Microsoft word - how to prevent falls at home in the alzheimer

How To Prevent Falls At Home In The
Alzheimer’s/Dementia Patient
Falls are common in seniors living at home.
Every year approximately 30% of seniors falland 5% of those falls result in broken bones.
Approximately 1% of seniors who fall willfracture a hip. Hip fractures have been shown toshorten life expectancy, lower the quality of lifeand increase the expense of caring for someoneat home.
Elderly dementia patients fall for a variety ofreasons: Alzheimer's disease can be divided into early, middle and late stages. Early stageAlzheimer's patients have memory problems and few psychiatric complicationsexcept for depression and anxiety.
Middle stage Alzheimer's patients will have multiple intellectual problems as well assignificant psychiatric or behavioral complications.
Late stage Alzheimer's patients will have severe intellectual loss and forget how toperform basic bodily functions such as eating and walking.
Dementia patients retain the ability to move arms and legs, and muscular strengthis maintained through the early and middle phase of the illness.
Many late stage Alzheimer's patients lose weight and manifest muscular wasting.
The disease minimally damages the cerebellum, the brain region that coordinatesmuscular activity. Alzheimer's disease does not damage the inner ear or other brainstructures that are involved with balance. Alzheimer's patients lose coordinationbecause they forget how to perform complex motor tasks like walking.
Early stage Alzheimer's patients have a similar risk for falls as other seniorsresiding in the community. Patients may develop psychiatric complications, such asdepression, or complications that may cause low blood pressure upon standing/.
Copyright 2011. Alzheimer’s Care Resource Center, Inc. Al Rights Reserved The side effects of psychotropic drugs (sedation andconfusion) increase the risk of falls.
Early stage Alzheimer's patients are at risk for fallswhen placed on medication for medical illnesses whichsometimes causes confusion (i.e., delirium). Thestiffness medications (e.g., Haldol) increases difficulty of risingfrom a chair or walking for patients in all stages of thedisease. Delirious patients are at greater risks for fallsbecause of increased confusion and drowsiness. Anydementia patient with delirium should be placed on fallprecautions until the delirium resolves.
Mid-stage Alzheimer's patients may fall for a variety of reasons. Patients begin tolose fine motor coordination and forget how to perform basic functions of dailyliving.
Patients often misinterpret their environment and fail to recognize unsafe situationssuch as loose rugs, loose floor boards, etc. For example, patients may attempt tostep over shiny floors misperceived as wet spots. Patients may fail to exercisecaution with uneven pavement, slippery floor surfaces and other dangeroussituations. Confused, agitated patients arise in the middle of the night withoutsufficient environmental light and fall.
Patients can’t remember the location of light fixtures to illuminate the room.
Patients with previous motor problems due to stroke, severe arthritis, or a pasthistory of falls, sensory impairments, cataracts, and hearing impairments, havetwice the risk of falling.
Late stage dementia patients are particularly prone to falls. Patients forget how towalk (gait apraxia) and seem uncoordinated with the placement of their feet.
Patients can no longer follow verbal direction and communication barriers can makeassisting these patients difficult.
The abrupt onset of a patient falling should tip caregivers to look for causes besidesdementia. Delirium, medication, stroke and unrecognized fractures are commoncauses.
Patients who fall and then become agitated or combative should be carefullyassessed for fractures. Moderate to severely demented patients lose the ability tocommunicate and localize pain for the caregiver. Agitation after a fall mayrepresent symptoms of a fractured hip or broken rib.
Copyright 2011. Alzheimer’s Care Resource Center, Inc. Al Rights Reserved Fall prevention in the Alzheimer patient involves multiplepreventive measures. Dementia patients should beambulated and maintain physical activity for as long aspossible. Psychotropic medications that increase the risksof falls such as antipsychotics, antidepressants andbenzodiazepines should be avoided whenever possibleand if prescribed, a careful assessment for side effects isnecessary to avoid falls. Over-the-counter medicines likeBenadryl can also increase the risk for falls.
Patients should remain on an active, physical fitnessprogram to assure peak muscular strength and maximumrange-of-motion around joints through all stages of thedisease. The patient’s home should have basic safety features such as grab bars, no-skid floor coverings, adequate lighting, etc.
Late stage dementia patients with gait apraxia will not walk again. Although thesepatients have normal strength in their legs, they have permanently lost the abilityto coordinate their trunk and legs in order to stand or walk. Caregivers shoulddiscuss with the patients physician, appropriate ways to protect such patientsagainst falls, fractured hips or increased pain through the possible use of active orpassive restraints and range-of-motion exercise. These patients may be able to rollout of bed but not be able to stand.
Patients with mild gait apraxia can often move around the house in assistivedevices like merri-walkers, which allow for the continued use of extremities whileminimizing risks for fractures. Basic bone-preserving treatments such as estrogenreplacement in females and oral calcium supplements are sometimes indicated forAlzheimer’s patients to sustain bone density.
Normal range-of-motion around joints will help to diminish pain experienced bypatients during moves, lessens agitation, diminishes the need for antipsychoticmedications and helps to improve quality of life for the patients, family andcaregiver.
Copyright 2011. Alzheimer’s Care Resource Center, Inc. Al Rights Reserved


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