Make the home environment safer
Remove mats, trailing electric cords, low stools or anything that the person might trip on. Put handrails near steps, toilet, bath etc. Get irregular parts of paths smoothed over and install a night-light so the person is not wandering in the dark. If possible get an occupational therapist to assess the home for risk.
People with dementia do better in a familiar environment and making too many changes at once can be disorienting. Explain why (for example) you are taking the mat away and remove it from the house; otherwise it is likely to be back in its old place next time you visit!
Make the person safer
Cleaning someone’s glasses can be one of the best ways to improve their vision. Take a trip to the optician or to have their hearing aid tested; the better they perceive the environment, the safer they will be. Make sure they have good footwear and are not going to trip over their slippers. Take them to the podiatrist if their feet need attention.
Ensure that nutrition is good and they are drinking plenty – but avoid alcohol, which can make any of us tottery, but especially those with frail brains and bodies.
Maintain the person’s physical health
Even an apparently minor decline in the person’s physical health such as a bladder infection or constipation can increase confusion and affect balance. If the person is uncharacteristically wobbly on their feet or more muddled, assume there is an underlying physical cause and get the person to the doctor. Arthritis, heart problems, diabetes hypertension, pain and other chronic physical conditions need careful medical management so that they are neither under nor over treated. Carers can encourage the person with dementia to see their GP regularly and help them to adhere to treatment. Sometimes easier said than done!
Treat behavioural and psychological that put the person at risk.
Only those symptoms that are dangerous, cause distress to the person with dementia or reduce quality of life need treatment. Because medication is required, the aim is to use the lowest dose for the shortest time possible. Ask about possible side effects and watch for these. Supervise the taking of medication if necessary.
Ask GP to review medication
The drugs commonly associated with falling are: anti-depressants, anti-psychotics (used for delusions and hallucinations), anxiety and sleeping medication, anti-convulsants (for epilepsy) and some drugs taken for abnormal heart rhythms. It is often difficult to decide whether the benefits of the drug outweigh the side effects. For example, it is often kinder to treat depression and accept the risk of falling than to let someone continue in misery and despair. However if treatment is necessary it is often possible to use of low dose of a drug less likely to cause a fall.
People with dementia may become apathetic and find it hard to remain involved in their usual activities, they might go out less and take less physical exercise. Joining an Alzheimers Society walking group or a gym can help them keep fit. Balance and gait training: The Otago Exercise Programme or modified tai chi classes are available to older people in many areas. People with mild-moderate dementia may enjoy these activities.
Hip protectors, worn in special underwear effectively prevent hip fractures. These are obtainable via www.impactwear.co.nz or through your GP or geriatric service. Sometimes, however, they are not well tolerated by people with dementia and they can be difficult to pull down quickly to go to the toilet (get the gusset-less ones if available). Talk to the GP about the treatment and prevention of osteoporosis, including whether Vitamin D would be beneficial.
In residential care
Supervision is the main way to prevent falls; staff need to know that ‘just’ watching residents is ‘doing’ something very useful. They must document where and when falls occur and the environment or level of observation can be changed as necessary. People may trip in the bustle around meal time, during a shift change, when interacting with other residents or at night getting up to the toilet. (Consider a pressure alarm pad.) There is rarely any justification for physically restraining a person to prevent falls. Being confined to a chair makes people ‘lose condition’ so that when they do fall, they are more likely to seriously injure themselves.
Despite our efforts, we cannot prevent all falls whether the person with dementia is at home or in care. Dementia care is always a balancing act! Deprivation of home or freedom might be worse than a fall, and the person with dementia and their family/whanau may choose to accept risk of falls and injury rather than trying to ensure absolute safety.