Dementia and Falls: After a Fall

What Doctors Should Evaluate After Someone With Dementia Falls
Senior patient at doctor's consultation
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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.

Blood work

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.

Medications review

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.

More to expect from a checkup after a fall

Gait and balance assessments

These simple tests usually include watching the person get up, walk ten feet, and turn around, and also to rise from a chair, while the clinician watches for signs of poor balance and/or muscle weakness. (Your doctor might refer you to someone else for one of these assessments.)

Why: Many older adults with dementia have problems with balance, gait, and/or strength. It's useful to pinpoint the trouble spots so they can be improved.

What can be done: The doctor may suggest a referral to physical therapy or occupational therapy, for balance and strength training. The physical therapist will also recommend a cane or walker if appropriate.

An assessment of vitamin D levels (and a prescription to supplement if the level is low)

Why: A low vitamin D level (less than 20 ng/mL) has been linked to weakness and falls.

What can be done: A supplement may be prescribed. In those with low levels, vitamin D supplementation helps reduce the chance of falls.

An exam to uncover any underlying heart condition or neurological condition

These chronic conditions are different from the immediate underlying illnesses (such as an infection) that are immediately looked for.

Why: In a minority of cases, a person with dementia may be falling because of an undiagnosed problem with the heart or neurological system.

What can be done: If this isn't explored by the doctor, it's worth asking, "Do you think a heart condition might be causing these falls? Do you think a neurological problem can be causing these falls?" Report other symptoms of these conditions you may be aware of, even if they seem unrelated to the fall.

And don't leave the doctor without asking this . . .

While you have the doctor's time and attention, inquire about referrals that can help reduce the risk of future falls. These include:

  • A home safety evaluation. A social worker, nurse, or occupational therapist may be able to come to the home and recommend safety modifications. Among the recommendations they may make: installing nonslip bathmats, hand rails, and stair rails; removing throw rugs and floor clutter; improving lighting at night (especially to the bathroom); and getting safer footwear.

  • A vision assessment. A brief assessment of vision can be done in the doctor's office, but a referral for a more detailed eye exam is often appropriate, especially if there's a previous history of vision problems or if there's been no eye exam for over a year. Poor vision is a common cause of falls, yet many causes of vision problems (such as cataracts) are treatable.

  • A foot exam. Sore spots, foot deformities, and overgrown or infected toenails can interfere with comfortable and safe walking. A podiatrist can treat these issues and provide routine care.

Dr. Leslie Kernisan

Leslie Kernisan is a clinical instructor in the University of California, San Francisco, Division of Geriatrics, and maintains a popular blog and podcast at BetterHealthWhileAging. See full bio