“Help I have fallen and I can’t get up”

The butt of countless jokes. That is until you are the caregiver for someone who is elderly.
Falls are responsible for 1 in 3 deaths due to injury.
First we will discuss why they fall.
Second we will discuss how to prevent falling.

Elderly dementia suffers fall for a variety of reasons:
Cognitive Recognition of Environmental Hazards slows, Coordination slows, and finally Muscular weakness.

Early Stage Dementia – Similar risks for falls as other elders.

Alzheimer’s patients lose coordination because they start to slow down to complete complex motor tasks like quickly avoiding hazards found in everyday life. Such as rounding the corner and suddenly seeing an obsitcal on the floor directly in front of their chosen path. How best to shift their body weight while moving their feet in a new direction. This takes quick cognitive ability recognizing environmental hazards and decision-making, coordination ability, and finally being able to draw on unplanned muscular strength.

Middle Stage Dementia – Increases the risk.

May fail to recognize change from carpet to vinyl flooring or uneven pavement.
Alzheimer’s patients lose coordination because they may start to forget how to complete complex motor tasks like walking and as well as basic daily living skills.
Increased agitation always puts individuals at greater risk for falls.
Start to fail to recognize unsafe situations.
Confused they may get up in the middle of the night, forget to turn on the lights or cannot remember where the switches are.
Wet spots on floor that they have just created may cause them to slip.
Individuals with other medical or physical problems such as visual and hearing loss have an even larger risk for falling
Increased risk for falls when placed on medication for medical conditions. Increased stiffness and rigidity can be caused by anti-psychotic medications making it difficult to rise from a chair or walking. Pain medicine is well-known for its side effects but what about that cold medicine.

Late Stage Dementia – Risk for falls is greatest, and deadly consequences for falls is greatest.

Forget how to walk and are uncoordinated with placement of their feet. Individuals afflicted with gait apraxia (forgetting how to walk completely) will not walk again.

At this stage individuals can no longer follow verbal direction such as “Please stand still” and have communication problems.

Fall Prevention

All caregivers should have a fall prevention program in place.
Encourage walking and help if necessary.
Maintain physical activity long as possible, include in range of motion programs.
Keep and eye out for pain or discomfort. Nothing stops the desire to get up and move like pain.
Beware of all medications side effects even over the counter medications. You will need to keep a note-book on this as it is too much for anyone to remember. Its not enough to just remember what is true today but also note when things change and how. Bring your medication book to doctor visits is a great idea. Not only will you remember to discuss the changes but it gives the Doctor more confidence in what you are describing and will be able to effect the changes you believe are necessary.
Maintain a health diet. There are many ways to get a well rounded meal in the home besides caregivers having to prepare every meal.
Proper bone maintenance is very important. Oral calcium supplements, are normal for dementia patients to keep bone density as robust as possible.

Activities

Top of the list. Take walks together. Adds to the quality of life in so many ways. Especially on pleasant days.
Simple household tasks, sweeping or raking. This improves self-worth as well as improves coordination and straight.
Work in a garden.
Play music and dance.
Break exercise into simple easy steps.
Use props to exercise: scarves, musical instruments, light hand weights.

Environmental Factors

Remove throw rugs.

Remove exposed power cords
De-clutter rooms. The fewer visual distractions the better for movement.
Keep young pets away. Even older pets will sometimes lie in the middle of the room.
Walkers or other movement devices should be available.
Vision should be checked and make sure glasses fit correctly.
Grab bars in Bathroom and anywhere else that seems right. Hallways by door jams. Many City and towns offer programs to the elderly for free of minimal charges. Check with your local city officials.
Non skid flooring. Waxed hardwood looks great but is a real problem.
Adequate lighting. Not to bright or dim.
Low beds
Proper footwear and clothing
Alarms, such as the ones to tell if they have left the bed or wheel chair.

Resources/handouts

Medical News Today http://www.medicalnewstoday.com/sections/alzheimers/

National Institute on Aging | The Leader in Aging Research

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www.nia.nih.gov/
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Caregiving  Helping You Help Family Members and Friends

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www.caregiver.com
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Public Health Agency of Canada
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www.phac-aspc.gc.ca/index-eng.php
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www.eldergym.com/ Exercise handouts with pictures

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http://www.stopfalls.org/
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