Falls and Dementia

Original Editor - Ahmet Begde

Top Contributors - Ahmet Begde, Lucinda hampton and Kim Jackson  

Introduction[edit | edit source]

Having Dementia -A greater risk for Falls

Dementia is a frequent disease in the elderly and may be a major risk of falling. Typically these falls are multiple and serious[1]. All types of dementia (eg Alzheimer's disease, dementia with Lewy bodies, dementia in Parkinson's disease, fronto-temporal dementia, vascular dementia) increase risk of falls, with the risk of falls in people with dementia (PwD) is almost twice that of cognitively intact older individuals [2]. Likewise, compared to healthy older adults, balance and mobility are more affected in cognitively impaired older adults [3]. Moreover, falling causes more serious consequences in PwD and increases the risk of hospitalisation, which might increase healthcare costs [4].

Falls Risk Factors: Dementia[edit | edit source]

In general age is a key risk factors for falls and the majority of PwD are older persons. Older people have the highest risk of death or serious injury arising from a fall and the risk increases with age. This risk level is in part due to physical, sensory, and cognitive changes associated with ageing, plus environments that are not adapted for older persons.

Additional risk factors for PwD additionally include affected visuospatial function, sensorial integration and motor planning, anxiety, and medication side effects, which can affect mobility and increase the risk of falling [5][6].

Mobility Risks: Dementia, which is characterised by cognitive and executive decline, prevents smooth walking and causes mobility problems [7]. Previous imaging, observational, and interventional studies have revealed a close and critical relationship between gait and balance [5][8].

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 [9]. 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 (the severity of this difference depending on the type and stage of dementia )[10].

  1. The cortico-cortical and cortico-subcortical connections defects in PwD cause problems in the highest sensorimotor functions leading to higher-level gait disorders [5].
  2. 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 [11].
  3. Studies have shown that sensory input, visuospatial function, and motor planning, which are important in this integration, may be impaired in individuals with dementia [12][13].

Fall Prevention Strategies in People with Dementia[edit | edit source]

Ensure clear paths and good lighting

Fall risk can be reduced in PwD using different strategies. Studies have shown that modifying the external factors/environment that create the risk of falling can be effective and prevention is possible[14]. Attention must be given to the patient (keeping in good health, limitation in sedative treatment) and on his environment (lighting, obstacles on the ground, stress levels).[1]

Examples include

  1. Adequate lighting, using obvious contrasting colours,
  2. Cleared/safe pathways
  3. Easy-to-reach in visible places items needed
  4. Modified noise levels (can be effective to eliminate the effects of the affected sensorial impulse caused by dementia) [15].
  5. Assistive technologies/devices, education, and encouraging the participation of PwD in fall prevention programs can be other effective strategies [16].

Inconclusive Results: 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 [16].

Exercise: One of the most effective fall prevention strategies for people with dementia is exercise (see the video below) [16][17]. Studies have shown that especially strengthening and balance training can reduce the fall rate by improving mobility [18]. It was also stated that exercises such as functional, cognitive-motor, and tai-chi could be effective in reducing falls [16]. 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 [16].

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 [17][19]. 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.

Viewing[edit | edit source]

Watch these 2 videos on falls reduction strategies and exercises to reduce falls risk.

Resources[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 Strubel D, Jacquot JM, Martin-Hunyadi C. Dementia and falls. InAnnales de readaptation et de medecine physique: revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique 2001 Feb 1 (Vol. 44, No. 1, pp. 4-12). Available:https://pubmed.ncbi.nlm.nih.gov/11587649/ (accessed 14.11.2022)
  2. Petersen JD, Siersma VD, Christensen RD, Storsveen MM, Nielsen CT, Waldorff FB. The risk of fall accidents for home dwellers with dementia—A register-and population-based case-control study. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring. 2018 Jan 1;10:421-8.
  3. Jahn K, Freiberger E, Eskofier BM, Bollheimer C, Klucken J. Balance and mobility in geriatric patients. Zeitschrift für Gerontologie und Geriatrie. 2019 Jul;52(4):316-23.
  4. Mitchell R, Draper B, Harvey L, Wadolowski M, Brodaty H, Close J. Comparison of hospitalised trends, treatment cost and health outcomes of fall-related hip fracture for people aged≥ 65 years living in residential aged care and the community. Osteoporosis international. 2019 Feb;30(2):311-21.
  5. 5.0 5.1 5.2 Zhang W, Low LF, Schwenk M, Mills N, Gwynn JD, Clemson L. Review of gait, cognition, and fall risks with implications for fall prevention in older adults with dementia. Dementia and geriatric cognitive disorders. 2019;48(1-2):17-29.
  6. Fernando E, Fraser M, Hendriksen J, Kim CH, Muir-Hunter SW. Risk factors associated with falls in older adults with dementia: a systematic review. Physiotherapy Canada. 2017;69(2):161-70.
  7. Mehdizadeh S, Sabo A, Ng KD, Mansfield A, Flint AJ, Taati B, Iaboni A. Predicting short-term risk of falls in a high-risk group with dementia. Journal of the American Medical Directors Association. 2021 Mar 1;22(3):689-95.
  8. Li KZ, Bherer L, Mirelman A, Maidan I, Hausdorff JM. Cognitive involvement in balance, gait and dual-tasking in aging: a focused review from a neuroscience of aging perspective. Frontiers in neurology. 2018 Oct 29;9:913.
  9. Thompson PD, Nutt JG. Gait disorders. Bradley's Neurology in Clinical Practice E-Book. 2021 Mar 23;334.
  10. De Cock AM, Fransen E, Perkisas S, Verhoeven V, Beauchet O, Vandewoude M, Remmen R. Comprehensive quantitative spatiotemporal gait analysis identifies gait characteristics for early dementia subtyping in community dwelling older adults. Frontiers in neurology. 2019 Apr 5;10:313.
  11. Hobert MA, Meyer SI, Hasmann SE, Metzger FG, Suenkel U, Eschweiler GW, Berg D, Maetzler W. Gait is associated with cognitive flexibility: a dual-tasking study in healthy older people. Frontiers in aging neuroscience. 2017 May 24;9:154.
  12. Dawes P, Wolski L, Himmelsbach I, Regan J, Leroi I. Interventions for hearing and vision impairment to improve outcomes for people with dementia: a scoping review. International psychogeriatrics. 2019 Feb;31(2):203-21.
  13. Panza F, Lozupone M, Sardone R, Battista P, Piccininni M, Dibello V, La Montagna M, Stallone R, Venezia P, Liguori A, Giannelli G. Sensorial frailty: age-related hearing loss and the risk of cognitive impairment and dementia in later life. Therapeutic Advances in Chronic Disease. 2019 Jul;10:2040622318811000.
  14. Zucchella C, Sinforiani E, Tamburin S, Federico A, Mantovani E, Bernini S, Casale R, Bartolo M. The multidisciplinary approach to Alzheimer's disease and dementia. A narrative review of non-pharmacological treatment. Frontiers in neurology. 2018 Dec 13;9:1058.
  15. Carnemolla P, Bridge C. A scoping review of home modification interventions–Mapping the evidence base. Indoor and Built Environment. 2020 Mar;29(3):299-310.
  16. 16.0 16.1 16.2 16.3 16.4 Peek K, Bryant J, Carey M, Dodd N, Freund M, Lawson S, Meyer C. Reducing falls among people living with dementia: A systematic review. Dementia. 2020 Jul;19(5):1621-40.
  17. 17.0 17.1 Begde A, Jain M, Hogervorst E, Wilcockson T. Does physical exercise improve the capacity for independent living in people with dementia or mild cognitive impairment: an overview of systematic reviews and meta-analyses. Aging & Mental Health. 2021 Dec 15:1-1.
  18. Lam FM, Huang MZ, Liao LR, Chung RC, Kwok TC, Pang MY. Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. Journal of physiotherapy. 2018 Jan 1;64(1):4-15.
  19. McDermott O, Charlesworth G, Hogervorst E, Stoner C, Moniz-Cook E, Spector A, Csipke E, Orrell M. Psychosocial interventions for people with dementia: a synthesis of systematic reviews. Aging & mental health. 2019 Apr 3;23(4):393-403.