What are evidence-based nursing interventions to address fall risk in patients with dementia?

From the Guidelines

Evidence-based nursing interventions for addressing fall risk in patients with dementia should include a multifaceted approach combining environmental modifications, physical activity programs, and enhanced supervision, as recommended by the most recent expert guidelines 1. This approach is crucial in reducing the risk of falls, which is a significant concern in patients with dementia due to their increased susceptibility to injuries and complications. The interventions should start with a comprehensive fall risk assessment using validated tools specific to dementia patients, then implement environmental safety measures such as:

• Removing tripping hazards
• Installing grab bars in bathrooms
• Using non-slip flooring
• Ensuring adequate lighting (especially at night with motion-sensor lights)
• Clearly marking pathways Establish consistent daily routines to reduce confusion and agitation, which can precipitate falls. Implement supervised exercise programs focusing on balance, strength, and gait training for 20-30 minutes at least three times weekly, tailored to the patient's cognitive and physical abilities, as supported by recent systematic reviews 1. Consider the use of bed/chair alarms or pressure mats to alert staff when patients attempt to move unassisted. Review medications regularly, as certain drugs like sedatives, antipsychotics, and some antihypertensives can increase fall risk; medications should be minimized when possible or administered at optimal times to reduce side effects, in line with previous recommendations 1. Ensure patients have appropriate footwear with non-slip soles and proper fit. For patients with severe dementia or high fall risk, consider enhanced supervision strategies such as hourly rounding, positioning patients within view of nursing stations, or implementing sitter programs during high-risk periods. These interventions are effective because they address the multiple factors contributing to falls in dementia patients, including cognitive impairment, gait disturbances, environmental hazards, and medication effects.

From the Research

Evidence-Based Nursing Interventions

To address the falls risk of patients with dementia, several evidence-based nursing interventions can be considered:

• A knowledge translation intervention, as described in 2, which involves collating existing evidence, identifying individual issues, understanding context, and evaluating change over time, can be effective in reducing falls risk.
• Goal setting and action planning using a discussion tool, as mentioned in 2, can drive implementation and increase readiness to change behavior for falls risk.
• Reducing the use of anticholinergic and sedative medications, as suggested in 3 and 4, can help minimize the risk of falls, as these medications can worsen functionality and cognitive status.
• Implementing patient-centered interventions, such as Structured Interdisciplinary Bedside Rounds (SIBR), as described in 5, can foster improved interdisciplinary communication and care planning, leading to a reduction in falls.

Key Considerations

When developing nursing interventions to address falls risk in patients with dementia, the following factors should be considered:

• The importance of engagement with the person with dementia and their caregiver, as highlighted in 2, to identify their needs and preferences and enable choice.
• The need for comprehensive and inclusive research in hospital environments, as advocated in 5, to improve fall prevention strategies for frail older adults with dementia.
• The potential for polypharmacy and prescription of anticholinergic/sedative drugs to contribute to falls risk, as noted in 3 and 4, and the need for interdisciplinary pharmacotherapeutic optimization strategies.

Intervention Effectiveness

The effectiveness of interventions designed to reduce falls among people living with dementia is a topic of ongoing research, with some studies suggesting that:

• Exercise-based interventions, as mentioned in 6, may be effective in reducing falls, but more high-quality studies are needed to confirm this.
• Interventions that address the cognitive and functional challenges faced by older adults with dementia, as described in 5, may be more effective in reducing falls risk.