Falls and Dementia
Ageing and Fall[edit | edit source]
Falling caused by a sudden and involuntary change in body position is one of the biggest health challenges that can cause serious injuries and even death in older adults . The risk of falling in people with dementia (PwD) is almost twice that of cognitively intact older individuals . Likewise, compared to healthy older adults, balance and mobility are more affected in cognitively impaired older adults . Moreover, falling causes more serious consequences in PwD and increases the risk of hospitalisation, which might increase healthcare costs .
Risk Factors for Falls in Dementia[edit | edit source]
In addition to general risk factors such as visual and balance problems, environmental hazards, and weakness, there are specific factors that create a fall risk in PwD . These factors, which are specific in individuals with dementia, such as affected visuospatial function, sensorial integration and motor planning, anxiety, and medication side effects, could affect mobility and increase the risk of falling .
Dementia, which is characterised by cognitive and executive decline, prevents smooth walking and causes mobility problems . Previous imaging, observational, and interventional studies have revealed a close and critical relationship between gait and balance . Walking, which is a high-level, complex and controlled body movement, takes place along the neural pathway formed by the cortical, subcortical, spinal and peripheral .
The fact that the cortico-cortical and cortico-subcortical connections in dementia cause problems in the highest sensorimotor functions causes higher-level gait disorders . Perception and resolution of the relationship between the person and the environment with the integration of information coming from the sensorimotor system are very important for postural stability and the continuation of walking . Studies have shown that sensory input, visuospatial function, and motor planning, which are important in this integration, may be impaired in individuals with dementia .
This cognitive decline causes gait abnormalities in individuals with dementia by affecting the spatiotemporal stool characteristics in individuals with dementia, which increases the risk of falls and hospitalisation due to falls . Compared to cognitively healthy elderly individuals, PwD have a gait characterised by decreased gait velocity, cadence and stance time, and increased stride and swing time, and the severity of this difference depends on the type and stage of dementia .
Fall Prevention Strategies in People with Dementia[edit | edit source]
Fall risk can be reduced in PwD using different strategies (see the video below). Studies have shown that modifying the external factors/environment that create the risk of falling can be effective . Modifications such as adequate lighting, using obvious contrasting colours, cleared/safe pathways, and easy-to-reach/visible places/ modified noise levels can be effective to eliminate the effects of the affected sensorial impulse caused by dementia . Likewise, assistive technologies/devices, education, and encouraging the participation of PwD in fall prevention programs can be other effective strategies .
In addition to these, although some studies report that interventions such as vitamin D, hip protectors, medications, brisk walking, and cognitive behavioural group may have positive effects in reducing the risk of falls in people with cognitive impairment, such applications are not recommended to prevent falls because the results are inconclusive .
One of the most effective fall prevention strategies for people with dementia is exercise (see the video below) . Studies have shown that especially strengthening and balance training can reduce the fall rate by improving mobility . It was also stated that exercises such as functional, cognitive-motor, and tai-chi could be effective in reducing falls . However, there is not yet high-quality solid evidence showing the type and intensity of the most effective exercise in preventing falls in people with dementia .
Overview of systematic reviews reported that multicomponent exercise training, including cognitive and physical exercises, may be more effective than other types of exercise in reducing fall rate by improving walking, balance, and cognitive functions . Considering the cognitive impairment that significantly increases the risk of falling in individuals with dementia, combining different strategies/exercises may have more positive results in improving physical and cognitive outcomes.
Resources[edit | edit source]
References[edit | edit source]
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