Falls Safety: Alzheimer's Disease

Christina Van Onselsen Clinical Group: Charles Anema, Sasha Bains, Flor Keen, Samantha Misslbeck, Emily Reina, Cristy Santiago MCA II

Alzheimers disease (AD) is the most common cause of dementia in the United States. AD is the 6th leading cause of death in America.
Alzheimers disease (named after a German physician, Alois Alzheimer) is a chronic, progressive, and degenerative disease of the brain. Out of all the other top ten causes of death, AD is the only one that is not preventable or curable. It affects every one in eight (12.5%) Americans over the age of 65. Even a higher percentage of Americans are diagnosed with AD (85%) over the age of 85. Overall, 5.2 million Americans are living with the disease. Of that 5.2 million, only 200,000 are under the age of 65. The estimated health cost of AD is around 203 billion dollars each year. By the year 2025, the United States expect the number to increase by 40% or to 7.1 million patients.

AD has a higher incidence with Hispanics and African Americans. Around 2/3 of AD patients are female.
plaques and neurofibrillary tangles will cause loss of connections between neurons, death of neurons and will eventually cause the brain to shrink. A deteriorating brain will lead to a higher risk of falls for AD patients. Patients with AD will have trouble with mobility and activities of daily living. These patients tend to walk cautiously. This is characterized by individuals shuffling or not lifting their feet off the ground when walking. Walking is accomplished slowly with a slightly bent or flexed posture and uncertain foot placement on the ground. Both situations can easily result in trips and slips. Due to the disturbed balance that AD patients have. In addition, these individuals exhibit a lack of ability to maintain stability during postural changes. For example, getting up from seated positions, reaching up for hard to obtain objects on ones tip toes or walking up steps can result in poor balance.

There is a higher frequency among people with lower socioeconomic status and education level and poor access to health care. There is also a clear pattern of familial inheritance with AD. AD exhibits several pathologic changes of the brain. First a patient diagnosed with AD will have an abnormally high amount of amyloid plaque within the brain. This plaque can develop in and disrupt multiple areas of the brain, which are vital for cognition, memory, language and reasoning. An AD patients brain will also show an abundance of neurofibrillary tangles or abnormal collections of twisted protein threads inside nerve cells. The combination of the amyloid

Cognitive loss is the hallmark of AD and adversely affects the persons memory, thinking, and behavior. This can place individuals at great risk for falls. Altered cognitive function can result in lack of understanding and awareness of the potential for falls and the need for assistance. Failing to remember limitations in daily living, such as forgetting that they cant walk by themselves will lead to more collapses. Inability to ask for assistance with mobility because of communication problems can also lead to falling. Refusing or forgetting to seek help with mobility or to use assistive devices, such as canes, walkers and bathroom grab bars leads to a higher risk to go head over heels.

the home and generally take place during ordinary activities. Walking is a cognitive process requiring higher-level control. As stated earlier, gait disturbances and altered mobility associated with Alzheimers means that walking requires caution. Clients with Alzheimers can show lack of ability to maintain stability during postural changes. This can include getting up from a seating position, reaching upwards, or walking up steps. Individuals may forget that they cant walk by themselves and will attempt to get up without assistance. If they are experiencing sundowning, the person exhibits disruptive behavior during late afternoon and early evening that can result in falls. The use of psychoactive drugs to control mood and behavior in patients with AD can also cause the individuals to experience falls. These medications can cause dizziness, unstable blood pressure, and worsening confusion. Visual problems and impaired depth perception may make a person unable to see hazards in their path or misjudge the location of a chair or step. Walkers and canes can help the client feel more

Falls are the most common safety problem in persons with Alzheimers dementia, yet they are not a normal part of the disease process.

At least half of all falls in clients with dementia occur in

confident with walking. However, the caregiver must remind the client to use them as well as bring the assistive device to the patient each time they get up. Some assistive devices are attached to the individuals clothes and the bed or chair that is activated when the client gets up. Home security systems chime when an exterior door is opened, and GPS trackers can locate an individual who has gone missing from home.

should be removed or tightly secured to the floor. The color of the flooring should not be similar enough to the color of the walls to cause possible confusion. In the restroom, tightly secured handrails should be installed to aid with the transfer from sitting to standing and if the shower does not Already have a seat one can be installed. All chairs with wheels in the house should be removed. In the kitchen a non-skid mat can be

For a patient who has Alzheimers disease it is important to keep the patient safe from falling. There are a number of ways to do this both at the patients home and in the hospital. If the patient is in a wheelchair it is important to be aware of whether or not the break is on, especially when transferring the patient. Inside their home you should first start with assessing the presence of stairs, if there are stairs how many are there? Is there a steady handrail for the patient to hold on to? If there are stairs inside the home it should be considered to install an automated lift to prevent the use of the stairs altogether. The lighting should be adequate in every room and all throw rugs

placed in front of the sink to avoid slippery floors while washing dishes. Frequently used items should be kept on low shelves so as to prevent unsafe climbing or reaching for items that are too high or inaccessible. A phone should be within reach especially while cooking.

Throughout the house loose wires or cords should be removed or secured with tape and out of the patients way. The patient should always wear shoes that fit properly and do not have extra thick soles while avoiding flimsy slippers. Slippers with firm soles can be worn but need traction to prevent from losing grip to the

dry and free of any cords or debris that the patient could possibly trip on. If the patient is on an IV the IV pole should be kept out of reach or a break should be applied to avoid the patient using the pole as an assistive device to walk with. Should the patient need an assistive device one should be available in the patients room and within easy reach. The bed should be kept at the lowest point and side rails should be raised, but always less than 4 to avoid the use of unnecessary restraint. If the patient is unable to ambulate to the restroom a commode should be available and within reach, otherwise the call light should be within reach and always visible to allow the patient to call the nurse for bedpan use. The patients medications should be monitored for

Should a patient with Alzheimers fall, the most common injury is a traumatic brain injury (TBI). Symptoms of a traumatic brain injury include: unconsciousness, impaired memory, confusion, headache, dizziness, blurry vision, nausea, vomiting, tinnitus, and dysphagia. Although unconsciousness is a symptom, if the patient remains conscious emergency care should still be called to ensure an injury has not occurred after any fall.
floor. In the hospital, prevention of falls is just as important as it is in the patients home. This may include keeping the floors possible side effects of dizziness or fatigue, which will increase the patients risk of falling. The patient should also be frequently oriented to

prevent from trying to leave the bed from fear of not knowing where he or she is. Exercise is also a huge piece in prevention of falls. Nurses can work with the patient to carefully ambulate or perform range of motion exercises to maintain muscle tone and prevent atrophy. Interventions that the nurse should make if the patient has indeed fallen are as follows: The first step is assessment. Before moving the patient, ask what they think caused the fall and assess any associated symptoms. Check the patients vital signs and the apical and radial pulses; and check cranial nerves for damage. Check the patents skin for pallor, trauma, circulation, abrasion, bruising, and sensation on any part of the patients body. Also, check the central nervous system for sensation and movement in the lower extremities to make sure they didnt damage any nerves. Assess the patients current level of consciousness and determine whether the patient has had a loss of consciousness. Look for subtle cognitive changes such as difficulty speaking or difficulty understanding. Assess the patients pupils and orientation; and note any pain and points of tenderness.

Observe the patient for hip pain, shortening of the extremity, pelvic, or spinal pain and the patient's leg rotation. Numbness or tingling in the extremities, back pain, rib pain, or an externally rotated or shortened leg may be suggestive of spinal cord injury, leg/pelvic fracture, or head injury. The second step is to notify the physician and a family member per hospital policy. All other healthcare providers should be notified to prevent a second fall. T The third step is to monitor and reassess. After the patient has safely returned back to their bed the nurse should perform frequent neurologic and vital sign assessments. Including orthostatic vital signs; in some cases patients who have fallen have appeared fine and were found dead a few hours after the incident.

The last step the nurse must perform is to document following the facilitys policies and procedures. Thorough documentation helps to ensure that appropriate nursing care and medical attention are given to the patient.

Documentation should include: all observations, patient statements, notifications, assessments, interventions, and evaluations. Be sure to note the patients thoughts about the cause of the fall and whether the patient lost consciousness.