Falls are common in older people and people with dementia, and can make it difficult for them to live independently. One in three adults over the age of 65, and half of people over 80, will experience at least one fall a year.
Falls and dementia
People with a cognitive impairment like dementia are at greater risk of falling and sustaining a serious injury. This is linked to some of the symptoms of dementia, such as difficulties with:
- sensory perception
- mobility and coordination
- communicating their needs (eg difficulty explaining that they need help to get out of bed)
Falls may indicate that someone is living with overall physical frailty. This is particularly true for older people, although people with young onset dementia (where symptoms develop before the age of 65) can also become frail.
Most falls only result in minor injury, but sometimes they can cause a more serious injury like a broken bone (fracture). They can lead to a loss of mobility and independence and knock the person’s confidence.
GP: if you have concerns about the person with dementia becoming unsteady and/or falling, their GP is the first port of call. They may recommend some simple tests and checks including:
- a review of medication
- an electrocardiogram (ECG) to check heart rate, rhythm and activity
- blood pressure checks whilst lying and standing
- an eye test and hearing test
- an assessment of overall bone health
Falls prevention service: the person’s GP may refer them to the local falls prevention service to investigate the cause of their falls and provide advice on managing the risk, eg by supporting them to improve their postural stability; providing healthy living advice; and improving their overall mobility confidence to reduce their fear of falling.
Physiotherapists and occupational therapists: physiotherapists can assess the person’s falls risk and advise on ways to reduce it, eg through strength and balance training.
Occupational therapists (OTs) work with people to identify daily activities that they find difficult and suggest ways to make them easier, including giving advice on home equipment and adaptations.
The person’s GP can arrange a referral to a physiotherapist or OT, or you can contact social services for advice. Some work within falls prevention services.
Many falls happen at home, so it is important to identify possible hazards. You can request a needs assessment and home assessment to help with this.
Needs assessment: this looks at what help the person with dementia needs to cope with everyday life, eg assistive living products like a walking frame; changes to the home like a walk-in shower; or support from a paid carer.
The assessment is free, but the person may need to pay for any adaptations, equipment or care that are recommended. This is means-tested based on their finances.
Home assessment: this looks specifically at home adaptations and equipment to support daily living. The local council should fund small adaptations costing under £1,000, such as grab rails or movement-activated lighting.
If larger, more expensive changes are recommended, like fitting a stairlift or converting a bathroom to a wet room, the person with dementia may need to pay for them, although they may be entitled to a Disabled Facilities Grant towards the cost.
Our information on making the home safe and comfortable for a person with dementia contains lots of advice on changes you can make at home to reduce the risk of falls.
It is important to be prepared for the possibility of falls, especially if the person with dementia is becoming increasingly frail and immobile.
- Consider providing the person with a personal falls alarm: these are usually worn around the neck and can alert a family member or help centre if the person falls
- Think about where you could place items like phone handsets, blankets and bottles of water around the home in case the person falls and cannot get up
- The person may be able to ask an Alexa device, Siri or other voice-activated device/system to call a family member, neighbour or emergency services if they fall
- Consider how the emergency services can access the property and contact you if the person falls, for example by installing a key safe; nominating a trusted person such as a neighbour to keep a spare key; and placing contact information in a prominent position (eg a hallway table) so it is easy to find
If a person begins to fall from an upright position, do not attempt to catch them or stop their fall; instead, control their fall by lowering them to the floor.
If the person with dementia falls, it is important to keep calm.
If you are sure they have no injuries and it is safe for them to get up, support them do so slowly and steadily. You may need another person to help.
To get up, the person should:
- Roll onto their hands and knees.
- Look for a stable item of furniture such as a heavy chair.
- Hold onto this with both hands for support.
- Rise slowly until upright – then sit down and rest.
It is a good idea to book an appointment with their GP to check for any injuries and do some simple health checks.
If the person is injured and/or cannot get up off the floor, ring 999 for an ambulance.
If there is a blanket to hand, cover their legs until help arrives. Keep them comfortable, and if it is possible/safe to do so, try to change their position slightly every 30 minutes to reduce the risk of pressure damage to the skin.
Children or young people are sometimes the first to find a loved one who has fallen, so it is important that they know what to do.
- Ensure they do not try to move the person without help
- Encourage them to cover the person’s legs with a blanket and stay with them
- Teach the child how to contact a family member – you could save key phone numbers as emergency contacts in the person’s mobile phone (or the child’s mobile phone, if they have one) or set them up as speed dial numbers on a landline
- If you have a smart device such as an Alexa or a smartphone with Siri, teach them how to ask the device to call a family member
- Explain how to call 999 and when they might need to do so
- Ensure they know the person’s full address and ideally their phone number
- If the child is old enough and interested, they could join a first aid course or club such as St John Ambulance or British Red Cross first aid champions
After a fall, it is important to reassess the person’s needs and evaluate if anything more can be done to prevent further falls. Their GP or healthcare professional can help with this.
If you have any questions or concerns relating to dementia, call our free Dementia Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm), email email@example.com or you can book a virtual appointment with an Admiral Nurse via phone or video call.