From the Guidelines
The most effective nursing intervention for preventing falls in dementia patients is a personalized, multimodal intervention based on their specific risk factors, as recommended by the latest expert guidelines 1. This approach should include a combination of environmental modifications, exercise programs, and personalized risk assessment.
- Environmental modifications may include removing environmental hazards, ensuring adequate lighting, using non-slip flooring, and installing handrails in high-risk areas.
- Regular exercise programs focusing on balance, strength, and gait training should be incorporated into daily routines, as they have been shown to reduce fall risk by improving physical function, with studies demonstrating a significant reduction in falls incidence rate ratio = 0.70,95% CI: 0.52 to 0.95) compared to usual care 1.
- Nurses should conduct comprehensive fall risk assessments upon admission and regularly thereafter, addressing factors such as medication side effects, vision problems, and footwear.
- Staff education and consistent supervision during high-risk activities like toileting and transfers are essential components.
- Assistive devices should be properly fitted and maintained, while low beds, floor mats, and bed alarms may be beneficial for some patients. This multifactorial approach is effective because it addresses the complex nature of fall risk in dementia patients, who experience cognitive impairment affecting judgment, spatial awareness, and risk perception alongside physical limitations. The use of safety items, such as grab rails, sensor night lights, electronic bracelets, and tele-assistance support centers, has also been shown to reduce the number of people who fall (RR = 0.50,95% CI: 0.32 to 0.78) compared with individuals who received usual care 1. Overall, a personalized and multifaceted approach to fall prevention in dementia patients is crucial for reducing morbidity, mortality, and improving quality of life.
From the Research
Nursing Interventions for Preventing Falls in Patients with Dementia
- The most effective nursing intervention for preventing falls in patients with dementia is not clearly established, as the evidence is tentative and limited by the studies' limitations 2.
- A knowledge translation intervention that involves goal setting and action planning with patients and their caregivers may be effective in reducing falls risk, with a non-significant trend towards reduced falls risk and high adoption of falls prevention strategies 3.
- Exercise- and motor-based interventions, nursing staff-directed interventions, and multidisciplinary interventions may also be beneficial in preventing falls in patients with dementia, although more research is needed to determine the effectiveness of these interventions 2.
- The use of sedating medication and physical restraints should be avoided, as they can increase the risk of falls and decrease the quality of life of patients with dementia 4.
Key Factors in Preventing Falls
- Engagement with the patient and their caregiver, through identification of their needs and preferences, and enabling choice can result in high adoption of falls prevention strategies 3.
- Dementia-specific training of employees and an appropriate personnel complement can also reduce agitation and behavioral problems of patients, and decrease the use of sedating medication and physical restraining measures 4.
- Architectonic design and spatial aspects of the care environment may also play a role in preventing falls, although more research is needed to determine the effectiveness of these interventions 4.