By Micha Shalev
People with dementia are four to five times more likely to experience falls than older people without significant cognitive impairment. Rehabilitation is more difficult if the person has moderate or severe cognitive impairment, and the majority of people with dementia experiencing a hip fracture never achieve their previous level of functional capacity.
As well as memory disturbance, people with dementia have impairment in thinking, orientation, comprehension, calculation, language, perception and judgment. There are also psychological, behavioral and motor symptoms. These deficits increase the likelihood of falls.
Perceptual difficulties often mean the person is unaware of changes in levels, making them more likely to miss a step or lose their balance on a slope. Some have difficulty seating themselves; angle parkers do not seem able to line themselves up with the chair, possibly because of perceptual difficulties. Some premature parkers sit down too early and miss the seat. This may be because of difficulty delaying gratification.
The person with poor judgment fails to recognize risk. Take for example an elderly man who suddenly decides to scrape the lichen off his roof. Even if the person becomes aware of a risk, the slowness of reactions, poor problem solving and loss of protective reflexes mean they cannot avoid falling anyway. Impaired comprehension may mean that the person cannot take in or respond to warnings.
The effort of doing something mentally taxing appears to affect balance.
Psychotic symptoms can lead to risky behavior: A frail lady with Lewy Body dementia heard boys throwing stones on her roof at night and went outside to chase them away. Not only was she delusional, but she also showed bad judgment. She fell in the dark and broke her hip.
Someone who is agitated and pacing will not be looking out for external dangers. There is evidence that people with dementia walk too fast for their situation, perhaps because of a loss of control of gait velocity.If people become less active, either from reduced socialization or because concerned caregivers limit their walking, they become physically weaker. There is loss of condition as the dementia progresses and the person becomes frailer with poor balance and posture.
Acute conditions, such as infections or constipation, cause balance and gait changes. The risk of developing delirium is high in people with preexisting dementia and associated with increased confusion. Epileptic seizures occur in 10 to 22 percent of people with Alzheimer’s disease.Reduced visual acuity, arthritis and cardiac conditions may contribute to falling.
Drugs of various types increase confusion and the likelihood of falls. Even a small amount of alcohol will affect balance and sometimes people forget they have already had a drink and have another one.
Medications with strongest links to an increased risk of falling include:
•Serotonin reuptake inhibitors and tricyclic antidepressants;
•Class A anti-arrhythmic.
Hip protectors with hard shells can be uncomfortable if body fat is lost as dementia progresses and may not be tolerated. Soft-shelled hip protectors are available. The person with dementia may not recognize the garment as underwear or comprehend why hip protectors need to be worn. So, they may forget to put them on.
Finally, check footwear, clean glasses and turn on hearing aids. Some carry (or forget) their walking frame, though eventually with repetition may become used to the security of the frame and learn to use it.
Micha Shalev MHA CDP CDCM CADDCT is the owner of Dodge Park Rest Home and The Adult Day Club at Dodge Park located at 101 Randolph Road in Worcester. He is a graduate of the National Council of Certified Dementia Practitioners program, and well-known speaker covering Alzheimer’s and dementia training topics. He can be reached at 508-853-8180 or by e-mail at [email protected] or view more information online at www.dodgepark.com.