1. Falls in the Context of Dementia
Lynn Flannigan
Up and About in Care Homes Deputy Project Lead
@lynnflannigan1

2. Dementia in Scotland
About 88,000 people living with dementia in Scotland in 2014 (including 3,500+ people under 65 years)
Predicted to almost double over next 20 years
Prevalence:
% population prevalence
Prevalence doubles every 5 years up to 80s
% population prevalence
25% of people in acute hospital beds have dementia
80-90% of care home residents have dementia
Approx 63.5% live in private households compared with 36.5% living in care homes

3. Dementia and Falls Dementia and falls 2-3 X greater risk falls
carer stress and institutional care
psychological impact
6 month mortality post hip # 71%
3 X fracture incidence
70-80% fall annually
experience 8 x more incident falls

4. Why People with Dementia Fall?
Physical weakness, gait changes poor balance
Difficulties dual tasking
Visual misperception
Memory impairment and disorientation
Depression
Orthostatic hypotension
Medication side effects
Impaired judgment
Stress and Distress
Type of dementia

5. Challenges Double jeopardy
Wenger et al found people with dementia who fell were not questioned about falls or had their gait and balance evaluated.
Self fulfilling prophesy – Reduction in social world. people with dementia more sedentary (Littbrand et al 2011) Loss of autonomy not caused exclusively by disease but by sedentary habits (Serda i Ferrer & Valle 2014)
Until recently falls and dementia were studied and regarded as distinct geriatric syndromes (Montero-Odasso et al 2012)

6. Challenges Continued
Many studies exclude people with dementia (Barnes et al 2004, Allen et al 2012)
Available literature on nonpharmacological interventions predominantly cog rehab, psychosocial and multi sensory (de Andrade et al 2013)
Collation and synthesis of studies difficult due to heterogeneity of methodologies

7. Access to Rehabilitation
Given lower priority particularly in institutional care
There is a cultural perception that rehab cannot be achieved for people with dementia because of the degenerative nature of the disease (Cahill & Dooley 2005)
“Inappropriate referral”
Some health professionals and payer sources have questioned the value of providing rehab to cognitively impaired patients (Barnes et al 2004)
People with dementia received less therapy post hip therapy (Rӧsler et al 2009) discharged directly to LTC and had shorter hospital stays (Buddingh et al 2013)
Refused entry to rehab programmes as staff believe people with dementia cannot be rehabilitated(McGilton)
“Not suitable for rehab as they cannot retain information”

8. The Evidence INTERVENTIONS OUTCOMES PHYSICAL ACTIVITY
DELAY IN FUNCTIONAL DECLINE
EXERCISE PROGRAMMES
PSYCHOSOCIAL FUNCTION
AHP INTERVENTION – OT, PT, MDT
AFFECTIVE STATUS
MULTICOMPONENT
CAREGIVER STRESS
POST HIP FRACTURE
QUALITY OF LIFE
REHABILITION FACILITIES
PHYSICAL FITNESS
FALLS PREVENTION
COGNITIVE FUNCTION
BEHAVIOUR & PSYCHOLOGICAL SD
DEPRESSIVE MOOD
GAIT
FALLS

9. Falls Prevention Interventions
Multi factorial risk assessment – as you would with older people without dementia. Identify risks – with particular attention risks already discussed i.e. medication, orthostatic hypotension, pain, psychological, depression
Dementia friendly environments - way finding, contrast, lighting etc.
Exercise – at least a few months, should be individualised, challenging, progressive, combined with a functional approach, continuous to maintain effect (Littbrand et al 2011) Cognitive domain in rehabilitation.
Physical activity has been found to be protective
Rehabilitation - multi component /multidisciplinary
Meaningful activity – Make Every Moment
Count

10. Multifactorial Risk Assessment

11. Approaches Person Centred Care Effective Good Dementia Care
Falls Prevention
Good Dementia Care

12. The Way Forward?

13. What Can You Do?
Questions?