Home' Australian Ageing Agenda : AAA Mar-Apl 2016 Contents Dr Keith Hill
While falls are common among people aged over 65
years, they are even more frequent among older
people with dementia, with up to 80 per cent of
people living with dementia falling in a 12-month
period. In addition to the high risk of falling,
people living with dementia have a substantially higher risk of
injury associated with their falls.
Despite the magnitude of the problem of falling for people
living with dementia, and the projected growth in the incidence
of dementia associated with the ageing population, until
recently there has been little high quality research investigating
interventions to reduce the risk of falling in this clinical group.
While it might be assumed that the main problem of falls for
people living with dementia is for those with advanced dementia
requiring residential care, falls rates are also unacceptably high
for people with dementia living in the community, and also for
people admitted to hospital who have dementia or delirium.
The different forms of dementia have different impact on an
individual, and this is seen with differing rates of falls. Nearly one
in two people living with Alzheimer's disease or vascular dementia
in the community experience one or more falls each year,
but the rate is 80 to 90 per cent for people living with
Lewy Body dementia or Parkinson's disease dementia.
WHY ARE FALLS RATES SO HIGH?
It is not uncommon to hear from staff or to read in incident
reports that the cause of a fall is listed as "dementia" for
people living with dementia. While there is no doubt that
the neurological degeneration associated with the various
forms of dementia does contribute to increased risk of
falling, it is rarely the main or only contributory factor.
As such, it is very important for health professionals and
care staff to look beyond the diagnosis of dementia for other
contributory intrinsic (health) or extrinsic (environmental or activity
related) risk factors for falls, many of which can be addressed.
Examples of some concurrent risk factors for falls that
the person living with dementia may present with, and which
research evidence suggests interventions can reduce, include
vision problems (for example, cataracts), polypharmacy or
use of high falls risk medications such as benzodiazepines,
environmental hazards, and impaired balance.
It is equally important for a falls risk assessment to be
undertaken and a targeted management plan developed to address
identified risk factors for the person living with dementia who
presents with a fall, (although this may need some tailoring), as it
is when an older person without dementia presents with a fall.
There are additional considerations associated with increased
risk of falls for a person living with dementia. Acute health problems
such as urinary tract infection or chest infection can increase the
level of risk. Transitions to unfamiliar environments can increase
falls risk for a person living with dementia. And yet people with
dementia admitted to hospital may have a number of room or ward
moves during a short length of stay, each of which can contribute to
increased confusion, agitation and increased falls risk.
Similarly, the change of environment associated with
transitions in and out of respite care can also increase
the risk of falls. In any necessary change of environment
for a person living with dementia there is a need for
increased falls prevention vigilance by staff, and for
efforts to minimise excessive number of transitions.
Because of perceptual difficulties often seen in people
living with dementia, the environment plays a very
important role. Clear and uncluttered environments are
important. However, other environmental considerations
associated with a dementia-friendly environment, such as
avoiding glare and stark contrasts in floor surfaces (which
Falls risk is unacceptably
high for people living
with dementia, and it's
time for a concerted
approach to reduce it,
writes Dr Keith Hill.
48 | MARCH -- APRIL 2016 | AAA
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