Falls in the Context of Dementia

Lynn FlanniganUp and About in Care Homes Deputy

Project Lead@lynnflannigan1

Lynn.Flannigan@nhs.net

Dementia in ScotlandAbout 88,000 people living with dementia in Scotland

in 2014 (including 3,500+ people under 65 years)Predicted to almost double over next 20 yearsPrevalence:

65-69 1.3% population prevalencePrevalence doubles every 5 years up to 80s85-89 20.3% 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

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

Why People with Dementia Fall?Physical

weakness, gait changes poor

balance Difficulties dual

tasking

Visual misperception

Memory impairment

and disorientation

DepressionOrthostatic hypotension

Medication side effects

Impaired judgment

Stress and Distress

Type of dementia

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)

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

Access to Rehabilitation

Some health professionals and payer sources have questioned the value of providing rehab to cognitively impaired patients (Barnes et al 2004)

•Refused entry to rehab programmes as staff believe people with dementia cannot be rehabilitated(McGilton)

“Inappropriate referral”

“Not suitable for rehab as they cannot retain information”

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)

•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)

•Given lower priority particularly in institutional care

The EvidenceINTERVENTIONS 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

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 protectiveRehabilitation - multi component /multidisciplinaryMeaningful activity – Make Every Moment Count

Multifactorial Risk Assessment

Approaches

Person Centred

Care

EffectiveFalls

Prevention

Good Dementia Care

The Way Forward?

What Can You Do?

Questions?