Alzheimer’s disease (AD) is a disease associated with a loss of memory and intellectual abilities. The risk of developing AD increases with advancing age and gradually gets worse over time. One of the most common safety problems in persons with AD is that of falling. It’s estimated that up to 60% of persons with AD experience one or more falls annually. Of even greater importance, the risk of sustaining an injury from a fall is considerable. Fall-related fractures (e.g., arm and hip fractures) are all too common; often leading to long term care placement. If caregivers are aware of why AD individuals fall, they can take steps to prevent falls and potential injuries.
Risk of Falling
It’s important to understand that falls are not a normal part of AD. In order to stop falls from happening, it will help you to understand who is at greatest risk and why. There are certain conditions or situations putting AD individuals at high risk (i.e., persons with AD may not exhibit all the risk factors discussed. As the disease gets progressively worse, however, the likelihood of exhibiting a number of fall risk factors increases). For example:
Mobility includes the ability to walk safely and maintain good balance. Persons with AD tend to exhibit marked impairments with both, which places them at increased fall risk. These include:
Cautions walking. This is characterized by individuals shuffling or not lifting their feet off the ground when walking. Walking is accomplished slowly with a slightly bent or flexed posture and uncertain foot placement on the ground. Both situations can easily result in trips and slips.
Disturbed balance. Individuals exhibit a lack of ability to maintain stability during postural changes. For example, getting up from seated positions, reaching up for hard to obtain objects on one’s tip toes or walking up steps can result in poor balance.
The addition of disorders such as stroke, arthritis, diabetes, and neurological disease can seriously affect the walking and balance capability of persons with AD.
Cognitive loss is the hallmark of AD and adversely affects the person’s memory, thinking, and behavior. This can place individuals at great risk for falls. Altered cognitive function can result in:
Lack of understanding and awareness of the potential for falls and the need for assistance.
Judgmental errors, such as an inability to recognize a difference between safe and hazardous mobility, and a misperception of environmental dangers.
Overestimation of one’s capacity for safe mobility (“I can do it myself”), and, as a result, individuals attempt to accomplish tasks that they are no longer capable of safely performing by themselves.
Failing to remember limitations in daily living, such as forgetting that they can’t walk by themselves.
Insistence on performing activities, such as attempting to get up from a chair and going to the toilet even though they are wearing incontinence garments, either because of forgetfulness or a failure to understand the intervention
Inability to ask for assistance with mobility because of communication problems.
Refusing or forgetting to seek help with mobility or to use assistive devices, such as canes, walkers and bathroom grab bars.
Incapable of understanding the need for assistive devices or using them correctly.
Any significant loss of cognitive function can lead to:
Behavioral manifestations (e.g., wandering, pacing, agitation, restlessness, disorientation, hallucinations, etc.), which can result in increased fall risk.
“Sundowning”, a specific type of behavioral problem, results in disruptive behaviors that appear during late afternoon or early evening (i.e., its thought that increased tiredness and/or lack of afternoon sunlight or lighting contributes to this situation).
Use of Medications
Taking too much medication or the wrong combination of drugs can sometimes affect judgment, coordination and balance. In particular, the use of psychoactive drugs to control mood and behavior can result in adverse effects (i.e., drowsiness, dizziness, unstable blood pressure and worsening confusion) that increase fall risk.
Vision plays a critical role in avoiding falls. Good eyesight is necessary for an individual to distinguish their surrounding environment clearly and to detect any hazardous conditions correctly. AD is associated with several visual problems that can heighten fall risk, especially when combined with hazardous environmental conditions.
Restrictions in peripheral or side vision. This can keep individuals from seeing hazards and objects in their path, and lead to trips or slips.
Decline in depth perception (i.e., the ability to judge distances and relationship among objects in one’s field of view). As a result, the person’s perception is no longer accurate. They may miss-judge where the edge of a chair is when sitting or not clearly judge the location of a step edge.
Loss of contrast ability (i.e., the ability to perceive spatial detail and contrast between objects). Individuals experience great difficulty walking from one surface to another, such as from carpeting to tile. They may perceive the new surface as a hole. Stepping off a curb can be especially challenging – they can no longer discern how far down that step is.
At least half of all falls in persons with AD occur at home. They generally take place during ordinary activities like walking, climbing stairs, sitting/rising from furnishings, getting in/out of shower/tub, etc. Common environmental obstacles associated with fall risk in AD include:
Low lighting, lack of nightlights and increased lighting glare.
Room clutter and slippery floor surfaces/rugs.
Low seating height of beds and chairs.
Low toilet seats and lack of grab rail support.
Aside from poor cognitive ability, there are several reasons why persons with AD fall. Next month’s blog will look at approaches to reducing the risk of falls in AD.
To learn more about Fall Prevention in Seniors, read Dr. Rein’s article, “Medications & Disorders that Increase the Risk of Falling”.
Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Dr’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592 If you have any questions about preventing falls, please feel free to e-mail Dr. Tideiksaar at firstname.lastname@example.org