Dementia significantly increases the risk of falling; individuals with cognitive impairment have nearly double the fall rate of their peers without dementia. These falls are a leading cause of serious injury, frequently resulting in fractures, hospitalization, and a decline in overall quality of life. The heightened risk stems from a combination of factors, including physical weakness, changes in gait, impaired judgment, and medication side effects. Because dementia affects both the body and the mind, a successful prevention strategy must be multi-faceted, addressing the physical environment, medical state, and daily routine.
Modifying the Home Environment
The physical space must be systematically evaluated to remove specific fall hazards. The most immediate changes often involve the floor, beginning with the removal of all loose throw rugs. Secure the edges of any remaining area carpets with double-sided tape or non-slip backing. Removing clutter from walkways is important to establish clear and consistent pathways for safe movement throughout the home.
Lighting is a particularly sensitive area for people with dementia, as impaired depth perception and spatial awareness can cause shadows to be misinterpreted as holes or obstacles. Ensuring bright, even illumination throughout the day is necessary, especially in transition areas like hallways and stairwells. Glare from glossy floors or uncovered windows can also cause confusion and should be minimized by using sheer curtains or matte finishes.
High-risk areas like the bathroom require specific safety modifications to accommodate impaired mobility and judgment. Installing sturdy grab bars near the toilet and inside the shower or bathtub provides stable support for transfers. Replacing low toilet seats with elevated models reduces the physical effort and instability involved in standing up. Non-slip mats or adhesive strips placed inside the shower or tub are essential to counter the danger of wet, slippery surfaces.
Staircases pose one of the greatest environmental dangers and require clear visibility and secure railings. Ensure that a secure handrail is installed on both sides of the stairway. Consider applying contrasting-colored tape to the edge of each step to improve visual recognition. For those with advanced cognitive decline, a safety gate at the top and bottom of the stairs can prevent unsupervised access. Arrange furniture to create wide, open lanes, and secure electrical cords against walls to prevent tripping hazards.
Optimizing Medical and Physical Health
Addressing the clinical factors contributing to fall risk requires close collaboration with healthcare professionals, starting with a thorough review of all medications. Many drugs, including certain sedatives, antidepressants, and anti-anxiety agents, are known as fall-risk-increasing drugs (FRIDs) because they can cause dizziness, drowsiness, or orthostatic hypotension. Psychoactive medications, such as benzodiazepines and some antipsychotics, should be minimized or gradually withdrawn under medical supervision, as their use is linked to an increased risk of falls and fractures.
Sensory function must be regularly assessed, as impaired vision and hearing compromise balance and spatial orientation. Ensure that eyeglasses and hearing aids are up-to-date, properly fitted, and used consistently, as even minor sensory deficits can increase the likelihood of misjudging a step or an obstacle. Regular checkups should include an evaluation for cataracts or other vision changes that may distort perception.
Physical health maintenance is important to mitigate muscle weakness and gait changes associated with dementia. Physical therapists can conduct a mobility assessment and design a personalized exercise program focused on improving strength, coordination, and balance. Activities like Tai Chi or supervised walking programs help maintain mobility and stability, which aids in preventing falls.
Appropriate footwear provides a necessary foundation for safe ambulation. Individuals should wear supportive, well-fitting shoes with thin, non-slip soles both indoors and outdoors. Slippers, socks, and bare feet are discouraged because they lack adequate traction or ankle support. If an assistive device, such as a cane or walker, is necessary, a physical therapist must ensure it is properly fitted and used correctly to enhance stability.
Incorporating Daily Routine and Supervision
The cognitive and behavioral symptoms of dementia often make falls unpredictable, necessitating a management strategy focused on structure and anticipation of needs. Establishing a consistent daily routine is effective because predictability reduces the cognitive load, lowering anxiety and the agitation that precedes impulsive movement. Fixed times for waking, meals, and activities provide security and help regulate the sleep-wake cycle.
A significant behavioral challenge is “sundowning,” which involves increased confusion, restlessness, and agitation in the late afternoon and evening hours, a time when falls are common. To manage this high-risk period, maintain bright, consistent lighting as dusk approaches to eliminate shadows that can cause hallucinations or disorientation. Transition to calming activities, such as listening to soft music or gentle rocking, and limit exposure to overstimulating factors like television or multiple visitors.
Proactive management of bodily needs reduces the urgency that can lead to rushing and subsequent falls. Implementing a scheduled toileting routine ensures the person is taken to the bathroom at regular intervals, preventing the fast movement that occurs when they suddenly realize they need to go. Addressing hunger and thirst proactively is important, as dehydration or low blood sugar can cause weakness and dizziness.
Supervision strategies must be adapted to the individual’s level of cognitive impairment and tendency to wander. For those who pace or become restless, ensure continuous visual checks, especially during high-risk times like the evening. Technology, such as motion sensors or pressure pads near the bed, can alert a caregiver when the person attempts to get up unassisted, allowing for timely intervention. Managing confusion, agitation, and physical needs through a structured approach significantly reduces the risk of a fall.