How To Prevent Falls In Dementia Patients

How Can Falls Harm Me

Falls can be dangerous and lead to injury and hospitalization. Fear of falling can make you scared of moving around or performing your day-to-day activities. When you move less, you get weaker and frailer, and you may need more help from others.2 When your body gets weaker, you are at higher risk of falling and getting hurt.

Weak Perception Of The Surrounding

It is very common for seniors with dementia to have an impaired perception of their surroundings. As a result, they may often fail to understand any fall hazard signs and signals. Again, we can simplify the cause with an easy example.

Suppose there is a wet floor sign on the floor. We all may think that it is easy to understand. But a dementia patient may not realize the sign before its too late. This happens because they face trouble in catching these minor details.

Also, such seniors can lack common sense at times. For example, they have known throughout their lives that feeling dizzy is a sign of taking a break and relax. But they can forget all about it and walk around in such a condition. Eventually, this will result in falling and hurting.

Nursing Interventions To Prevent Falls In Older Adults

Falls are a leading cause of injury in older adults. However, there are many interventions that nurses can use to help prevent falls in this population. Some interventions include: -Educating patients and their families about fall risks and how to prevent falls -Assessing patients for fall risks and implementing fall prevention strategies -Using assistive devices to help patients with mobility -Improving the safety of the patients environment -Providing regular exercise and balance training for patients

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Keep Reminders In A Standard Place

If you are planning to keep notes for reminders, create a single place for them. That place in the house should be easily accessible. It is more organized when you are using a common place for information and reminders.

You can create an erase board or bulletin board for them. Then, keep the board near their eyesight or at a familiar place. This will ensure that the senior is not walking around the house for the information.

Causes Of Falls In People With Dementia

Physical weakness: Changes in gait and balance can occur in dementia patients even if they are in excellent physical condition. Some researchers believe that these changes that occur early on are one of the first indicators of dementia. As dementia progresses, this weakness progresses, too, declining muscle strength, walking ability, and balance.

Lack of physical exercise: If a person lacks physical strength, meaning they were already quite weak prior to diagnosis, this can increase their risk of falls.

Memory impairment: Memory impairment can affect a persons risk of falling because the person may not remember that they were told not to get up or move around. They may also not remember that they are now weaker and that their ability to move is limited. Because of cognitive issues, patients may not be able to recognize that they cannot simply get up and go any longer.

Poor judgment: Poor decisions can lead to falls. For example, a patient may step on ice or go out alone even though they need assistance.

Visual-spatial problems: A patient may misinterpret their surroundings, so they misjudge steps, uneven terrain, and other obstacles that may cause them to fall.

Clutter: In cluttered areas, a patient may trip or bump into objects in their way. Or, they may fall on a rug that is not well placed because they cannot determine that it is a hazard. Its important to clean up living spaces and avoid clutter as best as possible.

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Designing A Safe Living Space For Fall Prevention

Before a resident moves into a community, its important to develop a bedroom checklist with the family and explain risks regarding specific furniture.

Items to consider when designing a space for fall prevention

• Bedside table <
• TV and console table
• Chair with arms
• Accessible storage/shelving
• Mobility status influences design: Remember to factor in the range of mobility when designing a bedroom.
• No mobility aid: Reduce risk by making sure items are within reach of standing or sitting.
• Two- or four-wheeled walkers: Room should have more space for the pathway to exit, which means no bulky furniture and positioning the bed against a wall.
• Wheelchair: Ensure there is additional space for safe transfers from bed and chairs with multiple care staff in the room.

Identifying Causal Factors And Change Mechanisms

Qualitative work and formative realist analysis

The initial qualitative work comprised 58 semi-structured interviews and 5 focus groups with health and social care professionals . Professionals were identified through snowball sampling facilitated by local study investigators. Recruitment continued until data saturation was reached. Details of participants are provided in Additional file . Interviews and focus groups were audio recorded, transcribed, and anonymised prior to analysis.

We used realist methodology to identify both causal factors and change mechanisms. This is an approach to literature review and data analysis which seeks to answer the question what works for whom under what circumstances, how and why, describing mechanisms which produce particular outcomes in specific contexts . Members of the qualitative team generated first if-then statements and grouped these according to emerging themes . We refined the if-then statements, looking for data that could be interpreted as a causal factor or a change mechanism. We expressed these using the realist framework of Context, Mechanism or Outcome , with mechanisms further divided into resource and reasoning . Finally, we presented these initial Context-Mechanism-Outcome configurations to a panel of clinicians and further refined them based on their feedback. This framework formed the basis for extracting data from the literature. For examples of finalised CMOcs, see Table .

Effectiveness review

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Fall Risk For Dementia Patients: Risk Factors

Individuals with dementia are four to five times more likely to fall than older people without cognitive impairment. For those who fall, the risk of sustaining a fracture is three times greater than for cognitively healthy individuals.

While not every dementia patient will experience falls, many symptoms can contribute to elevated fall risk for dementia patients. Falls in older individuals with dementia are associated with multiple intrinsic and extrinsic risk factors, some of which are shared with older adults in general, while others are unique to dementia.

Risk factors for falls in dementia patients include:

Balance and Gait

Depending on the cause of dementia, patients may experience changes in gait and balance. For example, impaired balance and changes in gait typically occur in both Alzheimers and Parkinsons disease however, in the case of Alzheimer’s disease, these symptoms usually arise later in the disease course.

Changes in balance and gait in dementia patients, such as decreased coordinated stability, increased postural sway, and impaired static standing balance, have been associated with an increased risk of sustaining falls. These deficits can contribute to difficulty walking and balancing, which can ultimately lead to falls.

Vision

Several causes of dementia can affect the way patients perceive and process information from the eyes. Common issues with visual perception in dementia patients that can increase fall risk include:

Medications

Psychosocial

Six Facts About Falls For Dementia Patients And Caregivers

As children, we fall, get up quickly, brush ourselves off and continue with our activities. When we become older adults, we dont get up as easily, and can possibly even be injured from a fall. And dementia patients are more likely to fall than older adults who do not have cognitive impairment.

Here are six facts about falls and ways to help prevent them.

According to the Centers for Disease Control and Prevention:

Many people who fall, even if theyre not injured, develop a fear of falling which can lead to curtailment of their everyday activities. If someone is less active physically, they become weaker which increases the chance of falling. And a vicious cycle begins.

What You Can Do to Prevent Falls

Although falls are common in older adults, addressing certain risk factors can help prevent them:

How AFC Addresses Fall Risks

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Alzheimers Falls In Nursing Homes

When people with Alzheimers disease or a similar dementia move into a nursing home, they are more likely to develop falls, delirium, and other negative conditions as a result.

People with Alzheimers and other types of dementia have an increased risk of falling. Falls are a problem that people with dementia face and one way to avoid them is to understand why they occur. We can make predictions about what factors make our loved ones more prone to falls if we know what causes them to fall. Visuospatial abilities can be compromised in Alzheimers disease. A person can misconstrue what he sees and looks for when walking, when looking at uneven terrain, or when looking at shiny areas on the floor. Some dementia patients may hoard things, increasing their chances of tripping. If he needs to use the bathroom, why do he get up so often?

Boredom is a frequent problem for people with dementia. Some people are unable to walk around alone because they are lonely, but they attempt to walk around on their own. People of all ages require social interaction, which does not fade as Alzheimers progresses. Using root cause analysis, it can be determined what caused the fall and how to avoid it in the future. Increasing awareness about potential causes of falls can help to prevent others from occurring in the first place. Falls prevention is an important aspect of quality dementia care because it is done in proactive ways.

Tips To Reduce Falls In People With Dementia

Here are some tips to help reduce the incidence of falls in people with dementia:

• Have a family member or a friend come to take a fresh look at your home they may point out an obstacle you hadnt identified, such as a throw rug or cable on the floor, which might cause you to trip.
• Replace light bulbs to provide you with good lighting in all the rooms, staircases, and hallways that you use.
• Make sure your prescription lenses have been recently upgraded by your ophthalmologist. Avoid bifocal lenses, unless absolutely necessary.
• Check the soles of your slippers: if they are worn out, replace them.
• Rearrange your furniture so that your most needed items are within an easy reach from your favorite chair.
• Unclutter your home and dispose of items that are no longer meaningful to you.
• Be careful of slippery surfaces in your kitchen and in your bathroom.
• Consider having an occupational therapist advise you on how to safe-proof your home with grab bars and non-skid equipment.
• Participate regularly in an exercise balance program, such as Tai Chi.
• Get a Life Alert system to summon help in the event of a fall.
• Read side effects listed on medication bottles.

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How Should Identified Risk Factors Be Used For Fall Prevention Care Planning

Knowing which patients have risk factors for falls is not enough you must do something about it. Care planning guides what you will do to prevent falls. Once risk assessment has helped identify patient risk factors, care planning should match the identified risks. This includes planning for any risks found on the risk factor assessment tool, such as mobility challenges, medications, mental status, and continence needs. It also includes planning around a patient’s personal risks that may not have been captured by the assessment tool.

3.4.1. What is fall prevention care planning?

Fall prevention care planning is a process by which the patient’s risk assessment information is translated into an action plan to address the identified patient needs. These are the patient-specific actions that, in addition to the universal precautions described in 3.2, aim to prevent falls. Care planning’s specific purpose is to identify specific care practices that will be implemented so that the patient is less likely to fall during the hospitalization.

Care planning accounts for multiple factors that pertain to the patient’s problems, and the clinician therefore must synthesize multiple types of clinical data rather than just relying on one specific piece of information. Because each patient has a unique risk profile that needs to be integrated with care for the condition that caused hospitalization, the care plan should be individualized for each patient.

Altered Mental Status

What Can I Do To Avoid Falling

Talk to your health care team about your fear of falling and ways to prevent falling. Table 1 includes some tips and actions that you can use to prevent falls. Share these recommendations with your health care team to find which ones are best for you based on your current health and physical abilities.

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Which Fall Prevention Practices Should You Use

Given the complexity of fall prevention, the task of implementing a program may seem daunting. To simplify things, we have broken down fall prevention activities into separate steps:

• Universal fall precautions, including scheduled rounding protocols .
• Standardized assessment of fall risk factors .
• Care planning and interventions that address the identified risk factors within the overall care plan for the patient .
• Postfall procedures, including a clinical review and root cause analysis .

Your practices should be tailored to your organization. In addition, at the unit level, you should cover these components in a manner tailored to the types of patients and care flow on each unit .

Your program is more likely to be successfully implemented and sustained when it is compatible with hospital priorities and what is best for the patient. The hospital’s first priority is acute medical care patients come to the hospital because they are ill and their primary purpose is to receive treatment for their illness.

The goal of patient safety practices like fall prevention is to prevent additional harm to patients while they are hospitalized. Hand hygiene to prevent spread of nosocomial infection is an example of a patient safety practice that avoids patient harm without interfering with the patient’s medical care. As you read through this section, think about how you can integrate your fall prevention program with the variety of acute medical treatments that your hospital must deliver.

Design A Safe Living Place

The first task is to design an abode that is safe for them. So what does a safe living place mean for dementia patients? Lets find out.

• The bed structure should be risk-free with no sharp corners. The bed size should be adequate for the room as well.
• The number of drawers should be limited. This will help keep them organized.
• There should be a bedside table with a lamp on it. The lamp should be easy to turn on and off.
• The lighting of the room is very important. As dementia can cause visual impairment, the lighting should reduce any difficulties for them.
• Finally, the chairs should have arms on them for better mobility.

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Avoiding Restraints In Patients With Dementia

Issue #1 of Dementia Series

WHY: Use of physical restraints in older adults is associated with poor outcomes: functional decline, decreased peripheral circulation, cardiovascular stress, incontinence, muscle atrophy, pressure ulcers, infections, agitation, social isolation, psychiatric morbidity, serious injuries, longer length of hospital stay, and death. Of all patients, older adults with dementia have the highest risk for being restrained when hospitalized. Impaired memory, judgment, and comprehension contribute to the difficulty these patients have in adapting to the hospital. Patients may try to escape or resist care because they feel lost and afraid, yet language deficits associated with dementia limit their ability to clearly express these concerns. Brain damage associated with dementia also places patients at greater risk for delirium or acute confusional state, further increasing agitation, disorientation and confusion.

TARGET POPULATION: Older adults admitted directly or via the emergency department from home,nursing home or other non hospital setting. At particular risk for restraint use are patients whose behavior is judged to be unsafe, e.g., potentially contributing to falls or interfering with treatment.

ASSESS COMMUNICATION AND BASELINE BEHAVIORS ASSESS RESTRAINT RISK

• Assess the message in the patients behavior:- Ask the patient what she or he needs: Many patients with dementia can still communicate needs, both verbally and nonverbally.

Strategies To Reduce Falls Among The Elderly With Dementia Or Cognitive Impairment:

For the elderly with delirium in the acute hospital setting, routine assessment for fall risk and mental state is important to reduce hospital falls. This include putting up routine falls precaution, diagnosis of delirium and background cognitive issues. The elderly patients with cognitive impairment and delirium have difficulties retaining information and instructions and their care needs are higher. Once cognitive issues are identified, supportive care such as reorientation, ensuring regular sleep pattern , using appropriate sensory aids , adequate pain control, monitor elimination needs, regular ambulation and implementing a daily routine are all helpful to reduce in-patient delirium and falls.

There is currently insufficient evidence for interventions to reduce falls specifically among the elderly with dementia or cognitive impairment in the community or living in long term care. Shaw and colleagues were unable to show benefits of multifactorial interventions in fall prevention among the elderly with dementia presenting to the emergency department.

The elderly with dementia were able to comply with prescribed interventions like modifications of gait and balance, environmental factors, medications and exercise programmes. The effect of interventions on fall reduction was observed among the elderly with higher MMSE scores compared to the elderly with lower scores.

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