Expert: Mary Gordon - 4/11/2009

Question
The patient is in stage 6 with the primary problems relating to safety. She is in an  Alzheimers Unit in a good care facility. She is still able to walk a few steps etc. therefor falling is a risk as the attendants cannot watch her 24-7. Have you ever heard of any facilities that provide 24-7 observation or will we need to hire third party attendants?

Thanks-you're cool :)

Bill

Answer
Bill, there is no way to completely prevent falling in a person with advancing dementia - i.e. even if a facility had a one to one patient to caregiver ratio, this would not completely protect her.  Just to give you an example, my mother in law was in a locked special care AD ward - she was sitting in a chair in the small common area where there were several staff present. She stood up, and without taking a single step, went down onto the carpeted floor and broke her hip. Who would have thought ? It was the end of her walking because despite a lot of effort to get her going again by a range of family and staff, therapists etc. we couldn't get her on her feet again.

There are some devices that may be helpful. There are hip guards that may be protective in a fall. Here's a link that shows several types.
http://www.hiprotector.com/works.html

Merry walkers can also be helpful - they are essentially a walker with a built in chair that they can't get out of, so they always have a frame around them to grab onto. It is designed to prevent falls but still permit the person to walk around. They must be sized to the person.
http://www.merrywalker.com/faq.html

There are pressure pad alarms that will alarm if she gets up on her own at night - there are various types that can be placed in the bed, on a chair or on the floor beside the bed. Staff will be alerted that she needs someone to check on her because she's on her feet alone.
Here are some examples.
http://ucanhealth.com/goto.php?page=alzheimers_disease_low_bed

A low bed and a bedside cushion may help as well - here is a sample of a bedside pad
http://www.ameds.com/moreInfo.php?ProductNumber=9274-53&SubCategoryID=4001

Have you met with the home and done a walk around with the director of care to discuss fall prevention? Do they have a strategy in place? Here is some information from the CDC
http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html
and another article
http://www.alzbrain.org/pdf/handouts/2017.%20PREVENTION%20OF%20FALLS%20IN%20THE%...

They should be reviewing her risk factors and see if there is anything that can be do to make her safer. Could there be problems from medications she's on? Does she have porper footwear. Is the facility well designed, well lit, lots of hand rails and grab bars? Are there transitions from smooth floors to carpet (a big tripping hazard for people with balance problems). Are the beds low so if they roll or fall out, they won't get hurt?

There are also products like gerichairs, bed rails, wheel chair trays etc. that keep the person from getting up and walking alone unless someone is there to help them. However, they are restrictive devices, and may make the situation worse by causing the person struggle to get out, or because the person who is restrained will get less exercise - which makes the balance and gait problems worse.

I'd have a talk with the facility and see what they have in the way of assessment and a plan - which they should have, since falls are a major cause of both morbidity (i.e. illness and disability) as well as mortality.

Hope this helps. You can certainly hire a companion for her, to encourage her to exercise etc. but even that will not guarantee she will not fall.  Sadly, she will eventually stop trying and become chair bound.

Mary G.