ALZHEIMER’S AND FALL PREVENTION

Cassandra Warner Frieson, DNP, CRNP

Fall Injury Prevention and Rehabilitation Services LLC

IMAGINE

• Losing the strength in your muscles
• Having changes in the way you walk
• Not being able to balance yourself
• Having gaps in memory with increased confusion and forgetfulness
• Experiencing a myriad of feelings, including:
• Anger
• Depression
• Fear
• Loneliness
• Sadness

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OBJECTIVES

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• Increase knowledge of the types of dementia
• Review facts on falls in individuals with Alzheimer’s
• Discuss common behaviors exhibited in each stage of Alzheimer’s
• Discuss research findings of fall prevention interventions in individuals with Alzheimer’s
• Enhance the caregiver’s knowledge of tips to prevent falls in individuals with Alzheimer’s
• Explore ways to engage individuals with Alzheimer’s in physical activity

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ALZHEIMER’S DISEASE VS DEMENTIA

• Dementia is a general term for a group of characteristic symptoms that include difficulties with:
• Memory
• Language
• Problem-solving and other cognitive skills
• Ability to perform everyday activities

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• Dementia has many causes; Alzheimer’s disease is the most common cause.¹

https://www.google.com/url?sa=i&url=http%3A%2F%2Fseniorsfirstbc.ca%2Ffor-professionals%2Fdementia%2F&psig=AOvVaw1U04e-gRiKixecrKyGwZNv&ust=1596872229972000&source=images&cd=vfe&ved=2ahUKEwj6lrbhyojrAhWCOFMKHY-ZC5UQr4kDegUIARCmAQ

FACTS ON FALLS IN ALZHEIMER’S

• By 2050, the number of people ≥ 65 with Alzheimer’s disease (AD) is projected to reach 13.8 million.⁷
• People with AD have a higher incidence of hip fracture than other older persons
• Following a hip fracture, persons with dementia are:
• Less likely to recovery to their previous health status
• More likely to require nursing home placement 2

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FACTS ON FALLS IN ALZHEIMER’S

• Independent of falls and osteoporosis, an increased risk of hip fractures in individuals with AD might be contributed to:
• Low body mass index (BMI)
• Weight loss
• Decreased muscle mass
• Nutritional deficiencies
• Falling sideways²

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STAGES OF ALZHEIMER’S

MILD STAGE OF ALZHEIMER’S

• Memory loss: Trouble recalling recent events, difficulty remembering newly learned information, and repeatedly asking the same question
• Problem-solving, complex tasks completion, and sound judgments or decision-making: Extreme difficulty planning a family event or making sound judgments, such as managing money or personal bank account.
• Personality changes: Becoming socially withdrawn, showing irritability or anger that is uncharacteristic, and lacking motivation to complete tasks
• Organization and expression of thoughts: Searching for the right words to describe common objects, much difficulty expressing ideas
• Unaware of surroundings and misplacing belongings: Getting easily lost or having difficulty finding your way, even in places that are familiar; frequently losing or misplacing objects, including valuable belongings³

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MODERATE STAGE OF ALZHEIMER’S

• Poor judgment and worsening confusion: Increasingly worse judgement; wandering; losing track of place, day of the week, and season; mistaking family members for close friends, or mistakeing complete strangers for family members
• Worsening memory loss: Increased forgetfulness, such as home address, phone number, place of work, or school; confabulation, or making-up stories to fill in any gaps in memory
• Assistance with activity of daily living: Needing help for some daily activities, such as bathing, dressing, caring for hair, taking medications, preparing meals, and feeding self; having occasional incontinence of bowel and bladder
• Personality and behavioral changes: Developing suspicions that are unfounded, such as family, caregivers, or friends stealing from them, or that the spouse is having an affair; developing visual or auditory hallucinations; restlessness; agitation; physical aggressiveness; and/or outbursts, especially as the day progresses³

SEVERE STAGE OF ALZHEIMER’S

Severe impact on mental and functional abilities:

• Incoherent communication: Unable to communicate clearly with others; words do not make sense, only occasionally using words or phrases
• Total assistance with activities of daily living: Needing total help with activities, such as bathing, dressing, taking medications, preparing meals, feeding self, and using the bathroom
• Decline in functional abilities: Unable to walk, sit, or hold head up without assistance or support; having rigid muscles and abnormal reflexes; eventual loss of swallowing reflex and control of bowel and bladder

NOTE: common causes of death include FALLS, DEHYDRATION, MALNUTRITION, PNEUMONIA, AND OTHER INFECTIONS!!!³

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AREAS OF THE BRAIN AFFECTED

• Memory
• Thinking
• Judgment
• Language
• Problem-solving
• Personality
• Movement

NOTE: Individuals with Alzheimer’s are at an increased risk of falls.³

RESEARCH FINDINGS

• Fall prevention interventions should consider impaired cognition, communication difficulties, and behavioral problems
• An increase in fall risk in people with dementia may also be contributed to:
• Environmental hazards
• Multiple comorbidities
• Use of restraints
• Medications side-effects (antidepressants, nonsteroidal anti-inflammatory drugs, vasodilators, antianxiety agents)
• Postural hypotension
• Improper footwear
• Vision and/or hearing loss
• Cardiovascular disorders
• Wandering
• Ambulation assistive device use.^4,5

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TIPS TO PREVENT FALLS

• Impaired cognition:
• Light and dark contrasts help to identify objects, such as walls, handrails, floors, and chairs
• Solid colors are more suitable than patterns
• Information and reminders are kept in a familiar place⁶

TIPS TO PREVENT FALLS

• Communication difficulties:
• Anticipate unmet needs, such as the closeness of the bed and bathroom with a clear path that is free of distractions; hunger; and thirst
• Encourage them
• Allow adequate response time for questions asked, as well as time for them to act on a request
• Use verbal cues, such as repeating words or phrases for emphasis, speaking slowly and clearly, stressing certain words, and varying tone of voice; use nonverbal cues, such as eye contact, facial expressions, body language, distance, appearance, and touch
• Suggest one instruction at a time
• Use short, simple sentences and allow for silence without interruptions or filling in gaps
• Limit distractions in the conversation, such as chattering
• Remain calm and mindful of your approach⁶

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TIPS TO PREVENT FALLS

• Behavioral problems:
• Caregivers: Be willing to ask for help
• Monitor for emotional discomfort, such as restlessness, boredom, loneliness, sadness, hopelessness, or helplessness⁶

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TIPS TO PREVENT FALLS

• Environmental hazards:
• Eliminate all in-home safety hazards, such as throw rugs, ill-fitting clothing, furniture in pathway, objects on floor, extension cords across the floor, loose carpet, or poor lighting. Utilize non-skid slippers
• Rearrange furniture to maximize clear pathways free of interfering objects
• Replace high-raised beds, armless chairs, tub without mats, or low-sitting toilet seats with furniture that is at the sitting level of the individual
• Avoid wet, slippery floors; shiny, waxed floors; black surfaces; multi-level walking surfaces; or stairs
• Clear clutter outside the home
• Avoid loud, busy home environments that may increase stress⁶

PHYSICAL ACTIVITY AND FALL RISK

• Fall prevention interventions that include progressive muscle strengthening, balance training, gait and mobility assessments, cognitive stimulation, and environmental hazard assessment can significantly reduce the risk of falling in community-dwelling older adults with dementia.⁷

TAI CHI AND FALLS IN ALZHEIMER’S

Tai Chi is effective in preventing falls in individuals with Alzheimer’s and incorporates principles such as:

• Control of body movements
• Slow
• Smooth
• Continuous
• Improved balance, coordination, and internal strength
• Cultivates internal strength
• Builds the deep supporting muscles
• Increases internal energy⁸

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TAI CHI AND FALLS IN ALZHEIMER’S

• Promotes good body structure and body alignment
• Upright posture
• Loosens the joints
• Incorporates mindfulness and mental alertness
• Breathing
• Weight transference
• Situational awareness⁸

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320763/figure/F1/

Links between Tai Chi and Cognitive Functioning

REFERENCES

1 Alzheimer’s Association. (2020). Alzheimer’s disease facts and figures. Retrieved 6 August 2020. https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf

2 Weller, I., & Schatzker, J. (2004). Hip fractures and Alzheimer's disease in elderly institutionalized Canadians. Annals of Epidemiology, 14(5): 319-324.

3 Mayo Clinic. (2019). Alzheimer’s stages: How the disease progresses. Retrieved 6 August 2020. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-stages/art-20048448

4 Stapes, S. (2006). Comprehensive rehabilitation for older persons with dementia. Topics in Geriatriatric Rehabilitation, 22: 197-212.

5 French, D.D., Werner, D.C., Campbell, R.R., et al. (2007). A multivariate fall risk assessment model for VHA nursing homes using the minimum data set. Journal of American Medical Directors Association, 8: 115-122.

6 10 tips for preventing dementia-related falls. (n.d.). Homewatch Caregivers. Retrieved 6 August 2020. https://www.homewatchcaregivers.com/resources-and-specialty-care/dementia/preserving-skills-and-function/10-tips-for-preventing-dementia-related-falls/

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REFERENCES

7 Mirolsky-Scala, G., & Kraemer, T. (2009). Fall Management in Alzheimer-related Dementia: A Case Study. Journal of Geriatric Physical Therapy, 32(4): 181-189.

8 Lam, P., & Miller, M. (2006). Teaching Tai Chi Effectively: Simple and Proven Methods to Make Tai Chi Accessible to Everyone, 2nd Edition. Narwee: Tai Chi Productions.

9 Chang, J. Y., Tsai, P. F., Beck, C., Hagen, J. L., Huff, D. C., Anand, K. J., Roberson, P. K., Rosengren, K. S., & Beuscher, L. (2011). The Effect of Tai Chi on Cognition in Elders with Cognitive Impairment. Medsurg Nursing: Official Journal of the Academy of Medical-Surgical Nurses, 20(2): 63-70.

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