Dementia and Falls: After a Fall
What Doctors Should Evaluate After Someone With Dementia Falls
If a person is hurt in a fall, the first medical evaluation will probably focus on assessing the injury. Make sure a prompt follow-up appointment is scheduled to further evaluate the possible causes for the fall and to talk about how to prevent future falls.
Here's what a thorough medical evaluation will likely cover. If the doctor overlooks certain points, don't be shy about asking why.
An assessment for underlying illnesses
This is especially important if the person has generalized weakness and/or delirium.
Why: In some people with dementia, weakness and/or increased confusion may be the only outward signs of an underlying infection or illness, such as urinary tract infections.
What can be done: The treatment of the underlying illness can bring strength and mental clarity back to the person's baseline (what was "normal" for him or her before the fall).
A blood pressure/pulse reading when standing and sitting
Why: Up to 30 percent of older adults may experience a clinically significant drop in blood pressure when they go from sitting to standing.
What can be done: If blood pressure is dropping with standing, it may be necessary to reduce the dosage of certain medications.
This might include a complete blood count plus a check of electrolytes, kidney function, glucose, thyroid function, vitamin B12 level, and vitamin D level.
Why: A low red blood cell count (anemia) can cause weakness and falls. Other abnormalities in blood work are common and can provide clues to why someone is falling.
What can be done: Ask the doctor to explain any abnormalities found in blood work results, whether they might be related to falls, and what the plan is for addressing them.
Particular attention should be paid to those medications your loved one is taking that are known to contribute to falls. These include:
Medications for blood pressure or heart disease
Medications from a class known as anticholinergics, such as meds for overactive bladder, itching/allergy, vertigo, or nausea; or tricyclic antidepressants for nerve pain or depression
Opiate pain medications, especially if they’re new
Other psychoactive drugs, including sedatives/tranquilizers (Ambien, Valium, Ativan), antipsychotics (Haldol, Risperdal), and antidepressants
Why: These medications have been linked to increased falls in older adults because they can cause dizziness, unsteadiness, or other conditions that contribute to falling.
What can be done: If possible, the doctor should try to eliminate or reduce dosages of drugs that cause concern. If no change is made in your loved one's roster of medications, be sure the doctor explains why.