Falls & Mobility- Why People with Dementia Fall & What Can You Do

Persons with dementia fall up to three times more often than individuals without cognitive impairments. Dementia not only causes individuals to experience normal age-related vision and mobility changes that increase fall risk, but it brings it own set of challenges that can cause unsafe situations:

  • Inability to housekeep, maintain a home, or hoarding behavior can create mounds of clutter and other home hazards.
  • Reduced attention and/or depth perception can make certain objects, like doorsills, glass and/or small tables, unnoticed and easily tripped over.
  • Becoming easily agitated (lowered stress threshold) and storming off or possibly striking out and losing balance.
  • Fear of falling and consequently, not walking much, which further increases fall risk — no exercise leads to weakened muscles and stiff joints.

Impaired memory and judgment can cause such risky behaviors as:

  • Attempting to get out of a bed or chair independently because the person has forgotten he/she cannot transfer or walk without assistance.
  • Forgetting to use a cane or walker when he/she cannot walk without one.
  • Descending steep stairs in the dark, searching for a mother or adult child the person believes is still in his/her care.

Changes in perception and balance can cause problems such as knowing where to place one’s feet going up or down stairs, walking with a shuffle and getting one’s foot caught on area rugs or doorsills, or walking off balance and holding onto unsteady furniture.

Other activities outside of the environment may increase fall risk, such as certain medications or wearing poorly fitting shoes.

What Can You Do to Prevent Falls?

Now for the good news. Since people with dementia are ultra-sensitive to home hazards, you can do many things to help prevent a fall. Throughout our virtual home, you’ll find practical tips and strategies for making every room safer.

Below, we’ve put together six key fall-safety areas so that you can more easily locate specific information. Please note that routine and familiarity are important to someone with dementia. So, whenever possible, make changes slowly and only a few at a time.

  • Make Bathing Safer Wet, slippery surfaces, high tub walls that have to be climbed over, and resistance to bathing make the bathing area a key target for fall prevention.
  • Make Getting On and Off the Toilet Safer Toilets are typically too low and lack side arm support, making getting on and off unsafe. Use special equipment to make transferring as easy as possible to reduce injury risk, both the individual’s and yours.
  • Make Getting In and Out of a Chair or Sofa Safer Low and deep chairs, soft cushioning, and inadequate side arms make transferring difficult and dementia may cause the person to be unable to remember the specific body movements needed to rise from a seated position, something we take for granted. The person may attempt to get out of a chair independently when no longer able to rise safely without assistance.
  • Make Getting In and Out of Bed Safer-Falls around the bed area are common. The bed may be too soft or not at a good transfer height. The person for whom you care may have forgotten how to stand up without reminders, or weak leg muscles may make getting out of bed difficult. And sometimes the person may attempt to get out of bed independently when no longer able to safely get up without assistance.
  • Make Stair Climbing Safer-The person may attempt to use the stairs independently when unable to do so safely without assistance. Frequently, only one handrail is available, making it unsafe or even impossible for a person with a weak side due to a stroke. Poor depth perception may cause the person to miss a step. Poor nighttime lighting and wintery icy stairs can also cause falls.
  • Make it Safer to Walk Around -Exercise and walking, both indoors and outdoors, are vital to a person’s health and well-being, but home hazards often abound. For example, loss of homekeeping skills can result in clutter and flooring in disrepair. Shuffling feet can become caught on area rugs or extension cords, and furniture leaned on for support may be too rickety to be safe. Ottomans and small or glass tables, once easily seen, may now become objects to trip over, especially in low lighting.

Canes and Walkers

Many individuals can learn to use a cane or walker after several short training sessions and ongoing reminders from you. Please note that some people will resist using a mobility aid (getting an attractive colorful cane or walker can sometimes help) and others may be unable to learn.

Since a person’s gait, balance skills, and grip strength must be assessed before the right type of cane or walker can be recommended, physical therapists often assist in selecting of mobility aids. To make sure the mobility aid is safe to use, watch the person use it on an ongoing basis. Always place the cane or walker directly next to the person’s bed on the side that he or she exits.

Canes

Many people with dementia will be able to continue using a cane and some can learn. At times, you’ll have to remind the person or put the cane in the person’s hand. If the person often misplaces the cane, buy one in a bright color so it’s more easily found.

What you need to know:

  • A cane is useful when one side of the body is weak or in pain. It allows the person to support up to 25% of his/her weight.
  • If the person has one-sided weakness or impairment, the canes should be used on the opposite side.
  • The cane’s height should be even with the top of the person’s hip. If his/her shoulder is raised, the cane is too high and needs to be lowered.
  • A foam handle is more comfortable for someone with a weakened grip. For an existing wood or metal handle, try wrapping cushioned tennis tape around the handle (available in sports stores).
  • An adjustable height feature increases flexibility.
  • A rubber tip provides traction. For icy weather, however, use a special “ice tip grip” attachment that screws into the cane. Both are available at medical supply stores.
  • Individuals can trip over canes, so, for example, consider mounting colorful easy-to-see hooks around the home on which the person can hang the cane.

Walkers

Many different types of walkers are available today. Check with a physical therapist before purchasing one, for what’s safe for one person with dementia may not be safe for another.

What you need to know:

  • A walker supports up to 50% of a person’s weight and offers support through both arms.
  • Walkers may be appropriate for someone with arthritis, especially of the knees and hips; someone with generalized weakness of the hips and legs, and someone with moderately severe balance and gait disorders.
  • Walkers with seats may be appropriate if your care receiver tires easily. Brake systems, however, wear out and need to be checked regularly to ensure safety. People with dementia, however may try to sit down without braking first. For safety reasons, the person should only sit when the walker is against a wall or the walker can roll out from under the person if the brakes are not fastened securely. For sitting comfort, be sure to choose a padded seat and padded bar in the back.

Safety Caution: Never try to push a person when seated in a walker Caregivers have told us stories of pushing a loved one (who was sitting due to fatigue) when the walker broke, with ensuing falls.