”
Some other things to consider:
- Dementia impacts someone’s judgment, ability to reason, and retention of information.
- It also impacts their recognition of sensory input, such as sight, sound, and touch.
- People living with dementia lose coordination of movement; while they may still have the physical ability to carry out day-to-day movements, their brains can lose the ability to communicate with their muscles.
- As their mobility decreases, their muscles weaken, and they lose agility.
- People living with dementia are also more prone to illusions and misperceptions, e.g., depth, light intensity, color, pattern, temperature, changing how they interpret their environment.
- Dementia affects a person’s ability to understand and express needs — they may be in pain but unable to recognize or communicate their discomfort.
- Medications can be a culprit of dementia-related falls — is the person taking multiple medications? Is the person experiencing side effects or interactions from these medications? Are medications being taken as prescribed?
- Sometimes, if the person is restless or fatigued from sundowning symptoms, they may be more likely to get up and wander.
Tip #2: Assess your loved one’s risk of falling and look for signs of falls
“Falling is one of the greatest risks associated with older adults being home alone, so it’s important for caregivers to assess the risk and work to improve safety in their homes,” says Sheila Davis of Always Best Care, a leading senior care franchise system that helps thousands of families with in-home care and assisted living referral services.
Davis says this is one reason Always Best Care introduced the Balance Tracking System (BTrackS™) for balance assessment and fall risk analysis. The system utilizes “Gold Standard” force plate technology to provide an accurate and reliable measure of postural sway, which is known as a critical indicator of balance ability commonly used in fall risk assessment.
The tool categorizes a person’s fall risk across a spectrum ranging from low, to moderate, to high and can be used to put a plan in place that will potentially reduce the risk of falling and serious injury.
Davis also advises caregivers and family members to assess for behaviors that may indicate a loved one is at high risk for falling or signs that they have suffered from falls. These can include:
- A decline in memory and attention
- Weight loss or diminished appetite
- Lack of interest in tidiness or cleanliness
- Reliance on supports when walking, getting up, or sitting down
- Unexplained bruises or injuries
Tip #3: Perform a complete home safety check and take protective considerations in your loved one’s environment
Home safety is perhaps one of the greatest tools in preventing falls — if their environment isn’t safe, they won’t be either.
“It’s a good idea to conduct a safety check in the areas of the house where your loved one spends the most time; usually the bedroom, bathroom, den or living room, kitchen, and hallways,” says Davis. Use this room-by-room checklist to complete a home safety check in each area of your loved one’s home.
First, Yousey says, families and caregivers should investigate where and when falls occur.
“Frequently, there is a traceable occurrence pattern,” she says. “For example, if falls are occurring in a long hallway, the issue may be endurance, and the addition of a resting bench may be a solution. If falls occur during the night while getting to the bathroom, a bedside commode may prevent a fall.”
Follow these basic safety measures throughout the home to help prevent trips, slips, and falls:
- Avoid clutter and keep all waking areas free of furniture and cords to prevent tripping hazards.
- Eliminate throw rugs or area rugs wherever possible.
- If there is carpeting throughout the home, ensure it’s firmly secured without rips or buckles.
- Use textured strips or nonskid wax on hardwood and tile floors to prevent slipping.
- Install transfer grab bars and add railings on both sides of steps and stairs.
- Apply non-skid step strips to help provide color contrast.
- Add grab bars to stairways and bathrooms.
- Ensure all rooms, walkways, and stairways are well-lit; consider installing motion-sensored lights and automatic timers on lamps. Put a nightlight in every room and hallway.
- Keep essential items in consistent, visible, easy-to-reach places. (Glasses, keys, medication, phones, remotes, etc.)
- Label cupboards and drawers with the name of the contents.
- Keep mobility aids close by and within reach.
Tip #4: Ensure your loved one has safe footwear
“Footwear assists with support while walking and transferring and can help stabilize the foot. Often seniors have difficulty putting on stable shoes and end up slipping into slippers that increase fall risk,” says Yousey.
- Buy shoes with Velcro® closures and good tread. Always avoid footwear with extra thick soles, as they are bulkier and can cause a person to trip.
- Regularly check your loved one’s shoes for the proper fit and ensure the soles aren’t worn.
- Make sure whatever shoes your loved one is wearing are appropriate for the weather.
- Purchase good house shoes and ensure your loved one avoids walking indoors in socks and slippers.
Tip #5: Learn how to communicate with your loved one to help prevent falls
How you communicate with your loved one is important in reducing the risk of falls. Here are a few things you can do to improve your communication with them:
- Obtain your loved one’s attention, reduce distractions, and make eye contact.
- Watch for non-verbal cues to help understand their actions and reactions.
- Be mindful of your approach — remain calm and be thoughtful with your facial expressions and gestures, and offer gentle encouragement.
- Give careful thought to how you deliver instructions — use short and simple sentences, suggest one step at a time, use cues, and allow plenty of time.
Tip #6: Consider using technology and other safety tools to prevent falls and alert if they do occur
There are all sorts of fall detection devices and medical alert systems, like Lifeline and MedicAlert® Safely Home®, that can help you monitor and protect your loved one.
“Another consideration is adding telehealth and/or healthcare artificial intelligence to the person’s home. This provides insights into their health status and general 24/7 insight into their daily activities,” Davis says.
She adds that ensuring your loved one has an adequate source to summon help if needed is most important.
“A Personal Emergency Response System (PERS) is an easy-to-use medical alert system that ensures older adults living at home get assistance whenever needed and provides GPS alerts for quick response.”
Tip #7: Have a response plan in case a fall does occur
First, safety is the top priority — for both you and your loved one. It’s important to keep that in mind if your loved one does fall.
- At the time of a fall, the immediate concern is your loved one’s condition. Go to their side, get to eye level, and determine if they are in pain or have an injury. Immediately call 9-1-1 whenever there is a concern.
- People frequently feel embarrassed and want to try to get up immediately. If they are not complaining of pain and have no visible injury, and they want to get up, proceed slowly.
- Stop and call 9-1-1 at any point if your loved one becomes stuck, experience pain, or become too tired to get all the way up.
- Caregiver safety is also a concern at this point, as injuries often happen when trying to lift someone off the floor or attempting to catch someone who is falling. Never try to lift your loved one if your safety feels at risk — if this is the case, call for help before you attempt to help them up.
- Always consult a primary physician to rule out serious injury or further risks after a fall.
Of course, there’s a chance your loved one could fall when no one is there. If you suspect they have fallen — or enter the room to notice they have fallen — take immediate action.
“If a caregiver believes that their loved one has suffered a fall, it is important to seek medical attention right away. Even if there are no apparent signs of an injury, medical professionals should be consulted in order to assess the risks of further falls and provide appropriate treatment or advice,” says Evan Tunis, president of Florida Healthcare Insurance, who has been a licensed health insurance broker for 20 years.
Tip #8: Consider in-home help or other living arrangements if falls continue to happen
While changing the living environment may be a consideration in some cases, it is not the solution in most.
“Increased supervision, assistance, and support are often beneficial,” says Yousey. “If families are unable to cover all the necessary hours, the support of an in-home caregiver may be helpful.”
“If a person falls multiple times, it is important for caregivers and family members to consider different living arrangements that could be more suitable and safer,” says Tunis.
“This may include moving the person to an assisted living facility where they can receive professional care and assistance with daily activities. Providing additional in-home support services such as home health aides or private duty nurses can help ensure the safety and wellbeing of the person with dementia.”
