Dementia and Falls

You can't completely prevent falls -- accidents do happen. Adults over age 65, and older adults with dementia in particular, are at a higher risk of falling, for some well-known reasons. These include a higher use of prescription drugs, more night waking, shuffling and other coordination problems, and weakening musculature and balance.

Most falls in people with dementia are "multifactorial," meaning that a combination of problems contributed to the fall. This makes it especially hard to eliminate falls altogether. But it's almost always possible to identify risk factors that can be changed or risks that can be compensated for.

What you can do:

With your doctor's help

1. Understand what you're dealing with. Identify, with a doctor's help, which risk factors for falls your loved one has, besides dementia (which is itself considered a risk factor). The list varies by individual, but for many people with dementia these include such common problems as poor eyesight, poor balance, arthritis, and generalized frailty. People with dementia may also have a shuffling gait, muscle weakness due to past stroke, or neurological problems.

2. Minimize or avoid medications that have been linked to increased falls. Review a complete medication list with the doctor, and ask which ones might cause increased confusion or worse balance in a person with dementia.

Those to especially look out for include drugs from a class known as anticholinergics, which includes drugs for overactive bladder, itching/allergy, vertigo, nausea, and certain drugs for nerve pain or depression. (Diphenhydramine, or Benadryl, is a commonly used anticholinergic that's often included in over-the-counter sleep aids and PM-version painkillers.) People with dementia are also more likely to fall when taking sedatives, tranquilizers, and antipsychotics. Finally, blood pressure medicines can sometimes work too well and cause blood pressure to fall when a person stands.

3. Ask the doctor about leg strength, gait, and balance evaluations. These tests help determine physical risk factors. A doctor (or a physical therapist, to whom you may be referred for testing) will watch whether your loved one uses both hands to rise from a chair, for example, which indicates muscle weakness.

4. Ask about vitamin D supplementation. Many (but not all) older adults are deficient in vitamin D. Studies have found that treating vitamin D deficiency does reduce the chance of future falls. The doctor can help identify the right supplemental dose.

5. Ask about osteoporosis. Whether or not they also have dementia, adults with osteoporosis are more likely to suffer injuries if they do fall. Note: Both older men and older women can suffer from porous bone. But since osteoporosis is more common in women, all women over age 65 should be screened at least once.