Minimizing the Risk of Falling

We may take walking for granted, but we are not born with the ability to walk. Learning to walk requires a lot of practice, taking a long time before a child walks with confidence. Walking requires navigation skills, coordination of muscles and balance, and precise brain management of incoming and outgoing messages to the appropriate muscles. Any breakdown in this process can cause a person to lose her balance and fall. Aging-related changes in our bodies increase our risk of falling. As we age, our eyes do not adjust as readily when going from light to dark—or from dark to light—which increases the risk of tripping over objects when getting up at night to look for a snack or go to the bathroom. Our eyes also become more sensitive to glare. The area we see becomes smaller, and our perception changes. For example, one might think a pattern on the floor is something to step over, which could cause one to trip and fall. Our reflexes also slow down as we age. An agile, younger person going downstairs is likely to catch himself without falling should his foot get stuck. An older person would not be able to respond as quickly and is more likely to fall. Muscle strength also decreases as we age, which can also lead to falls. There are many other changes happening in the body that make walking difficult as we grow older. Arthritis or painful joints affect the way we move and walk. The more difficult it is to walk, the easier it is to fall. Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness and, ironically, increasing their risk of falling. Those who fall are twice as likely to fall again! Considering how we walk and what causes falls, it is not surprising that people with cognitive impairment are at an even greater risk of falling. A brain affected with dementia has trouble telling the body what to do and how to move. It also has trouble perceiving or navigating features of the environment. Further, the body is aging. An aging person with dementia is also dealing with the same physical changes that cause elders to fall more often. Not only are people with dementia at a greater disadvantage, but they are at an ever-increasing risk of falling as the disease progresses. Falls tend to occur when a person is getting out of bed, trying to move from a bed to a chair, or simply walking. There is no sure way to prevent people from falling, but we must take all reasonable measures to decrease the fall risk for our loved ones with dementia. Falling is one of the leading causes of hospitalization for patients with dementia, including those living in dementia care facilities. Every hospitalization brings the risk of accelerated cognitive decline. The consequences of falling can be devastating. Research indicates that after just one hospital stay of any length, overall cognitive decline progresses twice as fast as before the hospital stay or compared to those who avoided hospitalization. Falls also generate an increased need for specialized post-care, which cannot always be provided at home. Many hospitalizations must be followed by a stay in a rehab care facility or skilled nursing home, which can further accelerate cognitive decline. Falls usually result from a combination of factors: The environment, changes in a person’s physical abilities, and changes in a person’s thinking (including perceptual) abilities are primary culprits. There are things you can change—the environment; and there are things you cannot change—the person’s cognitive abilities. As to the person’s physical abilities, in some cases they can be improved, in others they cannot. There are many things that you can do to promote safety and reduce the risk of accidental falls:

Keep your loved one with dementia as active as possible; people who are mobile are less likely to be injured due to a fall.

Keep pathways free of clutter and encourage movement.

Remove small throw rugs or use double-sided tape to keep rugs from slipping.

Keep necessary or desired items within reach (e.g., glasses, remote control, telephone).

Store frequently used items in cabinets that can be reached easily without using a step stool.

Use comfortable chairs that are easy to get in and out of.

Use boosters to adjust furniture height.

Equip bathrooms with slip-resistant strips and shower grab-bars.

Place a stool in the shower if balance is a problem while bathing.

Towel racks, if used for balance, are dangerous. Consider replacing with grab bars.

Make sure there is nothing to trip over.

Don’t run electrical cords across pathways.

Move items such as floor lamps and coffee tables to create safe areas to walk.

Pets and pet items can become trip hazards and cause falls. Consider obedience training for dogs and containment of pets in certain areas of the house, especially at night.

Provide good lighting. Install handrails and lights on all staircases. Use night lights in your bedroom, bathroom, hallways, and stairways.

Use bathroom signs with words and pictures to help orientation.

Place chairs or benches in hallways and other areas that can be used as rest-stops.

Use cleaning products that produce non-glare floors.

Wear shoes both inside and outside the house; avoid going barefoot or wearing slippers.

Have sidewalks and walkways repaired so that surfaces are smooth and even. Falls happen. As people age accidental falls occur at an increased rate and with more devastating long-term consequences. People with dementia are at increased risk of falls because of the additional changes to their cognitive and perceptual abilities. Doing whatever you can to minimize the chance of falling will help avoid hospitalizations and delay the need for placement in a long-term care facility. Excerpt from the book Ahead of Dementia, by Luciana Mitzkun, Edited by Karen Aldenderfer