How Dementia Increases the Risk for Falls

Falling can happen to anyone, but certain conditions common among older adults increase the risk. These risk factors include vision loss, hearing problems, balance disorders, arthritis, osteoporosis, and the effects of a stroke. Experts also identify Alzheimer’s disease and other forms of dementia as significant risk factors. Understanding the link between dementia and an increased risk of falls is crucial for ensuring the safety and well-being of individuals living with these conditions.

The connection between dementia and falls

Dementia, including Alzheimer’s, affects various cognitive functions such as memory, judgment, and spatial awareness. These changes can significantly increase the risk of falls for several reasons:

Impaired balance and coordination: Dementia can affect the brain areas responsible for balance and coordination, making it harder to maintain stability.

“Even simple actions, like stepping from a parking lot onto a curb or walking across different flooring patterns, can cause confusion or agitation,” explains Sandi Heintz, owner of Right at Home Northwest Houston. “The brain may not properly signal the body to lift the feet when walking, even though the person might feel they have the stamina and is walking normally.”

Cognitive decline: Difficulty in processing information and making quick decisions can lead to unsafe movements and falls. Cognitive decline can also hamper the person’s ability to remember the tools that could help them maintain mobility.

“It's important to remind them, ‘here's your walker,’ to help them maintain mobility safely,” Sandi says. “A lack of physical activity can lead to increased falls due to fear or a decreased ability to move safely, so we want them to continue engaging in any strength-building activities they can manage.”

Medication side effects: Many individuals with dementia take medications that can cause dizziness or drowsiness, increasing the risk of falls.

Visual and perceptual problems: Dementia can impact how a person perceives their environment, leading to misjudgment of distances or obstacles. They may perceive bold patterns like zigzags as moving objects, or a black-and-white check pattern as holes in the floor.

Fortunately, you can do things around the house to reduce your loved one’s risk of falls. Consider these strategies and be sure to discuss fall risks with their doctor:

Encourage physical activity.

• Inactivity can lead to a loss of muscle strength and balance, increasing fall risk.
• Encourage simple exercises at home, walking together, or joining an exercise program designed for people with memory loss, which also provides socialization and reduces the risk of depression.

Sandi’s caregivers support their clients in staying active by accompanying them to activities they enjoy in a safe environment. This helps maintain their independence and provides relief for their caregivers.

“For example,” Sandi explains, “one client who loves biking now attends spin classes, which allows him to engage in a familiar activity safely.”

Help them manage their medications.

• Many medications can cause dizziness, drowsiness, and disorientation.
• Have a doctor or pharmacist review all medications, including over-the-counter drugs, herbals, and supplements.
• Ensure medications are taken at the right dose and time; you may need to assist with this.

Ensure they get regular vision and hearing exams.

• Vision and hearing significantly impact spatial awareness.
• Keep their glasses prescription updated and ensure they wear them.
• Consult a hearing specialist for tips on hearing aid usage and maintenance.

Choose appropriate footwear.

• Well-fitted shoes with good traction can reduce fall risk.
• Avoid flip flops and high heels.

Make the home safer:

• Remove clutter, throw rugs, and electrical cords from walkways.
• Create open spaces by removing unnecessary furniture—especially low tables and floor lamps.
• Ensure stairs have sturdy handrails on both sides. Mark stair edges with contrasting tape. If necessary, use a gate to keep them from using the stairs.
• Keep walkways free of debris, ice, and snow, and clean up spills promptly.
• Improve lighting throughout the home and remove mirrors, which may cause confusion.
• Keep frequently used items within easy reach to avoid the need for step stools.
• Pad sharp furniture corners to reduce injury risk.
• Install grab bars and non-slip decals in the bathroom.
• Install locks on doors if it is unsafe for them to leave the house alone.
• Follow dementia-friendly guidelines when choosing flooring or wall patterns.

In-home care can help

If the thought of adapting your loved one’s environment to be more dementia-friendly seems like a daunting task, Right at Home is here to help.

It’s also important to note that 46% of Sandi’s clients experience some form of cognitive decline. “When seeking assistance,” she advises, “make sure the company you are hiring is experienced in handling these conditions.” Her caregivers participate in immersive “Dementia Live” trainings multiple times each year. Not only do these trainings help them understand the challenges of dementia, but they experience those challenges firsthand. “This helps them identify and minimize risks more effectively,” she explains.

Sandi also recommends reaching out to the SE Texas Alzheimer’s Association or Care Partners Texas for resources including adult day programs for people with dementia and their caregivers. Dementia caregivers can also download Right at Home’s Fall Prevention guide for more resources on creating a safe and welcoming environment for people with dementia.