Fall Prevention among Community-Dwelling Seniors with Dementia

An estimated 30% of community-dwelling adults age 65 and over experience one or more falls each year.¹ After a fall, rehab programs to reduce the risk of injury should be common, as they are proven effective and universally recommended.² Among seniors with dementia, the annual risk of falls skyrockets to 50% to 80%.³⁻⁴ While it is commonly understood that dementia creates challenges in social and self-care tasks, it is easier to overlook the fact that dementia is connected with difficulties in postural control and gait.⁵⁻⁶ Balance and mobility impairments rank as important fall-risk factors for seniors,⁷ and these factors are known to decline at a significantly faster rate among seniors living with dementia.⁸ Given these heightened risk factors, it would seem that seniors with dementia who have fallen would merit an increased impetus for rehab. However, it is also easy to imagine how clinicians could have concerns over how dementia would affect the efficacy of fall-rehab programs for community-dwelling seniors. Elissa Burton and colleagues recently addressed this question in a meta-analysis published in Clinical Interventions in Aging.⁹

When limiting their focus to community-dwelling seniors living with dementia (CDSLD), the researchers found four studies encompassing 243 participants. Interventions were multi-factorial and included teaching caregivers to lead home exercise programs that ranged in frequency from once per week to three times per week. Overall, the fall prevention programs reduced the risk of falls by 32% for CDSLD. The meta-analysis reports in-home exercise programs were more effective than group-based exercise programs. When prescribing rehab for CDSLD, it may be helpful to manage expectations. While the rehab programs significantly reduced the rate of geriatric functional decline compared to control groups, both control groups and rehab groups continued to experience functional decline. This differs from senior populations without dementia, where in-home rehab programs have been shown to reverse even long-standing geriatric disability.¹⁰

In addition to exercise therapy to improve strength, balance, and mobility, interventions included foot health, medication management, vision assessments, walking aids, footwear consultation, and home hazard reduction. With a multi-disciplinary home health approach, Five Star Home Health stands prepared to implement such programs for your patients. Combining physical therapy, occupational therapy, and skilled nursing gives Five Star Home Health an advantage in performing medication reconciliation, foot care, and certain activities modifications – compared to physical therapy alone. Visiting your patient’s home enhances care by enabling clinicians to personally review medicine cabinets and pantries for medications and supplements, closets for clothing consultation, and the home environment in general for hazard reduction. Having therapists visit the home on a regular schedule can help improve adherence compared to having caregivers transport patients to outpatient rehab. For homebound seniors, Medicare pays Five Star Home Health 100% of allowable charges for skilled home health services, and this further increases the likelihood of adherence to the doctor’s recommendations.

Providing Both Interim and Long-Term Home Care

When patients have disabilities, dementia, or problematic mobility, refer to Five Star Home Health because we provide both Medicare-certified home health for short-term medical needs and personal care for long-term, largely non-medical services. We can provide the continuity of care your patients with disabilities may need to live safely at home long term.

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References:

1. Gillespie L, Rovertson M, Gillespie W, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; 9: CD007146.
2. Sherrington C, Tiedemann A, Fairhall N, et al. Exercise to prevent falls in older adults: an updated meta- analysis and best practice recommendations. N S W Public Health Bull. 2011; 23 (3-4): 78-82.
3. Allan L, Ballard C, Rowa E, et al. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS One. 2009; 4 (5): (e)5521.
4. Eriksson S, Gustafson Y, Lundin-Olsson L. Risk factors for falls in people with and without a diagnosis of dementia living in residential care facilities: a prospective study. Arch Gerontol Geriatr. 2008; 46: 293- 306.
5. Australian Institute of Health and Welfare. Australia’s Health 2012. Australia’s Health Series No 13. Cat No. AUS 156. Canberra: AIHW; 2012.
6. Suttanon P, Hill K, Said C, et al. Can balance exercise programmes improve balance and related physical performance measures in people with dementia? A systematic review. Eur Rev Aging Phys Act. 2010; 7: 13-25.
7. Deandrea S, Lucenteforte E, Bravi F, et al. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology. 2010; 21 (5): 658-668.
8. Suttanon P, Hill K, Said C. A longitudinal study of change in falls risk and balance and mobility in healthy older people and people with Alzheimer Disease. Am J Phys Med Rehabil. 2013; 92 (8): 676-685.
9. Burton E, Cavalheri V, Adams R, et al. Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis. Clinical Interventions in Aging. 2015; 10: 421-434.
10. Vries N, Ravensberg C, Hobbelen J, et al. Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: A meta-analysis. Ageing Research Reviews. 2012; 11: 136- 149.