The Correlation Between Alzheimer's and Frequent Falls

Individuals with Alzheimer’s disease and other causes of dementia are at a significantly higher risk of falling and injuring themselves. Falls affect between 60% to 80% of individuals with cognitive impairment. Individuals with dementia are up to three times more likely to sustain a hip fracture compared to cognitively intact older adults.

Addressing and predicting fall risk in Alzheimer’s disease patients is a crucial aspect involved in care planning decisions. As the disease progresses and neurocognitive impairments become more severe, fall risk increases further.

Below, we discuss the correlation between Alzheimer’s and frequent falls, addressing common causes of falls, tips for preventing falls, and methods for improving the identification of Alzheimer's patients at risk of falls and injuries.

Alzheimer’s and Frequent Falls: Common Causes

Falls in Alzheimer’s disease patients are multifactorial, and their risk factors are highly interconnected. Many factors contribute to frequent falls in Alzheimer’s disease patients. 

While falls may seem like a purely physical issue, aspects of cognitive function are major factors that contribute to increased falls. In other words, while falls are typically due in part to functional impairments, cognitive impairment is a primary factor involved in falls. 

Some of the most common factors that contribute to falls are listed below:

• Severity of Alzheimer's disease: Generally speaking, Alzheimer's patients in the more advanced stages of the disease are more likely to experience frequent falls than those in the earlier stages of the disease. 
• Changes in gait and balance: Changes in gait and balance are a common symptom of Alzheimer’s disease, particularly as the disease progresses. These deficits can contribute to difficulty walking and balancing, which can ultimately lead to falls.
• Changes in visual perception: Alzheimer’s disease can affect the way patients perceive and process information from the eyes. Some patients experience loss of sight, while others may struggle with visualizing and interpreting their surroundings. Oftentimes, patients have difficulty judging distances, which can cause them to misjudge steps, trip over objects, slip, and fall.
• Confusion and delirium: Impairment of memory and other cognitive functions can lead to confusion and delirium in many Alzheimer's patients. This confused thinking and reduced awareness of the surrounding environment often causes patients to become irritable, anxious, or restless. A diagnosis of delirium increases fall risk by up to six times.
• Side effects from medications: Comorbidities in Alzheimer’s disease are common. Many patients are on several medications to treat several conditions. Certain medications can increase a patient’s risk of falls. Medications known to increase fall risk in older adults include benzodiazepines, antipsychotics, anticonvulsants, antidepressants, opioid analgesics, anticholinergics, and antihypertensives.

Other factors that can contribute to falls in Alzheimer’s patients include:

• The patient’s environment (e.g. poor lighting or a cluttered living space).
• Fatigue. 
• Restlessness and/or boredom.
• Pain or discomfort.
• Physical needs such as hunger and thirst or the need to use the toilet.

Tips for Preventing Falls

The National Center for Injury Prevention and Control recommends several methods for reducing the chance of falls in a home environment:

• Remove trip hazards, such as papers, books, clothes, and shoes, from stairs and places where you walk.
• Remove small throw rugs, or use double-sided tape to keep the rugs from slipping.
• Keep items you often use in cabinets you can easily reach without having to use a step stool.
• Install grab bars next to your toilet and in the tub or shower.
• Use non-slip mats in the bathtub and on shower floors.
• Improve the lighting in your home. As you get older, you need brighter lights to see well. Lamp shades or frosted bulbs can reduce glare.
• Install handrails and lights on all staircases.
• Wear shoes that give good support and have thin non-slip soles. Avoid wearing slippers and athletic shoes with deep treads.

Addressing and Predicting Fall Risk in Alzheimer’s Patients

Falls are a serious problem for many senior living facilities. Depending on the severity of falls, they can be extremely dangerous for patients and can greatly impact their quality of life and their required level of care. Falls are often a signal for a transition of care.

While the above tips can certainly help reduce the risk of frequent falls in Alzheimer's patients, there are more robust, strategic methods that can be employed in senior living facilities that may prevent or significantly reduce the risk.

If a patient is at high risk of falls, it is critical to assess a baseline for skilled nursing, not only to better inform care planning decisions but to cover liability. Assessing fall risk at intake and frequently reassessing fall risk throughout patient care is an essential element needed for developing fall prevention strategies to reduce the negative impact of falls on an individual’s quality of life as well as the economic burden of treating falls.