Reducing the risk of falls in community-dwelling elderly with dementia

BACKGROUND. Limited health services research and evidence-based programming has been focused on elderly fall prevention, despite high fall-related morbidity and mortality. PURPOSE. Although persons with dementia living in the community have an increased fall risk, assessment and management of fall risk is not routinely part of standard clinical care. RESULTS. A multi-disciplinary collaborative, representing Public Health, Sociology, Occupational Therapy, Neurology and Rehabilitative Medicine, has adapted an evidence-based fall prevention program (PROFET) for delivery to community-dwelling elderly diagnosed with mild to moderate dementia who have not experienced a fall-related injury. Program participants are enrolled through an outpatient neurology clinic. Intrinsic risk factors indicative of poor functionality (cognition, gait, balance, grip strength, polypharmacy) and extrinsic risk factors (hazards in home environment) are identified through a comprehensive clinical assessment and home visit. An individualized fall risk reduction protocol is then developed for each participant (N=20). Data is collected on the short term (6 month) impact of the program on reduction in fall risk factors, fear of falling and falls experienced as well as program satisfaction and adherence. The RE-AIM framework is guiding the analysis of essential program elements for sustainable adoption and implementation. CONCLUSIONS. Implementing fall prevention programs prior to an injury-sustaining event can delay or prevent unintentional injuries among community-dwelling older adults. Expanding the reach of fall prevention efforts to include at-risk clinical populations, such as community residents with mild to moderate dementia, could substantially reduce healthcare costs and sustain the health and functioning.