Common Causes of Falls in People With Dementia

People with Alzheimer’s and other types of dementia tend to be at a high risk of falling. They are more than three times more likely to fracture their hip when they fall, which leads to surgery and immobility. The rate of death following a hip fracture for those with Alzheimer's is also increased. Thus, fall prevention for people with dementia is critical.

One way to reduce falls in people with dementia is to understand why they fall. If we know what makes our loved ones more likely to fall, we can try to anticipate those needs and decrease falls.

Causes of Falls

These factors are the most common causes of falls in people with dementia.

Physical Weakness, Gait Changes, and Poor Balance

Some people in the early stages of Alzheimer’s are in excellent physical shape and walk for miles every day, while others seem to develop difficulties almost before memory problems begin. Some research even suggests that a decline in gait (the way a person moves their legs when they walk) or balance can be an early indicator of a decline in cognition. As Alzheimer's progresses into the middle stages and later stages, it causes a decline in muscle strength, walking, and balance.

Lack of Physical Exercise

Exacerbating the above, some individuals aren't getting enough physical activity. The benefits of physical exercise in dementia are many and can include increased daily functioning and improved cognition.

Memory Impairment

As Alzheimer’s progresses, keeping loved ones from falling can become increasingly difficult, in part because of the cognitive decline associated with the disease. For example, even though you might explain to your husband that he shouldn’t get up out of his chair without help because his memory is impaired, he may continually try to walk independently when he’s not safe to do so. He’s been walking when he wanted to his whole life, so to remember now that he is not strong or steady enough to do this can be a difficult change.

Poor Judgment

Sometimes, falls occur because of poor decision-making skills, such as attempting to walk alone down the steps or outside in the middle of winter on ice.

Visual-Spatial Problems

Because Alzheimer’s can affect visuospatial abilities, a person can misinterpret what he sees and misjudge steps, uneven terrain, shiny areas on the floor, or changes in floor color. Be sure to have his vision checked regularly, as eyesight can decline in the aging process. For example, poor vision could prevent him from seeing the paper that fell onto the floor which could cause him to slip and fall when he steps on it.

Clutter

Falls sometimes happen because of less than ideal home conditions, such as too much clutter to try to navigate around. Some people with dementia have a tendency to hoard things which can increase the risk of tripping.

Fatigue

Some falls happen at a certain time of the day, such as in the evening before bed when your loved one is tired from the day.

Medication Side Effects

Some medications can increase the risk of falls. Antipsychotic medications, for example, can sometimes have a side effect of orthostatic hypotension, where a person experiences a sudden drop in blood pressure if they stand up too quickly.

Other medications, such as hypnotics (medications that facilitate sleep) can also cause lingering drowsiness that can increase the chance of falls. Medications that work to lower blood pressure (called antihypertensives) can cause dizziness.

Other Contributors to Falls

These factors may lead to an increased risk of falls.

Restlessness

Does his body need to be stretched out and exercised? Perhaps he’s trying to get out his chair because he really should be moving about and he hasn’t had the opportunity to do so safely. Make sure your loved one has adequate physical exercise and changes his position enough. If you’re not strong enough to help him do this safely, consider having home health care or other help in the home to accomplish this.

Discomfort or Pain

Is he in pain or is he uncomfortable? Be sure to evaluate the possibility of pain, rather than just telling him to sit back down. Some people with dementia aren’t able to adequately express pain or discomfort verbally, but you may be able to see a grimace or notice a sigh or groan. If pain is an issue, you may be able to alleviate it through a different position or some medication.

Hunger or Thirst

Sometimes, a person tries to get up even if he’s too weak because he’s hungry or thirsty. If this is a trigger for your loved one, be sure to offer him plenty to drink and eat so that this need is met for him.

A Need to Use the Bathroom

Is he trying to get up by himself because he needs to use the bathroom? For many people, the urge to use the bathroom does not occur long before the actual voiding, so if your loved one has to wait a while for help, he may understandably get up on his own.

Boredom

Is he just looking for something to do? Boredom is a frequent problem for people with dementia. They no longer go to work or have a long list of things to accomplish in a specific time. If he’s falling because he’s wandering around and bored, you can try some ideas for meaningful activities.

Loneliness

Along a similar vein, some people try to walk around by themselves when they’re not able to because they’re lonely. Social interaction is critical for people of all ages, and this need doesn’t disappear when someone has Alzheimer’s. Make sure that he has the chance for socializing with others, even if it’s just for a few minutes. Not only could you decrease the chance of falls, you could also help improve his mood and overall quality of life.

A Word From Verywell

Looking at the various causes of falls can increase awareness and hopefully prevent some falls from happening. If falls do occur, a root cause analysis can help determine what may have triggered the fall and shed light on how to prevent a future fall. These proactive approaches to fall prevention are an important aspect of providing quality care for older adults living with dementia.