Open Access
Feature Article

Preventing falls in older people with dementia

Open Access
Feature Article

Preventing falls in older people with dementia

MORAG E. TAYLOR, JACQUELINE C.T. CLOSE

Figures

© rido/shutterstock.com models used for illustrative purposes only
© rido/shutterstock.com models used for illustrative purposes only
Dr Taylor is a Senior Postdoctoral Research Fellow at the Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney; and Conjoint Lecturer at UNSW Sydney, Sydney. Professor Close is a Geriatrician at the Prince of Wales Hospital, Sydney; Clinical Director at the Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney; and Conjoint Professor at UNSW Sydney, Sydney, NSW.

Abstract

Falls are common among older people with dementia and often have serious consequences. A number of validated assessment tools are available to help identify fall risk factors. GPs have an important role in screening older patients for dementia and implementing evidence-based management strategies to  help reduce falls.

Key Points

  • Older people with dementia experience more falls (>60% of those living in the community fall annually) and with more serious consequences than the general older population.
  • GPs have a critical role in screening and assessing for dementia and fall risk in older patients, and a number of validated assessment tools are available.
  • In community-dwelling older people with mild to moderate dementia, exercise that challenges balance may prevent falls.
  • In residents of care facilities, the evidence is inconclusive regarding exercise, but vitamin D supplementation and increasing dietary calcium and protein intake may prevent falls and fractures.
  • Some pharmacotherapies, such as centrally acting or psychotropic medications, increase fall risk and should be avoided in older people.
  • Fracture risk can also be reduced by assessing bone health and treating osteoporosis.

Falls are common among older people with dementia, with more than 60% of people with dementia living in the community falling annually and more than 40% falling multiple times.1,2 In residential aged care, 50% of residents with dementia fell over a six-month period.3 Fall-related injuries, including hip fracture and head injury, are more common in older people with dementia, and this population is less likely to regain their previous level of function and more likely to be placed in residential care and die after a fall than older people without dementia.4 The cost of falls and fall-related injury is substantial in this population; to the individual, their family and the healthcare system. This article outlines how GPs can screen for cognitive impairment and assess and manage fall risk for this population. 

Dementia vs cognitive impairment

A diagnosis of dementia, more recently termed major neurocognitive disorder, involves clinical assessment by a trained medical professional and requires an individual to have a cognitive impairment that affects their ability to function independently in daily life. When assessing a person in the context of diagnosing dementia, the clinician needs to exclude other possible causes of cognitive impairment such as depression and delirium, consider the individual’s previous level of cognitive function and, when possible, use information from an informant, such as a caregiver or family member who is in regular contact with the person.

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Many studies on fall risk factors and fall prevention strategies targeting ‘people living with dementia’ were pragmatic in their recruitment approach and used inclusion criteria of ‘diagnosed dementia’ and cut-points on validated cognitive assessments. Some of these studies, therefore, refer to the study population as ‘cognitively impaired’, and this has resulted in the terms cognitive impairment and dementia being used interchangeably in the literature. For the purposes of this article, we will refer to the study populations as having dementia. 

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