20 Ways to prevent falls in Alzheimer’s patients

Woman falls on slippery bathroom floor.

People with Alzheimer’s and other types of dementia are four to five times more likely to fall than older people who don’t have cognitive impairment. They are also three times more likely to fracture their hip when they fall, which leads to surgery and immobility. The rate of death following a hip fracture for those with Alzheimer’s is also increased.

A person with dementia may have trouble recognizing sight, sound or touch. Their vision may be distorted, not because of an actual eye problem but because of how the brain interprets what it is seeing. They may have problems with depth perception, get confused by patterns or light intensity, and they may lose coordination of movement and physical strength.

Some of these changes are inevitable and irreversible. However, movement and physical activity can go a long way toward fall prevention.

Scott Salus, occupational therapist and co-owner with physical therapist Daniel Basta, of Kind Rehabilitation says, “One of the main things that helps prevent falls is understanding that a fear of falling is one of the best predictors that someone will eventually fall.

“It’s really important to address falls before they happen. Caregivers need to come from an honest and firm place, because the moment someone has their first fall that can be the moment they lose their independence,” he says.

When Salus’ then-65-year-old, physically-fit mother and her boyfriend were moving, he insisted they look into the future to think about mobility issues. Would it be more prudent to live in a ranch than a multi-level home? “You can start the conversation early and plan for an eventuality that may never take place,” he says.

Salus, who specializes in working with patients with dementia and Parkinson’s, says, “The process of fall reduction is a delicate one that includes practicing every-day activities. We

reassure patients that it’s safe to practice pulling up their pants, or going into a shower fully clothed.”

He evaluates if the patient has vertigo when bending to tie their shoes or getting up from a seated position. Have they had a recent surgery or new diagnosis? How do they manage pain? Do they need a commode, or learn to reposition their arms, feet, and legs when toileting or getting out of a chair?

A physical therapy program might include exercises for strength, flexibility, good posture, and gait training. Learning to maintain balance while you’re walking and distracted or multi-tasking is also important, Salus adds.

The Feldenkrais Method® (Awareness Through Movement® and Functional Integration® developed by Moshe Feldenkrais) is another modality that helps prevent falls by teaching individuals to pay closer attention to the way they move.

Al Wadleigh, a Feldenkrais practitioner who teaches privately and at the Longmont Senior Center, starts a chair class by asking the participants to begin with a scan by turning the awareness inward. “Get a sense of how you’re making contact with the chair and with your feet on the floor. How is your weight distributed on the pelvis? Now roll back and forward to sense how your lower back is in relationship to the chair,” he says.

“We go through the lessons—and there are 2,000 of them—to fill out the idea of exploring and sensing what feels good. It’s to figure out, when given a better opportunity and choice, what the nervous system prefers. It’s development learning in order to change habits from old injuries, surgeries, emotions, work, and thoughts that don’t serve us.”

The aim of Feldenkrais is to invigorate your brain and nervous system with new ways of organizing and sensing your movement in the world. “Around age 50 the brain says ‘we’re not using all our neuro-pathways.’ We have fewer to rely on, so we have to neutralize the old habits in order to live life with more vitality,” Wadleigh adds.

He ends the class by asking participants to do a self-inquiry. One person says, “I’ve done the pelvis rock many times but sitting on a chair made it clearer.”

Wadleigh responds that the smaller the movement the more precise it can be. Once you’re aware of what you’re not aware of, you can fill in those parts.”

Another person with Multiple Sclerosis says that one of his feet was dragging that morning. “Now I can lift it up.” He adds, “I feel a centered-ness since doing Feldenkrais, and have better structure. Now when I stand and I’m reaching for something I’m able to move easier. That’s big for me.”

20 Tips for preventing falls

  1. Have adequate lighting throughout the house; place night lights in the bedroom and bathroom.
  2. Limit liquids after dinner to reduce night-time toileting.
  3. Get adequate sleep.
  4. Remove loose area rugs.
  5. Wear gripping socks, sturdy slippers, or shoes in the house.
  6. Avoid unsafe shoes, i.e. flip flops and high-heels.
  7. Place guardrails where needed.
  8. Stand up slowly.
  9. Use a walker or cane for steadiness.
  10. Declutter and remove excess furniture.
  11. Implement an exercise program to support muscle strength, stability, and balance.
  12. Use a “reach stick” to grab out-of-reach items.
  13. Do not use a step ladder.
  14. Eliminate or reduce alcohol and smoking.
  15. Be wary of medications that cause dizziness, sleepiness, and unsteadiness.
  16. Be attentive to pain management.
  17. Be aware of where your pet is to avoid tripping.
  18. Get adequate calcium and vitamin D to maintain bone health.
  19. Maintain a healthy weight.
  20. Get regular vision and hearing check-ups.
Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Dementia Increases Risk of Falls

A friend recently told me that her elderly mother developed dementia after breaking her spine. Dementia is a risk factor for falls and hip fractures in elderly dementia patients. But similar to the question of which comes first the hip fracture or the fall, the question of which comes first dementia or a significant fall is something to consider.

An individual with dementia is up to three times more likely than a cognitively intact older adult to sustain a hip fracture. This might occur due to several reasons including decreased activity, osteoporosis, vitamin D deficiency, smoking, side effects from drugs given to treat dementia, or unsafe environment.

Eight-six percent of hip fractures occur in individuals over the age of 65 years. Dementia prevalence increases exponentially with age, from 3% among those aged 65 to 74 years to 19% among 75 to 84 year olds and 47% in individuals over the age of 85 years.

There is some evidence that a hip fracture can in turn lead to cognitive decline. In one study, 25 of 26 Alzheimer disease patients with hip fracture had the onset of Alzheimer disease after the hip fracture. The researchers theorize that either the hip fracture brought the dementia to clinical attention or that patients who were marginally compensated prior to the event had further cognitive deterioration.

Whether your concern is staving off dementia or reducing risk of bone fractures, make sure your diet includes plenty of antioxidant-rich fruits and veggies for vitamins and the minerals necessary for maintaining healthy bones. Vitamin B complex is vital to supporting cognition, and most Americans, especially vegetarians, are deficient in vitamin B12. So consider supplementing your diet with a B12 nutritional supplement.

7 ways to protect yourself and your loved ones from bone fractures

  1. Protection of the hip with external padding can help in the prevention of hip fracture in individuals with low bone mass or with conditions that make falls inevitable.
  2. Low body weight, secondary to poor appetite or poor health, as opposed to intentional weight loss, has been associated with increased hip fracture risk. Nutritional deficiencies can also play a role in hip fracture risk. Make sure you or your loved one is eating a nutritious diet and getting a minimum of 1500 calories each day.
  3. Vitamin D deficiency is associated with cognitive decline, dementia and bone loss. Michael F. Holick, M.D., PhD., the world’s leading expert on vitamin D says that 200 million Americans are deficient in this essential vitamin. Through Holick’s research we know that every body cell has a receptor for vitamin D, which is why it is so crucial to overall health. Vitamin D is most commonly known for helping the digestive system absorb calcium and phosphorus. In that way it helps the body build and maintain healthy bones. But it does much more. Adequate vitamin D is necessary for reducing the risk for bone disease. Vitamin D is believed to play a role in the reduction of falls, as well as reducing pain, autoimmune diseases, cancer, heart disease, mortality and supporting cognitive function. 
  4. Exercise supports muscle strength, stability and balance, which are all important for preventing falls. If your or your loved one is mobile, implement a regular exercise program, which can be as simple as walking at least 30 minutes three times a week.
  5. Stop smoking—Smoking is a risk factor for both cognitive decline and dementia, with a relative risk of 1.79 for Alzheimer disease and 1.78 for vascular dementia. Smoking also has been shown to increase risk of hip fracture in both women and men.
  6. Reduce or eliminate soft drinks from your diet. Frequent intake of soft drinks and infrequent intake of fruits and vegetables have been associated with low bone mineral density.
  7. And of course, make sure you are getting the recommended daily requirement for calcium, vitamin K, and boron, either through food or supplements.

References

  1. Evans DA, Funkenstein HH, Albert MS, et al. Prevalence of Alzheimer’s disease in a community population of older persons. Higher than previously reported. JAMA. 1989;262(18):2551–2556.
  2. 24. Melton LJ 3rd, Beard CM, Kokmen E, Atkinson EJ, O’Fallon WM. Fracture risk in patients with Alzheimer’s disease. J Am Geriatr Soc. 1994;42(6):614–619.
  3. Holick MF. Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr Opin Endocrinol Diabetes 2002;9:87-98.
  4. Holick MF. Vitamin D. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, eds. Modern Nutrition in Health and Disease, 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2006.
  5. Slemenda C. Prevention of hip fractures: risk factor modification. Am J Med. 1997 Aug 18;103(2A):65S-71S
  6. McNaughton SA, Wattanapenpaiboon N, Wark JD, Nowson CA. An energy-dense, nutrient-poor dietary pattern is inversely associated with bone health in women. J Nutr. 2011 Aug;141(8):1516-23. doi: 10.3945/jn.111.138271. Epub 2011 Jun 8.
  7. Høstmark AT, Søgaard AJ, Alvær K, Meyer HE. The oslo health study: a dietary index estimating frequent intake of soft drinks and rare intake of fruit and vegetables is negatively associated with bone mineral density. J Osteoporos. 2011;2011:102686. doi: 10.4061/2011/102686. Epub 2011 Jul 2.