Friday, November 17, 2017

Dementia and Risk of Falling

A 2017 report in the Journal of the American Medical Association revealed encouraging data regarding rates of dementia in the U.S. Over 21,000 adults 65+ were tracked in a longitudinal study called the “Health and Retirement Study” sponsored by the Social Security Administration and the National Institute on Aging.

The findings reflected sweeping improvements in population brain health as the prevalence of dementia dropped from 11.6% to 8.8% between the years 2000 and 2012.

Rates of Dementia
While that is exciting news for older adults, the truth is that the cases of dementia will only rise as the second largest generation in the U.S., Baby Boomers, all age into the 65 and over age group in the next 15 years. While dementia is not a guaranteed part of aging, it does largely affect older adults.

Alzheimer’s and other forms of dementia are debilitating diseases that rob many seniors of the basic faculties with which they need to function. Over 5.5 million people in the U.S. currently live with some form of dementia, with Alzheimer’s accounting for roughly 60 to 70% of dementia cases according to the World Health Organization.

Damaged and dying neurons and synapses in the brain contribute to dementia symptoms including a deterioration in thinking, learning ability, memory, judgment, language, comprehension, and orientation. In addition to difficulty completing daily tasks, dementia can negatively impact a person’s behavior and emotional control. Dementia is typically a progressive and chronic degeneration of the brain, and in some forms of dementia, can actually result from conditions which prevent enough oxygen from reaching the brain.

Vascular dementia as it is called, or vascular cognitive impairment, is on the rise according to some researchers, in part due to the higher rates of heart disease, stroke, and other conditions which affect blood vessels. When widespread small vessel damage reduces the amount of or blocks blood flowing to the brain, it deprives brain cells of the oxygen and nutrients they desperately need.

Dementia and Falling
  • Medical providers and home health networks need to educate the caregivers of someone with dementia about increased fall risk and how to manage it in order to prevent life-threatening injuries. While falling is the leading cause of fatal injuries for older adults, when it comes to seniors with dementia, their chances of experiencing a harmful fall are even higher due to:  
  • Poor judgment - as cognitive decline progresses, poor decision-making can put an elderly person at risk of not just getting scammed on the internet, but in falling too. Mistakenly deciding to descend a steep staircase or head outside when it is icy, for example, can quickly lead to falls.
  • Impaired memory - when a senior with dementia is a “fall risk,” precautions are taken in their home or hospital room to prevent them from falling. This might include putting fall rails on the bed, setting up fall monitors, and making sure a patient is always accompanied out of bed and into the bathroom. Memory issues can lead a senior to forget that they have been asked to call for assistance if they need to get out of bed, or they may forget where they are and become disorientated and fall.
  • Vision problems - difficulties with vision and spatial awareness often accompany cognitive decline and can make safe mobility impossible. Oftentimes, people with vascular dementia will specifically have vision impairment due to blood vessel damage in the brain. Regular vision checks with a doctor, as well as mobility aids, home lighting audits, and home accessibility upgrades can help.
  • Clutter - some dementia patients will exhibit habits of hoarding and filling their living environment with unnecessary items and furniture. This clutter is a huge risk factor for falling, as the more “stuff” you have to move around or walk over to successfully navigate the home environment, the more likely you are to trip or lose your balance.
  • Physical weakness - being unable to exercise regularly or stay physically active, dementia patients will experience muscle loss and weakness as well as a reduction in bone density compounded with deterioration in balance, coordination, agility skills, and the risk of falling increases. 
  • Medication side effects - some medicines which are used to treat forms of dementia as well as other age-related diseases like Parkinson’s, can actually cause hypotensive side effects. A sudden drop in blood pressure when standing can lead to dizziness and loss of balance, increasing the potential to fall.

What Can Caregivers Do
In addition to learning as much as possible about dementia’s side effects and increased risk for falling, family members and caregivers of seniors with dementia should fall-proof the home. Grab bars, toilet seat risers, and a non slip bath mat in the bathroom are a must. Ramps up to outside doorways and porch railings help secure outside walking areas, and clearing clutter and trip hazards inside may include removing area rugs and large pieces of furniture too.

This is a guest blog entry.

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