A Team Approach in Dementia Care
Strategies for Reducing Falls
Among Residents with Dementia
In Long Term Care Facilities
Introduction
Rate of falls in long term care facilities
is 3x greater than people over 65 living in the
community
Residents with Dementia present a
greater challenge
Falls have serious consequences
Program Goal:
Help facilities develop
effective approaches for reducing falls
Program Developers:
Nurses
Certified Nursing Assistants
Therapists
Social Workers
Administrators
Interactive DVD
Sections specific to your role in the
facility
May be used in a group or
individually
Quizzes and case studies to review
topic
Dementia affects more than 60% of
all nursing home residents
Specialized dementia units provide
care to residents in more advanced
stages of dementia
Residents with mild to moderate
dementia may live in any area of a
nursing home
Staff working on a dementia unit generally
receives more specific training for caring
for their residents.
Staff working in other areas may be given
some education regarding dementia but
not necessarily detailed information.
This section presents basic information
about the changes in the brain.
The effects of those changes on a
person’s ability to function
Our goal is to help you better
understand residents with dementia to
reduce their risk for falls.
Everyone in a facility has an
important role in fall prevention.
All employees, volunteers and visitors
can have an impact on reducing the
risk of falls
BE ALERT and TAKE ACTION
What “Dementia” means:
A group of symptoms that result from a
disease or condition
Alzheimer’s is an example of a disease
that causes symptoms of dementia.
Stroke is an example of a condition that
causes symptoms of dementia.
Most common symptoms of Dementia
loss of memory
loss of “thinking” skills
loss of language skills
decrease perception
When the brain is affected by injury or disease,
neurons die and areas of the brain atrophy.
Early stages of Alzheimer's Disease:
short term memory loss
confusion about familiar places
takes longer to accomplish familiar tasks
trouble handling money
poor judgment
mood and personality changes
Advanced Alzheimer’s
disorientation to place, date and time
decreased communication; using
wrong words or
repeating themselves
loss of self care abilities
incontinence
difficulty walking
Symptoms will change over time
When judgment, memory and thinking
processes are affected by loss of brain
tissue, a person’s ability to function in their
environment is reduced and risk for fall
Increased.
It is important to understanding how
symptoms of dementia can cause changes
in physical functioning, decrease the ability
to recognize limitations and express needs.
Introduction to Strategies
for Reducing Falls
Falls cause stress for everyone.
Injuries may lead to loss of function
or may be life threatening.
Fall prevention begins with awareness
and understanding of fall risk factors.
Everyone has an important role in fall
prevention.
Goals of Fall Prevention:
Assess risk factors
Analyze circumstances after a fall
Correct problems and minimize risk
on a daily basis
Intrinsic Risk Factors-related to resident’s
health status
Gait instability
Lower limb weakness
Balance problems
Urinary incontinence or frequency
The effects of certain drugs,
particularly sedatives and hypnotics
visual impairment
dizziness
Residents with Dementia may also exhibit:
Disorientation
Anxiety and agitation
Impaired judgment and decision making
Impaired perception
Impaired communication
Failure to recognize limitations
Extrinsic Risk Factors-related to physical
environment
Poor lighting
Wet or shiny floors
Physical obstacles
Walkers/wheelchairs
Restraints
Inappropriate footwear or clothing
Organizational Risk Factors-any other
extrinsic factors not related to health status
or environment
Staff
Training
Most effective strategies for managing falls
in long term care facilities involves
everyone
who works at the facility and also includes
support from families.
Guiding Principles to Fall Management
Recognition that a comprehensive team
approach to fall assessment and management
is an integral part of the care process.
Commitment to a facility-wide approach
That includes every employee and volunteer
as well as family members.
A goal to create an environment that is safe,
with sufficient staff to adequately monitor and
assist residents as needed, while allowing as
much individual freedom and autonomy as possible
for residents, based on their capabilities.
Guiding Principles to Fall Management cont’d
A systematic approach, involving an
Interdisciplinary Falls Management Team,
for collecting and analyzing data on falls
and conducting thorough assessments of each incident
to identify and address risk factors.
Knowing that each resident has unique capabilities and
intrinsic risk factors, so fall prevention strategies must
be individualized.
Recognition that the intrinsic risk factors for each resident
will change over time as their physical and mental health status
changes, and individualized care plans and fall-prevention
strategies must be modified to accommodate these changes.
Although restraints can increase falls,
some can give freedom and mobility.
Risk Assessment and
Problem Solving
This module will:
Review elements of fall management
program
Review risk assessment for intrinsic
and extrinsic factors
Describe procedures for post fall
assessment
Offer ideas for reducing risk with
emphasis on dementia
Practice exercises
A formal assessment of fall risk should
be completed:
Prior to or at time of admission
At re-admission from hospital
A resident’s health status changes
Conditions affecting fall risk generally included
in a Fall Risk Assessment:
A history of falls
Mental status
Cardiovascular and pulmonary systems
Neuromuscular system
Orthopedic conditions
Vision
Pain
Physical functioning
Medications
Difficulties with communication
and other factors
Fall risk assessments are used to identify fall
risk factors and assist to develop care plan
approaches to prevent falls
Every member of the care team-including
family-should be aware and understand risk
factors that are specific to a resident
All staff members-direct care AND indirect care
including volunteers- have an important role
in looking for fall risks and Take Action:
Report changes (mental or physical) in residents
Move or report environmental hazards
Interact with and engage residents
Role of Therapy
in Fall Prevention
Goal of intervention and care plan approaches
is to minimize risk of fall while maintaining
functional mobility and ADL skills
Risk factors predict likelihood of fall
Therapist’s role is to identify actions that
challenge balance to recommend interventions
and train staff
Standardized testing may be limited
Vestibular system may be tested by observing
Body sway
Presence of nystagmus
Observation of gait for loss of balance
with head turning
Modify Functional Reach test to reach for object
at a preset distance
Observe, observe, observe functional mobility and ADLs
Observe in different setting and at different times of day
Additional training for direct care staff for
communication or task segmentation
List specific directions or commands
in care plan approaches
Emphasize importance of consistency
Following a fall
Review circumstances
Determine root cause
Be objective and identify details
Encourage creativity and think imaginatively
Post Fall Review
Circumstances of a fall are reviewed
immediately after a fall when details of the
fall are easier to remember.
The Post Fall tool is used to help determine
“root cause” of a fall and possible care plan
approaches to prevent another fall.
Problem Solving
to Reduce Risk of Falls
The best ideas or solutions to reduce the risk of
a fall are the ones created based on the unique
mix of intrinsic and extrinsic risk factors for a
specific resident in a particular situation and
organizational factors.
Root Cause Analysis
Ask at least 5 “Why” questions
when reviewing the circumstances
that may have contributed to a fall.
Answers will help to find solutions to
prevent another similar fall.
Residents with dementia are more apt
to fall when they are not engaged in
an activity, are unattended or when
they wander.
Risk reduction strategies focus on
ways to provide engaging activities
for residents and increase interaction.
Suggestions for active engagement:
Memory Boxes
Sing Alongs
Movies
Music
Balls
Quiet area
Suggestions cont’d
Tai Chi
Hand Massages
Repetition
Reading with resident
Talk about families
Know the resident’s like and dislikes
Environmental Changes:
Lighting
Gait or unit entryway
Decoration/Pictures
Non-skid surfaces
No overhead paging
Simple carpeting
Staff education and awareness
Enlist the help of all staff (direct and indirect care)
volunteers and families to “brainstorm” creative
ways to reduce the risk of falls.