1. Jane Bear-Lehman, PhD, OTR/L, FAOTA NYU Steinhardt/NYU College Of Dentistry NYU Alzheimer’s Disease Center April 9, 2014 SUPPORTED IN PART BY GRANT UL1 TR000038 FROM THE NATIONAL CENTER FOR THE ADVANCEMENT OF TRANSLATIONAL SCIENCE (NCATS), NATIONAL INSTITUTES OF HEALTH Fall Prevention in Older Adults with Dementia

2. Falls and Dementia Compromise activities of everyday living Increase dependency Reduce quality of daily life Increase the likelihood of institutionalization

3. Risk Factors: Falls Falls are often predictable, and injurious falls are often preventable Functional decline and activity limitation frequently occur from falling and fear of falling One-third of community dwelling elders > 65 years of age fall each year; 50% fall repeatedly

4. Risk Factors: Falls Fallers ↓ cognitive test results than non-Fallers and non-cognitively impaired elders Fallers ↓ gait speed and ↑ balance problems than non-Fallers and non-cognitively impaired elders Fallers ↑ fractures than non-Fallers and non- cognitively impaired elders Elders with cognitive impairment ↑ Falls compared to those without cognitive impairment

5. Functional Assessment Assessments are most effective and informative when conducted in the person’s natural living environment Falls prevention is effective when the individual has the opportunity to repetitively practice using the assistive devices and methods before their condition deteriorates.

6. Functional Risk Factors: Dementia ↓attention ↓concentration ↓memory produces ineffective judgment and impairs decision-making processes Inability to differentiate safe from unsafe environmental context Inability to recognize own strengths and limitations to engage in and to perform usual daily activities

7. Functional Assessment: Intrinsic Factors Cognition Gait and Balance Depression Visual Acuity and Perception

8. Functional Assessment: Performance Based Observation of daily life performance tasks: o Meal preparation o Taking medication o Getting in/out of bed, chair, toilet, shower

9. Functional Assessment: Extrinsic Factors Review of Home Safety o Navigate through the residence  Use of assistive devices: canes, walkers o Use of the bathroom  Need for assistive devices: raised toilet seat, grab bars in shower, near toilet o Use of the kitchen  Meal preparation  Eating o Sitting and rising from bed, chairs

10. Management Strategies Consistent and familiar environment ↑ safety and comfort even when functional decline is evident Since the ability to self-detect bodily cues, the person is reliant on others o Visual changes may need a change in glasses to ↑ improve visual acuity o Contrasting solid primary colors may ↑visual acuity, ↓ distractibility ↓ frustration o Advance from a cane to a walker to ↑ stability during activity

11. Findings from C-PROFET study An early look at the on-going pilot data collection of community dwelling elders with mild dementia who participated in an in-home safety assessment with intervention shows: o ↓ or stable gait speed o ↓ or stable balance o ↑ in-home safety, no falls reported

12. Summary Best to begin the assessment of intrinsic factors (about the person) early and to conduct an in-home assessment for safety early Those who have the opportunity to repetitively practice safety changes in the home environment prior to deterioration and whose home environment is adjusted in response to change, show greater capacity to prevent injurious advance from a cane to a walker to maintain activity participation and safety. falls