Yee Hong Logo

Home > Living Well with Dementia > Fall Prevention

Fall Prevention

Falling is one of the most common accidents among individuals with dementia. Individuals with dementia or cognitive impairment have a two to eightfold higher risk of falls compared to individuals without dementia[1]. Moreover, individuals with dementia are more likely to be admitted to hospital for falls and experience more severe health impacts after falling[2], [3], [4].

In 2015, the Canadian Institute for Health Information reported that among older adults living with dementia, fall-related incidents accounted for 15.9% of total hospital admissions, compared to 7.4% for those without dementia[5].

Fall Prevention

Falling is one of the most common accidents among individuals with dementia. Individuals with dementia or cognitive impairment have a two to eightfold higher risk of falls compared to individuals without dementia[1]. Moreover, individuals with dementia are more likely to be admitted to hospital for falls and experience more severe health impacts after falling[2], [3], [4].

In 2015, the Canadian Institute for Health Information reported that among older adults living with dementia, fall-related incidents accounted for 15.9% of total hospital admissions, compared to 7.4% for those without dementia[5].

On this page:

1. Impacts of Falls 5. Choosing and Using Mobility Aids
2. Contributing Factors of Falls 6. Responding to a Fall Incident
3. Fall Prevention Tips 7. Post-Fall Follow-Up
4. Create a Safe Home Environment  

On this page:

  1. Impacts of Falls
  2. Contributing Factors of Falls
  3. Fall Prevention Tips
  4. Create a Safe Home Environment
  5. Choosing and Using Mobility Aids
  6. Responding to a Fall Incident
  7. Post-Fall Follow-Up

Impacts of Falls

Falls can have significant health consequences for individuals with dementia, including:

  • Cognitive decline: Studies have shown that older adults who fall more than twice a year tend to experience cognitive decline at a faster rate compared to older adults with no history of falls[6].
  • Physical injuries: Individuals with dementia have a more than threefold increased risk of hip fractures when they experience a fall, leading to surgery and reduced mobility.
  • Individuals with dementia usually have lower metabolism,which leads to slower recovery from fall injuries[7].
  • Chronic pain: Falls can havelong-term health impacts, such as chronic pain, which further limit individuals’ mobility and independence.
  • Shrinking muslces: When fall injuries prevent older adults from walking, their muscles shrink and deteorioate quickly from reduced use[8].
  • Fear of falling: Falling may cause a fear of further falls in individuals with dementia, reducing their confidence in mobility. This fear of falling can deter them from participating in outdoor activities and social engagement, which can lead to social isolation, anxiety, or depression.

Given the range of negative impacts associated with falling, fall prevention for individuals with dementia is crucial. The following sections will outline contributing factors of falls, fall prevention strategies, and how to respond to fall incidents.

 

Impacts of Falls

Falls can have significant health consequences for individuals with dementia, including:

  • Cognitive decline: Studies have shown that older adults who fall more than twice a year tend to experience cognitive decline at a faster rate compared to older adults with no history of falls[6].
  • Physical injuries: Individuals with dementia have a more than threefold increased risk of hip fractures when they experience a fall, leading to surgery and reduced mobility.
  • Individuals with dementia usually have lower metabolism,which leads to slower recovery from fall injuries[7].
  • Chronic pain: Falls can havelong-term health impacts, such as chronic pain, which further limit individuals’ mobility and independence.
  • Shrinking muslces: When fall injuries prevent older adults from walking, their muscles shrink and deteorioate quickly from reduced use[8].
  • Fear of falling: Falling may cause a fear of further falls in individuals with dementia, reducing their confidence in mobility. This fear of falling can deter them from participating in outdoor activities and social engagement, which can lead to social isolation, anxiety, or depression.

Given the range of negative impacts associated with falling, fall prevention for individuals with dementia is crucial. The following sections will outline contributing factors of falls, fall prevention strategies, and how to respond to fall incidents.

 

Contributing Factors of Falls

The following are common factors that contribute to a higher risk of falls among individuals with dementia:

Cognitive impairment

Individuals with dementia often struggle with spatial perception and orientation. This can lead to loss of balance and falling. Occasionally, falls happen due to impaired decision-making, such as trying to go down the stairs alone or walking on icy surfaces during winter.

Decline in mobility, balance and muscle strength

Muscle weakness that leads to difficulties with movement and balance increases the likelihood of falls.

Vision and/or hearing impairment

Individuals with dementia may experience vision or hearing impairments that cause them to misinterpret their surroundings, increasing their risk of falls.

Medications

The use of certain medications, such as those for the heart, pain relief, mental health, and blood pressure, are linked to a higher risk of falls[9], [10], [11]. Individuals with dementia are also more likely to take antipsychotic medications to address cognitive problems, which can lead to drowsiness or low blood pressure, further increasing the risk of falls.

Having a history of falls

Evidence has shown that older adults who have previously fallen are at a higher risk of falling again. In fact, older adults with a history of falls are five times more likely to experience another fall compared to those who have never fallen[12] .

Contributing Factors of Falls

The following are common factors that contribute to a higher risk of falls among individuals with dementia:

Cognitive impairment

Individuals with dementia often struggle with spatial perception and orientation. This can lead to loss of balance and falling. Occasionally, falls happen due to impaired decision-making, such as trying to go down the stairs alone or walking on icy surfaces during winter.

Decline in mobility, balance and muscle strength

Muscle weakness that leads to difficulties with movement and balance increases the likelihood of falls.

Vision and/or hearing impairment

Individuals with dementia may experience vision or hearing impairments that cause them to misinterpret their surroundings, increasing their risk of falls.

Medications

The use of certain medications, such as those for the heart, pain relief, mental health, and blood pressure, are linked to a higher risk of falls[9], [10], [11]. Individuals with dementia are also more likely to take antipsychotic medications to address cognitive problems, which can lead to drowsiness or low blood pressure, further increasing the risk of falls.

Having a history of falls

Evidence has shown that older adults who have previously fallen are at a higher risk of falling again. In fact, older adults with a history of falls are five times more likely to experience another fall compared to those who have never fallen[12] .

Fall Prevention Tips

Improve Physical Health

  • Engage in regular exercise. Regular exercise is a crucial part to enhancing muscle strength and balance, which can prevent falls. Caregivers can help by encouraging individuals with dementia to engage in tailored exercise routines.
  • Conduct regular health checks. Health checks can uncover underlying health issues that may increase the risk of falls. If any concerns arise, it is important to seek guidance from your family doctor or healthcare provider.

Useful Resources

Fall Prevention Tips

Improve Physical Health

  • Engage in regular exercise. Regular exercise is a crucial part to enhancing muscle strength and balance, which can prevent falls. Caregivers can help by encouraging individuals with dementia to engage in tailored exercise routines.
  • Conduct regular health checks. Health checks can uncover underlying health issues that may increase the risk of falls. If any concerns arise, it is important to seek guidance from your family doctor or healthcare provider.

Useful Resources

Create a Safe Home Environment

Ensure adequate lighting

Install bright lighting in hallways, staircases, and rooms to help individuals with dementia navigate safely. Using motion-activated night lights in the bathroom and hallways can also be helpful.

Install handrails and non-slip strips

Add handrails to staircases and apply non-slip strips to floor surfaces to provide additional support and stability.

Remove tripping hazards

Keep the home environment organized and free of clutter to reduce tripping hazards. Place electrical cords near walls and away from walking paths.

Choose appropriate chairs

Sturdy chairs with armrests that are a suitable height can help individuals get up safely and prevent falls.

Choose an appropriate bed

Select a bed that is a suitable height for safe and easy access. Placing a protective mat near the bed can help prevent injuries if falls do occur.

Install bathroom safety aids

Install handrails and non-slip bathroom mats in the shower and around the toilet area. Use a transfer bench in the bathtub or a bathing chair in the shower. Consider replacing bathtubs with walk-in showers and installing a raised toilet seat.

Wear proper attire

Wear well-fitting clothing that does not obstruct movement. Opt for non-slip footwear rather than slippers to enhance stability.

Consult with an occupational therapist

Occupational therapists can conduct a comprehensive home safety assessment. This assessment will help identify potential hazards and provide recommendations for creating a safe living environment that reduces the risk of falls.

Use mobility aids

Using mobility aids can help prevent falls and support.

See more details in the Choosing and Using Mobility Aids section below.

Useful Resources

Create a Safe Home Environment

Ensure adequate lighting

Install bright lighting in hallways, staircases, and rooms to help individuals with dementia navigate safely. Using motion-activated night lights in the bathroom and hallways can also be helpful.

Install handrails and non-slip strips

Add handrails to staircases and apply non-slip strips to floor surfaces to provide additional support and stability.

Remove tripping hazards

Keep the home environment organized and free of clutter to reduce tripping hazards. Place electrical cords near walls and away from walking paths.

Choose appropriate chairs

Sturdy chairs with armrests that are a suitable height can help individuals get up safely and prevent falls.

Choose an appropriate bed

Select a bed that is a suitable height for safe and easy access. Placing a protective mat near the bed can help prevent injuries if falls do occur.

Install bathroom safety aids

Install handrails and non-slip bathroom mats in the shower and around the toilet area. Use a transfer bench in the bathtub or a bathing chair in the shower. Consider replacing bathtubs with walk-in showers and installing a raised toilet seat.

Wear proper attire

Wear well-fitting clothing that does not obstruct movement. Opt for non-slip footwear rather than slippers to enhance stability.

Consult with an occupational therapist

Occupational therapists can conduct a comprehensive home safety assessment. This assessment will help identify potential hazards and provide recommendations for creating a safe living environment that reduces the risk of falls.

Use mobility aids

Using mobility aids can help prevent falls and support.

See more details in the Choosing and Using Mobility Aids section below.

Useful Resources

Choosing and Using Mobility Aids

Using appropriate mobility aids can reduce the risk of falls and promote the independence of individuals with dementia. Mobility aids empower individuals to remain active and engage in daily activities.

There are various types of mobility aids, such as canes, walkers, rollators, and wheelchairs. These devices are designed to provide stability and support for individuals with mobility limitations.

Before purchasing mobility aids, it is crucial to consult with your healthcare professional to determine which mobility aids are best suited for your specific needs.

Different Types of Mobility Aids

Canes

A cane is a relatively less stable mobility aid. Canes require good balance, upper body strength, and coordination to be used effectively. Canes can be beneficial for improving standing and walking by reducing the weight placed on a weak or painful leg and providing additional support[13].

Avoid using an umbrella as a substitute for a cane because umbrellas lack the necessary sturdiness and may not have an anti-slip rubber tip, which could increase the risk of falls.

Walkers and Rollators

Types of walkers: (A) Standard (B) Two-wheeled walker (rolling walker) (C) Four-wheeled walker (rollator)

Walkers are supportive devices with four adjustable legs, providing stability for those with balance difficulties or weak legs. Walkers require upper-body strength and some weight-bearing ability to be used effectively. Using walkers improperly can lead to spine strain and other health and safety concerns[14], [15].

The standard walker is the most stable option. Standard walkers have four legs with rubber tips for improved grip.

The two-wheeled walker, or rolling walker, has wheels on the front legs and sliders or rubber tips on the back legs, making it easier to navigate compared to a standard walker.

The rollator, or four-wheeled walker, has wheels on all four legs. It offers a bit less stability compared to standard walkers and may slide if not used correctly. 

Wheelchairs

Wheelchairs are a suitable option for individuals with limited lower limb strength and balance. Many wheelchairs have safety features and can be tailored to accommodate individual needs, including adjustable leg rests, armrests, and more[16] [17].

There are different types of wheelchairs, each with different features and uses. Your doctor or physiotherapist can help you choose the suitable wheelchair for your needs.

For example, manual wheelchairs require the individual to propel the wheelchair by themselves. They can also be pushed by others standing behind the wheelchair user.

Transport wheelchairs are another type of wheelchair. Unlike manual wheelchairs which have two small wheels and two big wheels, transport wheelchairs have four small wheels. These wheelchairs are only designed for transportation.

Purchasing Mobility Aids

  1. Before purchasing any mobility aid or assistive device, consult a healthcare professional such as your family doctor, physiotherapist, or occupational therapist. They can help you find the right device that suits your needs. They can also determine whether a medical assessment is necessary before choosing an assistive device.
  2. Walkers, canes, rising aids, and other mobility aids are available in both general and specialty stores, including local pharmacies and medical supply shops.
  3. Purchasing mobility aids can be expensive. Rental options are available for some mobility aids.
  4. You may be eligible for financial assistance or subsidies to help you purchase mobility aids. Your local community organization can provide more information about financial supports. 
    For more information about financial support, refer to the “Community Support and Care Services” section.

Useful Resources

Find tips on choosing the right cane:

Find tips on choosing the right walker or rollator:

Find tips on choosing the right wheelchair:

Learn more about the proper use of a wheelchair:

Responding to a Fall Incident

Tips for Individuals Living Alone

If you live alone and experience a fall, here are some tips for what to do:

  • Stay calm.
  • Assess the extent of your injury. If you are not hurt, slowly and gradually move your body.
  • Crawl along the floor toward a wall or stable piece of furniture, then use it for support to get up.
  • If you are hurt or unable to get up, call for help by pressing the emergency button on your medical alert system (if you have one), call 911, or shout loudly for help.
  • If you experience difficulty moving or severe pain, you seek medical attention as this can be a sign of a fracture.

Tips for Caregivers and Care Providers

It can be frightening when an older adult falls, and many people may not know what to do after the accident. Knowing how to respond to an older adult’s fall is crucial, as a timely response can make a significant difference in their outcome.

 

Here are some Dos and Don’ts:

  • DO stay calm. Remaining calm allows for timely responses and sound decision making. It is also important to help the person who fell stay
  • DO assess the situation. Determine whether the fallen person is conscious or alert.
  • DON’T move the individual who has fallen. If they are not able to get up or are seriously injured, avoid moving them, as this could cause further harm. Keep them lying down until emergency support arrives.
  • DO provide proper assistance. If the individual has minor injuries and is able to move and get up, you may assist them in doing so.
  • DO call 911 immediately. If theindividual is unconscious or injured, you should call 911 for emergency support.

Responding to a Fall Incident

Tips for Individuals Living Alone

If you live alone and experience a fall, here are some tips for what to do:

  • Stay calm.
  • Assess the extent of your injury. If you are not hurt, slowly and gradually move your body.
  • Crawl along the floor toward a wall or stable piece of furniture, then use it for support to get up.
  • If you are hurt or unable to get up, call for help by pressing the emergency button on your medical alert system (if you have one), call 911, or shout loudly for help.
  • If you experience difficulty moving or severe pain, you seek medical attention as this can be a sign of a fracture.

Tips for Caregivers and Care Providers

It can be frightening when an older adult falls, and many people may not know what to do after the accident. Knowing how to respond to an older adult’s fall is crucial, as a timely response can make a significant difference in their outcome.

 

Here are some Dos and Don’ts:

  • DO stay calm. Remaining calm allows for timely responses and sound decision making. It is also important to help the person who fell stay
  • DO assess the situation. Determine whether the fallen person is conscious or alert.
  • DON’T move the individual who has fallen. If they are not able to get up or are seriously injured, avoid moving them, as this could cause further harm. Keep them lying down until emergency support arrives.
  • DO provide proper assistance. If the individual has minor injuries and is able to move and get up, you may assist them in doing so.
  • DO call 911 immediately. If theindividual is unconscious or injured, you should call 911 for emergency support.

Post-Fall Follow-Up

After a fall, it is important to see your family doctor or primary care physician and let them know about your fall. Be sure to mention any new symptoms you have noticed after your fall and how quickly they appeared. Your healthcare provider will check for any health issues that may be causing you to feel unwell, weakness, or changes in behaviour.

Here are some important topics to discuss during your medical appointment:

  • Blood pressure and pulse checks: If falls are associated with dizziness or fainting, it is important to check your blood pressure and pulse in both sitting and standing positions.
  • Blood tests: Falls can be worsened by blood-related conditions, such as high blood sugar levels, so it is important to run a complete blood cell count and electrolyte check.
  • Heart and neurological conditions: Chronic heart or neurological issues might cause falls. Ask your doctor if heart conditions or new neurological conditions could be linked to your
  • Review medications: Certain medications, such as those used to treat blood pressure, diabetes, and psychoactive medications can increase the risk of falls. Consult your doctor for a medication review to reduce medication-related risks of falls.

You may also wish to see a physiotherapist after a fall. A physiotherapist can help evaluate your gait, balance, and leg strength, and teach you exercises that improve balance and mobility to reduce the risk of falls. They can also educate you on how to properly and safely perform daily activities that may be impacted by cognitive changes.

Learn more about what to do after a fall

Post-Fall Follow-Up

After a fall, it is important to see your family doctor or primary care physician and let them know about your fall. Be sure to mention any new symptoms you have noticed after your fall and how quickly they appeared. Your healthcare provider will check for any health issues that may be causing you to feel unwell, weakness, or changes in behaviour.

Here are some important topics to discuss during your medical appointment:

  • Blood pressure and pulse checks: If falls are associated with dizziness or fainting, it is important to check your blood pressure and pulse in both sitting and standing positions.
  • Blood tests: Falls can be worsened by blood-related conditions, such as high blood sugar levels, so it is important to run a complete blood cell count and electrolyte check.
  • Heart and neurological conditions: Chronic heart or neurological issues might cause falls. Ask your doctor if heart conditions or new neurological conditions could be linked to your
  • Review medications: Certain medications, such as those used to treat blood pressure, diabetes, and psychoactive medications can increase the risk of falls. Consult your doctor for a medication review to reduce medication-related risks of falls.

You may also wish to see a physiotherapist after a fall. A physiotherapist can help evaluate your gait, balance, and leg strength, and teach you exercises that improve balance and mobility to reduce the risk of falls. They can also educate you on how to properly and safely perform daily activities that may be impacted by cognitive changes.

Learn more about what to do after a fall

References

[1] Lulu Zhang and others, Injurious falls before, during and after dementia diagnosis: a population-based study, Age and Ageing, Volume 51, Issue 12, December 2022, afac299, https://doi.org/10.1093/ageing/afac299

[2] Delbaere K, Kochan NA, Close JC et al.  Mild cognitive impairment as a predictor of falls in community-dwelling older people. Am J Geriatr Psychiatry 2012; 20: 845–53

[3] Allan LM, Ballard CG, Rowan EN, Kenny RA. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS One 2009; 4: e5521.

[4] Vaishya, R. & Vaish. A. (2020). Falls in Older Adults are Serious. Indian J Orthop. 2020 Feb; 54(1): 69–74. Retrieved April 24, 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093636/

[5] Canadian Institute for Health Information. Trends in Income-Related Health Inequalities in Canada: Summary Report. 2015.

[6] Padubidri, A., Al Snih, S., Samper-Ternent, R., Markides, K.S., Ottenbacher, K.J., Raji, M.A. (2014). Falls and cognitive decline in Mexican Americans 75 years and older. Clin Interv Aging. 2014 Apr 22; 9:719-26. Retrieved April 24, 2023 from https://pubmed.ncbi.nlm.nih.gov/24790424/

[7]Baker, N. L., Cook, M. N., Arrighi, H. M., & Bullock, R. (2011). Hip fracture risk and subsequent mortality among Alzheimer’s disease patients in the United Kingdom, 1988-2007. Age and Ageing, 40(1), 49–54. https://doi.org/10.1093/ageing/afq146

[8] Vaishya, R. & Vaish. A. (2020). Falls in Older Adults are Serious. Indian J Orthop. 2020 Feb; 54(1): 69–74. Retrieved April 24, 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093636/

[9] Graham, B. C. (2012). Examining evidence-based interventions to prevent inpatient falls. Medsurg Nursing, 21(5), 267–270.

[10] Mamun, K., & Lim, J. K. (2009). Association between falls and high-risk medication use in hospitalized Asian elderly patients. Geriatrics & gerontology international, 9(3), 276–281. https://doi.org/10.1111/j.1447-0594.2009.00533.x

[11] Aranda-Gallardo, M., Morales Asencio, J. M., Canca-Sanchez, J. C., Mora-Banderas, A. M., Moya-Suarez, A. B., & Group for preventing falls in Hospital Costa del Sol (2013). Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review protocol. Journal of advanced nursing, 69(1), 185–193. https://doi.org/10.1111/j.1365-2648.2012.06104.x

[12] Myers, A.H., Baker, S.P., Van Natta, M.L., Abbey, H., Robinson, E.G. (1991). Risk factors associated with falls and injuries among elderly institutionalized persons. Am J Epidemiol. 1991, 133(11): 1179–90. Retrieved April 24, 2023 from https://pubmed.ncbi.nlm.nih.gov/1903589/

[13] Sehgal, M., Jacobs, J., & Biggs, W. S. (2021). Mobility Assistive Device Use in Older Adults. American family physician, 103(12), 737–744.

[14] Walkers – Choosing the Correct Walker. (2023). In The University of Arizona Center of Aging (ACOA). Retrieved August 16, 2023, from https://aging.arizona.edu/sites/default/files/2023-04/Walkers.pdf

[15] Sehgal, M., Jacobs, J., & Biggs, W. S. (2021). Mobility Assistive Device Use in Older Adults. American family physician, 103(12), 737–744.

[16] The Hong Kong Council of Social Service [hkcss1947] (2018). 如何選擇合適的輪椅. [Video]. YouTube. Retrieved April 24, 2023, from https://www.youtube.com/watch?v=Xb0heVwIfMA

[17] Sehgal, M., Jacobs, J., & Biggs, W. S. (2021). Mobility Assistive Device Use in Older Adults. American family physician, 103(12), 737–744.

Share by Email
Share on Facebook
Share on Whatsapp
Print this Page