What to do when a dementia patient keeps falling?

With fall rates approaching 50% among older adults with dementia, it's a critical and concerning issue for caregivers. Knowing what to do when a dementia patient keeps falling is essential for mitigating risks, enhancing their safety, and preventing serious injury.

Quick Summary

Address recurrent falls in a dementia patient by consulting a doctor for medical issues and medication side effects, assessing the home for environmental hazards, and implementing a holistic fall prevention plan focusing on safety and supervision.

Key Points

• Medical Evaluation: Schedule a doctor's visit to review medications and identify health issues causing dizziness or unsteadiness.

• Home Safety Audit: Conduct a room-by-room assessment to remove trip hazards, improve lighting, and install grab bars, especially in bathrooms.

• Assistive Devices: Use appropriate aids like walkers, canes, and personal fall alarms to provide support and ensure help is accessible.

• Holistic Approach: Address unmet needs like pain or thirst that may trigger wandering; distract rather than restrain a restless individual.

• Select Safe Flooring: Choose flooring like rubber, cork, or low-pile carpet to provide cushioning and prevent slips, especially in high-traffic areas.

• Consistent Supervision: Maintain a watchful eye, especially during transitions or when the patient is in unfamiliar or high-risk areas.

Understanding the Root Causes of Falls

Recurrent falls in dementia patients are rarely a simple accident. They stem from a complex interplay of cognitive, physical, and environmental factors. A proactive approach starts with understanding these underlying issues.

Cognitive and Physical Impairments

As dementia progresses, it directly impacts the areas of the brain that control balance, coordination, and depth perception. Common contributing factors include:

• Poor Judgment and Impulse Control: The patient may misjudge distances, try to navigate stairs without help, or attempt to get up independently for an urgent need like toileting, leading to falls.
• Visual and Spatial Perception Issues: Changes in how the brain processes visual information can cause shadows to appear as holes and reflections to be misinterpreted. Poor contrast between flooring and furniture can also be confusing.
• Changes in Gait and Balance: A shuffling walk, unsteady movements, and overall physical weakness are common mobility issues that increase fall risk, especially with wandering behaviors.
• Dizziness and Postural Hypotension: A drop in blood pressure upon standing can cause lightheadedness, leading to a fall. This is particularly common if the person rises too quickly from a seated or lying position.

Medical and Medication-Related Factors

Medications are a significant and often overlooked cause of falls. Many drugs used to manage dementia symptoms can cause drowsiness, dizziness, or confusion. A comprehensive medication review with a healthcare provider is critical. Other medical conditions, such as vision and hearing impairment or untreated pain, can also increase the risk. Restlessness due to pain, hunger, or thirst may also cause someone to get up quickly and fall.

Immediate Steps to Take After a Fall

Knowing what to do in the immediate aftermath of a fall is crucial for both the patient's safety and the caregiver's peace of mind.

1. Stay Calm and Assess: Do not rush to move the person. Calmly assess them for pain, injuries, or unconsciousness. Look for signs of fractures, head trauma, or other serious injury. Communication may be difficult due to confusion.
2. Call for Help: If there is any doubt about the person's condition or if they complain of pain, call 911 or emergency services. If the fall was unwitnessed, it's safer to assume a potential injury and seek medical assistance.
3. Assist Safely: If you are certain there are no injuries, follow a trained protocol for helping someone up. Use a gait belt for a secure grip, and provide clear, simple instructions. Avoid pulling on arms or using methods that could cause further harm. Training from an occupational or physical therapist can be invaluable.

Comprehensive Fall Prevention Strategies

Proactive measures are the most effective way to address repeat falls. This requires a multi-faceted approach addressing the patient's physical and cognitive state, as well as their living environment.

Environmental Modifications

Creating a safe home environment is a cornerstone of fall prevention.

• Remove Clutter and Trip Hazards: Clear walking paths of furniture, electrical cords, and loose rugs. Secure any remaining rugs with double-sided tape or remove them entirely.
• Improve Lighting: Use motion-activated nightlights in hallways and bathrooms. Ensure all rooms are well-lit and reduce glare from windows and shiny surfaces, which can confuse those with visual perception issues.
• Enhance Bathroom Safety: Install grab bars near the toilet and in the shower or tub. Use non-slip mats and consider a shower seat or bench. Lower the water heater temperature to prevent accidental scalding.
• Use Visual Cues: Apply contrasting colored tape to the edges of steps or changes in floor level to improve visibility. A dark baseboard against a light wall is another effective cue.

Optimizing Health and Wellness

• Physical and Occupational Therapy: Therapists can provide targeted exercises to improve strength and balance. They can also work with families to determine suitable home modifications and assistive devices.
• Ensure Proper Footwear: The right footwear can prevent slips and trips. Opt for well-fitting shoes with non-skid soles. Avoid loose-fitting slippers, socks, or going barefoot.
• Regular Checkups: Schedule routine medical appointments to review medications and check vision and hearing. Addressing pain or other medical issues can reduce restlessness and wandering.

Assistive Devices

• Mobility Aids: Canes, walkers, and wheelchairs can provide stability and support. Ensure they are correctly fitted and used appropriately.
• Emergency Devices: Consider fall alert systems or smartwatches with fall detection. A readily accessible phone with pre-programmed emergency contacts is also vital.
• Monitoring and Supervision: Consistent supervision is often necessary, especially when confusion increases. Consider video monitoring or bed alarms for added safety.

Selecting the Safest Flooring for Seniors

Choosing the right flooring can significantly impact fall risk and injury severity.

Flooring Type	Pros	Cons
Rubber Flooring	Excellent slip resistance (even when wet); highly shock-absorbent to cushion falls; durable and easy to maintain.	Can be expensive; some may dislike the texture or look.
Cork Flooring	Soft, shock-absorbent, and eco-friendly; good traction; antimicrobial.	Vulnerable to moisture and dents; may require sealing; shorter lifespan than other options.
Low-Pile Carpet	Cushions falls well; provides warmth; helps delineate areas.	Higher pile can cause trips; can be difficult for walkers/wheelchairs; traps dust.
Luxury Vinyl Plank (LVP)	Durable, waterproof, easy to clean; mimics other materials; can be softer and warmer than tile.	Harder than rubber or cork; can be slippery if not textured; some LVP has higher VOCs.

A Proactive Caregiving Mindset

For the caregiver, a consistent and compassionate mindset is key. Learn to recognize unmet needs that might lead to falls, such as pain or thirst. Use clear, simple communication and provide cues and reminders. Instead of physically restraining a person who is wandering, try to redirect or distract them with a soothing activity.

Developing a strategic plan can help minimize the risk and secondary consequences of falls, ultimately enhancing safety, independence, and quality of life for people with dementia. A recent fall is a strong predictor of future falls, so a new or repeat incident should be a trigger for immediate action and a reassessment of current safety protocols. For more caregiver support and resources, the Alzheimer's Association offers valuable information on fall prevention.

Conclusion

Addressing repeated falls in a dementia patient requires more than just reacting to each incident. It demands a thorough, multi-layered strategy that involves medical review, extensive home safety modifications, the use of appropriate assistive devices, and compassionate caregiving techniques. By addressing the root causes and implementing proactive measures, you can create a safer, more stable environment for your loved one, reduce anxiety for both of you, and significantly improve their quality of life.

Frequently Asked Questions

What medical issues can cause a dementia patient to keep falling?

Medical issues can include medication side effects (like dizziness), poor vision or hearing, balance disorders, dehydration, weakness from lack of exercise, or undiagnosed pain that causes restlessness.

How can I make the bathroom safer for a dementia patient who keeps falling?

Install grab bars by the toilet and in the shower/tub, use a shower bench or seat, apply non-slip mats or strips to wet surfaces, and ensure there is adequate, non-glaring lighting.

Are personal fall alarms helpful for dementia patients?

Yes, personal fall alarms (often worn as a necklace or bracelet) and automatic fall detection devices can alert caregivers or emergency services quickly. This is particularly important for unwitnessed falls.

How do I manage a dementia patient's medication to reduce fall risk?

Schedule a medication review with their doctor. Certain medications may cause drowsiness or low blood pressure. Ensure they have proper footwear and change positions slowly to prevent dizziness.

What kind of footwear is best for a dementia patient with fall risk?

Opt for well-fitting, sturdy shoes with non-skid soles that provide good support. Avoid loose-fitting slippers or socks, especially on hard, slippery floors.

Can exercise help prevent falls in dementia patients?

Yes, gentle and appropriate exercises, like walking or chair yoga, can improve strength and balance. Consult with a physical therapist to develop a safe exercise plan tailored to their abilities.

What flooring is safest if a dementia patient keeps falling?

Shock-absorbent and non-slip flooring is best. Options like rubber, cork, or low-pile carpeting can cushion falls and provide better traction. Avoid shiny or highly patterned surfaces that can cause visual confusion.

How can I improve lighting to prevent falls for a dementia patient?

Use nightlights in high-risk areas like hallways and bathrooms. Ensure all rooms are brightly and evenly lit to reduce shadows and glare that can disorient a person with dementia.