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can be perceived as steps) can also reduce sensory challenges
and potentially reduce risk of falling. Other aspects supporting
dementia-friendly environments may also reduce agitation and
associated behaviours, thereby also potentially reducing risk of falls.
EMERGING POSITIVE RESULTS
Pleasingly, recent research is indicating some approaches that can
reduce risk of falling for people living with dementia. In particular,
exercise to improve balance and function, either in group settings, or
home based with guidance and support of a carer, with intermittent
physiotherapy advice, have been shown to reduce risk of falls.
While exercise and some other falls prevention approaches
can help to reduce risk of falls, a number of them require
considerable input from the carer of the person living with
dementia. Carers often have a high level of stress and burden
associated with their caring role, and it is important to discuss
the time commitment, options, and other factors that may impact
on the carer, before determining, collaboratively, whether a
specific intervention approach should be introduced.
In hospitals, many falls by people with dementia are unwitnessed,
and occur at night when staffing levels are low. Delirium, a reversible
form of cognitive impairment, can often occur with an acute health
problem, and is present but often unrecognised among many older
people admitted to hospital. Management can be effective with
identification and addressing the factors contributing to the delirium.
Improved identification and management of delirium among older
hospitalised patients is likely to reduce the risk of falls in this group.
SOME NOVEL APPROACHES
As well as the emerging research described above, researchers
are working to identify and evaluate novel approaches to reduce
the high falls risk for people living with dementia. Some that
we will see results coming out of in the next few years include
advances in technology for sensor systems to reduce risk of
unwitnessed falls in hospitals and residential care; and use of
music or rhythm to improve walking stability. It is imperative
for researchers to look more broadly and creatively in seeking
solutions to the problem of falls in people with dementia.
A HOLISTIC APPROACH
While falls are a major health problem in their own right for older
people living with dementia, it must be remembered that the
older person living with dementia who is experiencing falls will
also often have a number of other co-existing health problems.
Health professionals need to consider the complex interplay of
these co-existing health problems, and also identify opportunities
where an intervention may be beneficial across a number of co-
existing health problems.
For example, an exercise program can be tailored to address
various health problems, such as reducing falls risk, reducing pain
and improving function for lower limb arthritis, improving bowel
motility (reduce constipation), reducing depression, and potentially
improving sleep. However, exercise is not a one-size-fits-all
intervention, and depending on the goals of the exercise program
and health problems being addressed, a different mix of exercises
may be required. Health professionals need to move beyond
considering a single intervention for a single health problem.
WHERE TO FROM HERE
It is time for a concerted approach to reduce falls risk for people
living with dementia. Falls risk is unacceptably high for people living
with dementia, and we still have some way to go to have a quality
research evidence base in this area, and some gaps in attitudes
and knowledge of health professionals and care workers to ensure
optimal care for people living with dementia at high falls risk, whether
this be in their own home, in hospitals, or in residential care facilities.
Researchers, health professionals, health and care
organisations and staff, and policymakers and planners need to
put urgent priority and resources into improving falls and other
health outcomes for people living with dementia. n
Professor Keith Hill is Head of the School of Physiotherapy and
Exercise Science at Curtin University.
www.australianageingagenda.com.au | 49
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