A fall can be an isolated accident -- but for many people, falls happen repeatedly. People with dementia are at increased risk of repeated falls. They may have problems with balance and coordination, for example, and they're prone to a shuffling gait. Behaviors such as night waking, restless pacing, and poor hand-eye coordination can also contribute to trips and tumbles.
If your loved one has been falling, here's what to do after you receive the appropriate initial evaluation.
1. Identify patterns.
Was the fall an isolated incident, or has it happened before (in your presence or not)? Look for patterns by reviewing these ten questions to ask an older adult about falling. If your loved one can no longer supply the answers, try to answer them yourself.
2. Look for underlying conditions.
Work with a doctor to figure out if a health condition or medication is raising your loved one's risk. In addition to dementia, health conditions that can add to the risk of falling are postural hypotension (low blood pressure that's caused by a change in position), heart disorders such as arrhythmia or an irregular heartbeat, changes in vision, incontinence (causing the person to try to get to the toilet), numbness in the feet from diabetes, and Parkinson's disease.
Pain and decreased mobility due to arthritis can also predispose a person to falls, especially if the arthritis affects the knees, hips, or back.
Although osteoporosis doesn't lead to falls, thinned bones do raise one's risk of suffering an injury from a fall.
3. Ask if a new or changed medication might be at fault.
New or changed medications can easily cause falls, since many commonly prescribed drugs worsen balance and cause confusion in an older person with dementia. Some common culprits:
Medications 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.)
Sedatives, tranquilizers, and antipsychotics.
Blood pressure medications, which often cause blood pressure to fall when a person stands. Some medications for prostate problems can also cause this side effect.
Opiate painkillers, especially during the first few days of use.
Always monitor your loved one for new symptoms when there's a change in medication, and don't be shy about reporting it back to the prescribing doctor. Often an alternative medication can be found or a dosage can be reduced.
More ways to help stop recurring falls
4. Learn the safest way to catch someone who's falling.
The trick is to try to slow the fall rather than try to stop it, says Helen Lhim, director of Rehabilitative Services for the Institute on Aging, Ruth Ann Rosenberg Adult Day Health Center, in San Francisco. This helps avoid getting injured yourself or making the fall worse if it turns out you can't provide full support for a catch.
Learn how to help the person fall into you.
5. Try physical therapy or a walker to restore confidence.
Fear of falling again is common after taking a tumble. Yet, ironically, fear of falling puts a person at increased risk of falling again, partly because he or she tends to take more tentative steps and move about less often, impairing mobility. Fear also lowers mood and causes older adults to reduce needed social outings.
Physical therapy helps overcome that anxiety while also building muscles and balance -- another way to deter future falls. Some research studies have also found that tai chi can decrease falls in some older adults. Using a walker boosts confidence, especially when the user sees that it's not a symbol of infirmity but of greater mobility.
Bear in mind, though, that you'll have to continually remind someone with dementia to use the device. Consider posting reminder notes as well as using verbal reminders. Place the walker next to the bed or chair (in a safe spot), where it will be seen and therefore more likely remembered.
6. Remove the fall triggers.
It just makes sense to get rid of the thing that caused the person to trip and fall (if it was that kind of fall). Eliminate the clutter of newspapers and magazines on the floor. Remove scatter rugs.
Beware of pets and their scattered toys. Unfortunately, sometimes things get to a point where a beloved animal who's always underfoot or creating messes is just too much of a threat to the owner's well-being.
7. Improve the shoes.
Dementia affects gait, sometimes creating a shuffle. Discourage walking around in socks. Make sure your loved one is wearing footwear that contributes to stability rather than instability.
Good choices: Tennis shoes with treads that grip the ground (but not so thick that they cause the feet to stick and trip) and shoes that fit securely on the feet, ideally with easy-to-close Velcro fasteners (not scuffs or slippers).
8. Prepare for future falls.
Consider alarm devices that trigger help in an emergency, should your loved one fall when you're not right there.