What are the immediate steps to take after a dementia patient falls?

Immediate Steps After a Dementia Patient Falls

After a dementia patient falls, conduct a thorough assessment for injuries and implement a personalized, multimodal intervention based on specific risk factors to prevent future falls. 1

Immediate Assessment and Management

• Perform a complete head-to-toe evaluation to assess for injuries, even if the patient presents with seemingly isolated complaints, as occult injuries are common in fall patients 2
• Evaluate for fractures, lesions, and other adverse outcomes related to the fall 1
• Assess vital signs, with particular attention to the shock index (ratio of heart rate to systolic blood pressure) - if ≥0.9, consider more comprehensive evaluation for occult hemorrhage 2
• Determine if the patient can bear weight, as inability to do so indicates potential serious injury 2
• Consider imaging if clinically indicated - anteroposterior and lateral radiographs for suspected fractures, with CT as a follow-up if radiographs are negative but clinical suspicion remains high 2

Communication and Support

• If the dementia patient is approaching end of life or severely injured, consider offering families the opportunity to be present despite potential visiting restrictions 1
• Provide clear information to family members about the fall incident, assessment findings, and care plan 1
• Speak calmly to the patient, even if they have advanced cognitive impairments and may not fully understand the situation 1
• If family members cannot be present, use technology to enable connection between the patient and their family 1

Post-Fall Assessment

• Document the circumstances of the fall, including environmental conditions, time of day, and activities preceding the fall 1
• Review the patient's medication regimen, as certain medications can increase fall risk 1
• Assess for orthostatic hypotension, which is a significant predictor of falls in dementia patients (HR: 2.13) 3
• Evaluate for symptoms of depression using a short, simple tool, as depression is associated with increased fall risk (HR per point on Cornell depression score: 1.053) 1, 3
• Screen for autonomic symptoms, which are significantly associated with falls in dementia patients (HR per point on autonomic symptom score: 1.055) 3

Prevention of Future Falls

• Implement a personalized, multimodal intervention based on identified risk factors 1
• Consider physical exercise interventions including aerobic, strength, balance, and stability training 1
• Review and potentially modify medications that may contribute to fall risk 1
• Make environmental modifications to reduce hazards 1
• Consider mobility assistance devices if appropriate 1
• Implement cognitive interventions to enhance safety awareness 1
• Assess and address sensory deficits, particularly hearing and vision impairments 1

Special Considerations for Different Dementia Types

• Be aware that patients with Dementia with Lewy Bodies (DLB) have significantly higher incidence of fall-related injuries (10.7%) compared to Alzheimer's disease patients (1.1%) 4
• DLB patients may have high fall risk even without obvious Parkinsonism 4
• Consider continuous monitoring for high-risk individuals, as video monitoring has shown potential to reduce fall rates in memory care facilities 5

Common Pitfalls to Avoid

• Discharging patients prematurely based solely on normal initial imaging, especially after high-energy falls 2
• Overlooking the psychological impact of falls, including fear of falling, which can lead to decreased physical activity 6
• Neglecting to address orthostatic hypotension, autonomic symptoms, and depression, which are significant modifiable risk factors 3
• Failing to encourage appropriate physical activity, which is protective against falls (HR per point on physical activity scale: 0.827) 3
• Treating falls and dementia as discrete conditions rather than recognizing their frequent co-occurrence 7