Why do people with dementia fall and what can you do?

Falls can be a big worry if you’re caring for someone with dementia and sadly they’re pretty common, too. But there are steps you can take to keep your loved one safe and well

The likelihood of suffering a painful fall increases for everyone as they get older. Around one in three adults over 65 who live at home will have at least one fall a year, and about half of these will have more frequent falls. It's important that you take steps to try to prevent falls as they have been strongly linked to hospital admissions, which in turn can lead to a noticeable decline in people with dementia.

Falls can be caused by sight or hearing problems (the latter because of things like ear infections which can severely affect balance), and also because of health conditions such as heart disease and low blood pressure (hypotension).

However, people with dementia are particularly prone to falls not just because of their age, but also because as their brain deteriorates, it affects their spatial abilities, gait and ability to judge distances. People with Lewy body dementia and Parkinson’s disease dementia are most likely to have problems with falls. This is because they cause changes in a part of the brain called the basal ganglia, which is responsible for preparing for, starting, timing and organising a sequence of movements. They may struggle to respond to changes in an environment, such as a dip in the floor or a step.

Falls are part of getting older, and in many cases, it’s not always easy to prevent them altogether. However, there are some steps you can take to reduce the risk.

Look at the environment

Remove clutter:

Make sure that the main living areas of the home are free of clutter – piles of books, low coffee tables, bags, boxes – so they don’t become a tripping hazard.

Check their slippers:

Those comfy, cosy slippers they love to wear could cause a serious fall if they’re worn out or flimsy. In fact, slippers are one of the biggest causes of accidents at home in elderly people. Get rid of slippers without backs and bin any that have no grips. The ‘bootie’ style - which is a type of soft slipper shoe that looks like a boot - is definitely safest.

Think about colour contrasts:

Brain changes in people with dementia mean they can struggle to note the difference between colours unless they contrast well. For example, a cream-coloured sofa or chair that matches the cream carpet is a lot harder to notice than a blue or brown sofa. This means they could stumble as they try to sit down or trip as they walk past it. Similarly, dark mats in the middle of the floor can look like a hole in the ground to someone with dementia as their brain and eyesight aren’t communicating in the same way as someone healthy, and it means they could try and step round or over the ‘hole’ which could lead to a fall.

Watch out for loud noises:

Sudden loud noises – such as a shrill telephone sound or loud door knocker – could cause someone with dementia to turn quickly, meaning they become disorientated, dizzy and may fall. Obviously you want them to be able to hear when people are trying to contact them, but be mindful of the fact that if the sounds are too loud, they could pose a risk, too.

Be careful of slippy surfaces:

In most cases, the biggest risk for slipping is in the bathroom. This is because the floor can become wet, or someone can trip over a discarded towel or bathmat. However, also watch out for bathroom floor tiles that are very shiny, as someone with dementia may get confused and think the floor is wet, causing them to try and step over or around the floor and leading to a fall. If there are lots of mats and rugs, either remove them, or fix them down with gripping tape to prevent them sliding around.

Provide support

Set up grab rails:

Think about ‘problem areas’ in the house where someone with dementia may struggle with mobility. The key places are probably entering the house (particularly if there are steps to come up to the front door), the stairs, low seats or armchairs, bedrooms and bathrooms as they’re all places where you’re going from sitting to standing positions or having to step up. A well-positioned grab rail could come in handy here to provide extra support or to grab when about to fall.

Think about activities

Encourage exercise:

Getting out and about isn’t just good for boosting mood. It can also help to build strength in muscles, which is vital for helping older people maintain their balance and stability. While walking is a great place to start, other activities such as yoga, tai chi, Pilates or resistance exercises are even better.

Watch out for sundowning:

Sometimes, people with dementia can become restless and aggressive around late afternoon and early evening. This is known as sundowning and needs to be monitored as it’s also a time of increased risk of falls, as the person affected will be distracted and more prone to walking off. If sundowning is a problem, try to arrange activities that will help to keep them focused but calm during this time.

Get prepared:

If falls have become a real issue or worry, it’s worth looking into what products are available to help someone at risk. Some may not actually prevent the fall, but they could help the person once they’ve fallen, to reduce any damage done and get help as soon as possible.

Alarm pendants:

Often worn round the neck as a necklace, but also available as a bracelet, an alarm that someone can press if they fall and can’t get up is a really good idea. They’ll give the person with dementia and their carer peace of mind in case the worse should happen. HOWEVER, if they’re prone to forgetting to put their pendant on each morning, you may need to set up some kind of system to remind them.

Adjust your phone ringer:

If the phone starts to ring and someone is trying to reach it in time, they may try to rush to pick it up before the answerphone kicks in (which is when many people then hang up). If there are only a few rings, and the person you’re caring for isn’t especially mobile, this could prove tricky. Set up the phone so that it rings for a decent length of time for someone to get from one area of the house to the other to answer it, and then have it click onto an answerphone.

Movement sensors:

These can be placed throughout the house to monitor movement and alert someone if there hasn’t been any for a while (they can also do the opposite and tell you if there’s been movement when there shouldn’t be – at night, for example). That way, if a loved one falls over and can’t move for a few hours, a message can be sent to a carer or family member to let them know so they can check on them.

Hip protectors:

Hip fractures and breaks are all too common in people over 65 and can have a disastrous effect on mobility and confidence. However, you can buy special underwear which have built in padding around the hips to help cushion them in case they take a tumble. And don’t worry, you won’t be forcing them to look like the Michelin man – the protectors are actually quite small and discrete and usually won’t be noticed under clothing. The latest innovation is hip airbags, which inflate when you fall on your side, helping to protect your hips.

Low beds:

Try to avoid high divan-style beds as getting in and out of them can cause falls. Of course, very low beds can also be difficult to pull yourself up from, so try to find a happy medium and perhaps set up some rails near the bed to help them pull themselves up into a standing position safely.

For more tips on products in the home that will keep someone with dementia safe, well and happy, click here.

Recovering from falls

If the worst should happen and a loved one does have a fall, ensuring that they have a comfortable and as speedy as possible recovery is vital. Make sure they rest up at home, but have all the items they need to hand, such as drinks, food and items to keep them occupied. If they've sustained an injury, they may need painkillers (and be reminded to take them). A walking stick or frame could be useful if they're struggling to walk.