DIMENSIONS Winter 2002

Falls: Why They Happen and Tips on Preventing Them

by Raymond Houle

Falls are the leading cause of fatal and nonfatal injuries in people 65 and older in the United States. People with dementia are at an increased risk for falls due to physical, behavioral, and cognitive changes.

Physical changes in people with Alzheimer's disease (AD) can contribute to an increased risk for falls. AD can affect vision by altering a person's ability to judge both depth and distance. These problems are often referred to as "visual-spatial" difficulties because they affect the way persons with AD view spaces around them. Something may look closer or farther away, or taller or shorter in height than it really is. Persons with AD may also experience motor changes in their legs that make them more likely to stumble or trip. Finally, medications can be an important risk factor for falls; some medications increase confusion or have a sedative effect, whereas others increase dizziness when a person stands up or moves suddenly.

Behavioral manifestations such as aggression and disinhibition can lead to falls that happen in the home or out in the community. These behaviors place the patient and caregiver at risk for injury, as well as causing stress and social embarrassment. People with AD may get a bit restless and feel the need to move about or stay on the go. This restlessness and increased movement affects concentration and may make a person more likely to experience falls and accidents.

Finally, cognitive difficulties themselves contribute to an increased risk for falls. Due to memory loss challenges, a person may be concentrating so hard on locating an item or a place that he or she is less attentive to objects or uneven surfaces that may be in the path.

It is important to remember that Alz-heimer's disease affects each person differently, and some people may never experience these symptoms. It is helpful, however, to follow some basic principles of safety that can reduce the risk of falling.

Safety Tips to Prevent Falls in the Home:

• Avoid the use of extension cords if possible by placing lamps and appliances close to electric outlets. Keep telephone and electric cords tacked to floor and baseboards or out of pathways.
• Use "baby monitors" or motion sensor alarms to let you know if the person gets up at night.
• Have adequate lighting in all rooms. Use nightlights in the bathroom, bedroom and hallways.
• Stairways should have at least one handrail that extends beyond the first and last steps. Light switches should be placed at the top and bottom of stairs.Consider marking stairs with brightly colored strips of tape to outline changes in elevation.
• Avoid clutter that can increase confusion and danger. Keep walk areas free of clutter. Remove throw rugs that are easily tripped on. Arrange furniture so that walking routes are not obstructed. Eliminate or pad corners of furniture that have sharp edges or angles.
• Be aware that a small pet that blends in with the floor or lies in the walkway may be a hazard for tripping.
• Store frequently used objects within easy reach. Avoid using step stools or chairs to reach things.
• Mop up spills or debris on floor immediately.
• Install grab rails in the shower and by the toilet; a raised seat on the toilet may also be helpful. Use a mat in the tub and shower with suction cups to keep it in place.

Safety Tips to Prevent Falls in the Community:

• Wear sturdy non-slip, low heeled shoes that fit snugly. Rubberized soles have better traction then leather, but make sure they are not so "sticky" that they make it easy to stumble.
• Make sure prescriptions for eyeglasses are current.
• Watch out for walking routes that have uneven surfaces and obstructions such as garden hoses, children's toys, and bicycles.
• Consider using a cane for balance. A cane is also helpful to judge distances or heights of curbs and stairs.
• Avoid walking alone on busy streets. Memory loss combined with too much noise and distractions can affect both concentration and judgment and increase risk for accidents.
• Exercise regularly to maintain muscle flexibility and strength.
• Make sure you let someone know if a fall occurs! Sometimes we are not even aware of an injury and need to be evaluated by a nurse or doctor.

Adapted from:

• "Preventing Falls: Reducing Risk for Individuals with Alzheimer's," by Lisa Snyder, LCSW. Perspectives, A Newsletter for Individuals Diagnosed with Alzheimer's Disease. Alzheimer's Disease Research Center, University of California, San Diego, May-August, 2000.
• "Responding to Safety Issues in Frontotemporal Dementia," by Talerico KA, Evans L.K.
• "Reduce your risk of falling," by Lyn Holt, M.S. Nov. 2001.