Dementia increases the risk of falling.
Research shows that people with dementia have a significantly higher risk of falling than people who don’t have the cognitive disorder, says Alexa Rohach, a physical therapist at Providence Saint John’s Health Center’s Performance Therapy in Santa Monica, California. Dementia isn’t a specific disease, but a general term covering a range of symptoms, such as memory loss or “a decline in other thinking skills severe enough to reduce a person’s ability to perform everyday activities,” according to the Alzheimer’s Association. More than 5 million people in the U.S. are living with Alzheimer’s, which accounts for 60 to 80 percent of all dementia cases, the association reports, citing 2017 figures. To complicate matters, when people with dementia fall, they are three to four times more likely to sustain severe and possibly life-threatening injuries than people without dementia, Rohach says. “Because of heightened risk, fall prevention strategies are imperative to their well-being,” she says. “To better protect this population, there are a number of steps caregivers and family members can take to decrease the fall risk.” Experts recommend these strategies:
Maximize home safety.
Evaluating the living space of a person with dementia is important in reducing the risk of a fall, says Penny L. Wolfe, a neuropsychologist and co-director of the brain injury service section at MedStar National Rehabilitation Hospital in the District of Columbia. “Ideally, this would be done by a health care professional, such as an occupational or physical therapist, but even family members and [other] caregivers can evaluate and make changes,” Wolfe says. “For example, throw rugs that have the potential to cause tripping or sliding need to be secured or moved. There may be a need for nightlights, or leaving overhead lights on, in hallways or often-used paths to the bathroom or the kitchen if the individual has to get up during the night.” A more advanced modification could involve relocating the bedroom to an area near a bathroom to avoid stair use. It’s also important to keep frequently used pathways free of clutter or extra furniture.
Provide a daily routine.
Because the cognitive effects of dementia are progressive, people with the disease often have difficulty communicating their needs, coordinating their movements and performing tasks that require judgment and reasoning, Rohach says. “These impairments make it more difficult to perform daily activities safely and efficiently,” she says. Caregivers and family members can help by providing daily schedules and lists describing specific daily tasks. It’s ideal to post schedules and chores in an easily accessible common area, such as the kitchen or living room. “Using a bulletin board or a dry erase board for this information can help their day run more smoothly,” Rohach says. “Furthermore, reminders can be posted in multiple places throughout the house. For example, if a person is no longer driving, he or she may still wonder where the car is every day. Signs throughout the house will help with this confusion.” Reminders should be worded gently to avoid upsetting the person with dementia.
Color-code stairs.
People with dementia can have a difficult time differentiating similar colors, which can be hazardous in a home where colors are similar but surfaces are not, says Jimmy McKay, a physical therapist and director of communications at Fox Rehabilitation in New York City. “An occupational therapist can assess particularly high-risk areas like stairs and help define the top and bottom [of a stairway] by using contrasting colors,” McKay says. For example, colorful strips of tape could be placed on stairs to indicate a change in a floor level or surface, says Kelsey Swope, an occupational therapist and mentor services occupational therapy coordinator with Fox Rehabilitation based in Wilmington, Delaware. “Some type of electrical tape or duct tape should be used to differentiate between stairs,” Swope says. “This is especially important for stairs that have limited contrast, such as those that are completely carpeted or the same color wood. The tape should contrast the stair color to allow for comprehension of each stair ending.” Other things that could be made safer with color contrasting include door moldings, cabinet edges, grab bars and light switches.
Check medications.
Some prescription and over-the-counter medications can interact with each other and create negative side effects, including dizziness, says Peter Ross, chief executive officer and co-founder of Senior Helpers, which has more than 300 franchises nationwide that provide personalized in-home senior care. Family members and caretakers should inquire about dizzy spells, specifically asking the person with dementia’s pharmacist whether any prescribed medications could cause dizziness in combination with each other or with OTC drugs. “If so, ask for a different medication or solution to prevent a fall,” Ross says.
Consider safety equipment.
Getting a cane or a walker for your loved one or the person under your care could reduce the chances of a fall, Ross says. He or she should try out different models before choosing one. “Make sure they pick out the one they like and that they find comfortable,” Ross says. “Letting your senior choose [his or her] cane or walker for themselves makes it feel more like their own decision, which is especially important if they’re hesitant or feel they don’t need it. Shower chairs, railings and [if it’s in the budget] a walk-in shower can make simple tasks much more manageable and safer.” You can purchase a cane online for about $11 to $40, though some pricey ones sell for more than $400. Many different models of walkers are available online from about $30 to $200. Stores such as Walgreens and CVS sell canes and walkers online, and many of their outlets have these products in their aisles.
Boost bathroom safety.
One room that may require more attention is the bathroom, Rohach says. “Stepping in and out of the shower, walking on tile and ultimately navigating wet, slippery surfaces increases the likelihood of a fall,” she says. “Though these [potential hazards] cannot necessarily be avoided, providing a few modifications can improve safety.” Rohach recommends using nonslip mats both in and out of the shower to improve traction, installing bars by the shower and the toilet to provide additional support when transitioning from different positions and placing a shower chair or bench in the tub. Shower chairs are available online for about $30 to more than $300, depending on the level of sophistication. Many shower benches are priced from about $25 to $100; some can be attached to the shower wall.
Prioritize exercise.
It’s a good idea for people with dementia to perform simple exercises and movements with a physical therapist to improve their strength and conditioning, McKay says. “There are three components that contribute to your balance,” he says. “Visual, what you see. Somatosensory, what you feel. And your vestibular system, which receives motion and spatial orientation information. Strength is important in preventing falls because these balance systems tell the brain when we might be about to fall. Our reaction to that feeling is what can prevent the fall, by adjusting how we are standing or sitting. If someone does feel like they’re going to fall, they need to be able to move and support themselves to prevent it. To do that, they need muscular strength.”
Music can help.
“Music boosts brain activity in patients with memory loss, and its rhythmic nature can be an excellent complement to a physical therapy session by helping synchronize movement and promote coordination during balance exercises that decrease the risk of falls,” McKay says. “Plus, music is a mood booster.” Listening to music can encourage some people to exercise. “First off, music adds some fun to the exercise,” he says. “Second, the rhythm of the music can help increase or decrease the pace of the exercise program with a nonverbal cue. This can help with exercises with a physical therapist and be used to continue the program and help regulate pace when a physical therapist isn’t present. Anything that will help a person do more of an exercise is a help. The best music to play during exercise is whatever the client likes. Music can bring back memories and help motivate and energize us.”
Schedule regular eye exams.
For someone with cognitive issues, regular eye exams and checkups can make a world of difference. “Maintaining vision is important,” Ross says. “Taking your elderly loved ones for regular eye exams and keeping their eyeglass prescriptions updated can’t be swept aside.”
By: Ruben Castaneda