CHAPTER ONE: THE CONNECTION BETWEEN AD AND FALLING
Instability and falling are common problems for older people. About one-third of all persons aged 65 and older fall each year. With increasing age, the frequency of falling increases. Persons with Alzheimer’s disease (AD), the most common of the dementing disorders, are not immune from the problem of falling. In fact, compared to cognitively healthy older people, individuals with AD experience twice the risk of falling. The rates of injury from falls are also higher among persons with AD. A hip fracture is the most serious; in many cases, resulting in decreased ambulation, and increased immobilization. Subsequently, periods of prolonged immobility place individuals at risk for lethal events, such as deep venous thrombosis, pulmonary embolism, pressure sores, etc.
Health providers typically respond to the problem of falls in AD by restricting the person’s mobility. In the short run, this strategy may seem appropriate since it does protect the individual against further falls. However, the long-term effects on the individual can be devastating and negate any preventive advantage. Restricting an individual’s mobility requires varying levels of assistance with their activities of daily living (ADL), such as walking, toileting, bathing, etc. Subsequently, the loss of functioning will threaten the individual’s sense of autonomy, no matter how precarious. A loss of autonomy can lead to increased behavioral symptoms (i.e., agitation, restlessness, passiveness). After a period of time, because of the effects of immobility (e.g., muscle weakness, loss of joint flexibility, balance loss, etc.), all the person’s ADL skills atrophy; and the consequence is the need for around-the-clock supportive care.
Falls in AD, for the most part, have been attributed solely to cognitive defects--a progressive loss of mental abilities causing individuals to fall. However, falls are not an inevitable aspect of AD, but rather, for the most part, are predictable occurrences that stem from a host of health problems, medication side effects, and unsafe environmental conditions. If health providers are aware of why AD individuals fall, they can take steps to prevent falls and potential injuries.