From the Guidelines
Environmental modification is a crucial nursing intervention to prevent falls in patients with dementia, and nurses should implement multiple environmental changes, including safety items such as grab rails, sensor night lights, electronic bracelets, and tele-assistance support centers, which have 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.
Key Environmental Modifications
- Removing clutter and securing loose rugs to prevent tripping hazards
- Improving lighting, especially in hallways, bathrooms, and stairwells, to reduce visual confusion
- Installing grab bars in bathrooms and using non-slip mats to improve stability
- Ensuring appropriate bed height and marking thresholds with contrasting colors to reduce falls
- Arranging furniture to create clear pathways and keeping personal items within easy reach
- Using motion-sensor lighting and nightlights for nighttime safety
Importance of Combining Interventions
These environmental modifications should be combined with other interventions, such as:
- Appropriate footwear to prevent slipping
- Regular toileting schedules to reduce the need for urgent toileting
- Medication reviews to minimize the risk of falls due to medication side effects
Regular Reassessment and Adjustment
Regular reassessment of the environment is necessary as the patient's condition changes, with modifications adjusted accordingly to maintain safety while preserving as much independence as possible. This comprehensive approach to fall prevention can help reduce the risk of falls and related injuries in patients with dementia, as supported by recent guidelines and studies 1.
From the Research
Environmental Modification as a Nursing Intervention
To prevent falls in patients with dementia, environmental modification is a crucial nursing intervention. This approach involves altering the patient's surroundings to reduce the risk of falls and promote safety.
Key Strategies
Some key strategies for environmental modification include:
- Removing tripping hazards such as rugs, cords, and clutter
- Improving lighting to reduce glare and increase visibility
- Installing handrails and grab bars in strategic locations
- Using non-slip mats and flooring in areas prone to moisture
- Rearranging furniture to create a safe and accessible path
Evidence from Studies
According to 2, reducing falls among people living with dementia requires a comprehensive approach that includes environmental modifications. The study found that high-quality and methodologically rigorous research is needed to inform evidence-based practice initiatives.
Assistive Technologies
Assistive technologies can also play a role in preventing falls in patients with dementia. Studies such as 3 and 4 have explored the use of technologies such as monitoring systems, wearable devices, and mobile apps to support people with dementia and their caregivers.
Limitations and Future Directions
While environmental modification and assistive technologies show promise in preventing falls, more research is needed to fully understand their effectiveness. As noted in 2, there is currently insufficient evidence to endorse any intervention to reduce falls for people living with dementia in any setting. Further studies are needed to address this knowledge gap and inform evidence-based practice.