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Educating staff on fall-prevention techniques for dementia patients

Nurse Leader Weekly, August 20, 2004

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Reducing falls for residents with cognitive impairments involves different approaches than doing so for other residents. A one-size-fits-all method of fall prevention isn't going to address each residents' individual risk factors. No two people fall for exactly the same reason, and no prescribed set of interventions will work for everyone.

A study by Fiona E. Shaw, published in the July/August 2003 Geriatrics & Aging, estimates the annual incidence of falls in seniors with dementia to be about 70%-80%-almost double the incidence of falls for elderly people without dementia. Additionally, residents with dementia are three times more likely to sustain a fracture from a fall, and those who fracture a hip have a 50% higher mortality rate at one year than those without dementia.

According to the study, a multifaceted intervention consisting of physiotherapy, environmental hazard reduction, and cardiovascular interventions-including treatment of orthostatic hypotension (OH), a sudden drop in blood pressure-with dementia patients who had fallen produced significant improvements in gait, environment, and stability.

Train your staff to try other fall prevention techniques for residents with dementia, including the following:

Consider a broad range of fall causes. The resident with dementia may not be able to give a reliable history, and witnesses to falls may be unavailable. In the absence of hard facts, it is important to consider all the possible causes of a fall.

Assess cognitively impaired residents to determine the direction in which they are most likely to fall. This will help you determine the body parts residents are most likely to injure, so you can fit the resident with protective padded clothing. Residents with dementia tend to develop distinctive fall patterns, depending on the areas of the brain that are damaged and on muscular responses particular to the individual.

Try soft, flexible moccasins or socks without shoes. This type of footwear enables the cognitively impaired resident to feel the floor and compensate for declining depth perception, thereby reducing falls.

Be on the lookout for OH. This is common in older people who have dementia, but it is easily diagnosed and potentially treatable. Consider assessing the condition with continuous monitoring equipment, such as the noninvasive blood pressure monitor that constantly measures arterial blood pressure in the finger. This type of assessment is well tolerated and accurate.

Small interventions can make big improvements in mobility. Trying a different walking aid or finding more suitable shoes for a resident may make a big difference.

Consider protective clothing. Hip protectors, knee pads, elbow pads, wrist splints, and soft foam helmets have shown great efficacy in reducing or eliminating serious injuries in people who fall.

Nutrition changes. Try supplementing residents' diets with calcium, vitamin D, and vitamin C. These vitamins may help prevent fractures and reduce falls, according to several studies conducted in the United States and the United Kingdom.

-Adapted from Briefings on Long-Term Care Regulations (August 2004), published by HCPro, Inc.

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