From the Research
To prevent recurrent falls in elderly patients with dementia in long-term care, implement a comprehensive multifactorial approach that addresses both environmental and patient-specific risk factors, as supported by the most recent study 1 which highlights the importance of special care concepts in reducing the use of sedating medication and physical restraints.
Key Interventions
- Conduct regular fall risk assessments using validated tools and create individualized care plans
- Modify the environment by ensuring adequate lighting, removing clutter, installing grab bars in bathrooms, using non-slip flooring, and providing appropriate footwear and mobility aids
- Implement exercise programs focusing on balance, strength, and gait training for 30-45 minutes, 2-3 times weekly, tailored to each resident's abilities
- Review and minimize psychotropics, sedatives, and antihypertensives that increase fall risk, as anticholinergic medication use has been associated with an increased risk of dementia 2
- Consider vitamin D supplementation (800-1000 IU daily) for residents with deficiency
- Use assistive devices appropriately, including properly fitted walkers or canes, and consider hip protectors for high-risk individuals
- Staff education on proper transfer techniques, recognition of fall warning signs, and dementia-specific communication strategies is essential, as shown in a study that found participation in a fall intervention program significantly improved the Nursing Quality Indicator for Preventing Falls (NQIPFD) 3
Additional Considerations
- Implement consistent daily routines to reduce confusion, use visual cues for orientation, and ensure adequate hydration and nutrition
- Consider the use of occupational therapy programs that involve environmental assessment, problem-solving strategies, carer education, and interactive carer skills training, as these have been shown to increase independence in activities of daily living and improve quality of life 4
- Be aware of the potential risks associated with the use of sedating medication and physical restraints, and strive to minimize their use in favor of more person-centered approaches 1