The Dementia – Fall Injury Connection 7 October

One half to 80% of them fall each year!^2,3 For retirees with or without dementia, falls can cause injury and even death. Short of those obvious outcomes, accidental falls also make retirees reluctant to perform some usual self-care activities. The good news is that there are things families can do to manage this risk. For seniors with dementia, risk management starts with understanding the relationship between dementia and fall injuries.   

Dementia and Physical Decline

It’s easy to imagine how dementia could interfere with activity planning and how this could result in accidents. What many people don’t realise is that dementia is also connected with loss of physical ability. People with dementia have more problems with posture control and gait.^4,5 Worse yet, these problems progress more quickly in dementia compared to other seniors.⁶ Greater fall risk among people with dementia comes from both mental and physical challenges, and those challenges progress more quickly.

Fall-Injury Prevention Rehab Helps Most Retirees

For retirees without dementia, the answer is simple and well known. An accidental fall plus having some risk factor means the person should enroll in a fall-injury prevention program. The additional risk factor would be some characteristic such as low foot clearance, slow walking, difficulty getting out of chairs, etc. A rehab program at Advanced Physiotherapy would include gait training, balance training, and cardiovascular improvement. It would also include fall training so people are less likely to sustain an injury from a fall. Our coaching on activity modifications to prevent falls will also help. Research proves such programs can reduce the risk of fall injuries, and medical guidelines universally recommend them.⁷  

However, until fairly recently, dementia threw a question mark into that formula. Most studies were performed with seniors without dementia. Clinicians noticed anecdotally that people with dementia did not seem to fare as well in gait rehab as people without dementia.

Does Rehab Prevent Falls for People with Dementia?

Elissa Burton and colleagues recently answered this question with a study published in the medical journal Clinical Interventions in Aging.⁸ Their meta-analysis followed 243 seniors with dementia and found that these programs reduce the risk of falls 32%.

The results were different compared to people without dementia, though. For people without dementia, fall-injury prevention programs not only reduce the risk of falls, they tend to reverse even long-standing geriatric decline.⁹ Seniors with dementia continue to decline physically, but the rehab program does put them in a better standing than people not receiving rehab.

 

References:

1. Gillespie L, Rovertson M, Gillespie W, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; 9: CD007146.
2. Allan L, Ballard C, Rowa E, et al. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS One. 2009; 4 (5): (e)5521.
3. Eriksson S, Gustafson Y, Lundin-Olsson L. Risk factors for falls in people with and without a diagnosis of dementia living in residential care facilities: a prospective study. Arch Gerontol Geriatr. 2008; 46: 293-306.
4. Australian Institute of Health and Welfare. Australia’s Health 2012. Australia’s Health Series No 13. Cat No. AUS 156. Canberra: AIHW; 2012.
5. Suttanon P, Hill K, Said C, et al. Can balance exercise programmes improve balance and related physical performance measures in people with dementia? A systematic review. Eur Rev Aging Phys Act. 2010; 7: 13-25.
6. Suttanon P, Hill K, Said C. A longitudinal study of change in falls risk and balance and mobility in healthy older people and people with Alzheimer Disease. Am J Phys Med Rehabil. 2013; 92 (8): 676-685.
7. Sherrington C, Tiedemann A, Fairhall N, et al. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull. 2011; 23 (3-4): 78-82.
8. Burton E, Cavalheri V, Adams R, et al. Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis. Clinical Interventions in Aging. 2015; 10: 421-434.
9. Vries N, Ravensberg C, Hobbelen J, et al. Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: A meta-analysis. Ageing Research Reviews. 2012; 11: 136-149