Advanced dementia and keeps falling over

[Fresh01]

Looking to see if anyone has any ideas of what we could do.

A family member has advanced vascular dementia and is already in a nursing home. His nature was never to just sit in one spot and he has been fine wandering up and down the corridors - you need a code to get the lift off the floor, so he can't get out. In recent months his number of falls has increased to now one every 3 days. Thankfully he hasn't caused himself damage yet but it is a worry for me and the staff that he breaks something. Some falls are just him missing the chair as he is trying to sit down.

The staff are great and I have no issues with them but they can't be at his side all day. He would get very anxious if he wasn't able to wander about.

He is too far gone to use a walking stick or rollator. He doesn't always sit on the same lounge chair or dining chair so putting a raised metal bar on a chair arm wouldn't help.

Any other ideas?

[ElspethFlashman]

They have to do an up to date risk assessment. It's not enough for them to just wring their hands and say oh what can we do.

He cannot be restrained so realistically they have a duty of care to come up with a plan to keep him safe. They really should be able to prevent him falling that much through supervision particularly if he is a very high falls risk. How he hasn't broken his hip is anyone's guess. It's negligent to be allowing that many falls.

Ask them when his last risk assessment was done. Say the family would like it reviewed.

[Fresh01]

Thank you, that is a good suggestion. I know there is a falls risk assessment as they showed me it a while ago but I haven't seen it since the number of falls has significantly increased.

By chance his social worker has called me today. His last review was cancelled as she was off sick for 3 or 4 months. She is now back and concerned at the number of falls that have been reported to them whilst she was away. So I have arranged to meet her together with the home in a couple of weeks to go over all aspects of his health and care.

Is there anything else you could suggest I see/ask at a review appointment?

[drinkingtea]

A resident at our care home is just like that - he has an "easy walker" - in all honestly its a lot like the baby walkers babies sit inside. He was in a wheel chair for a while but kept getting up - he's much happier in the easy walker. Wouldn't work in a private home but does in a purpose built nursing home built to accommodate electric wheel chairs etc.

[ElspethFlashman]

His bed. Does he fall out of it? If so, it needs to perhaps be changed to a Hi Lo bed which can be lowered down to the floor. They sleep with it lowered down, so if they climb out of it in the middle of the night to go wandering, they are already at floor level. (usually a flat mattress is placed beside the bed also for softness when they roll out)

Why he is having difficulty when transferring in and out of chairs. Are the chairs too high/low/on casters? Is it only certain chairs or all? How does he manage the chair in his room? Cos their occupational therapist can advise on chair options to reduce the risk.

His toilet - is he falling off that? Is it just a flat pan or is there any special commode over it.

His shoes. If he is tripping over his shoes/laces he may need more orthotic ones.

And lastly, is he wearing hip protectors and if not, why not?

[drinkingtea]

I have just realised the product probably isn't formally called an Easy Walker - I had a quick google and couldn't find it under that name! It's a model of anterior support walker to use instead of a rollator when balance is very poor indeed. Obviously other adaptions needed too but a nursing home will already have beds that can be lowered hopefully. He will need supervising for transfers including walker to chair.

[Fresh01]

Thanks for the replies. He is in a proper nursing home which was designed as one so maybe the Easy Walker type idea of device may help.

He has a raisable bed down low with a sensor mat that goes off when he stands on it. Some falls were due to him getting up from bed so they have moved his room so he now 10 steps from the nurses station and they all know when his alarm goes off to check him and they are generally there before he is upright. He is an early riser so the night staff are still on and not busy when he is trying to get up. He doesn't fall out of bed when lying down.

There are only 2 types of chairs in the home. Classic nursing home chairs with curved arms and wings in lounge and his room, though he never sits in his room one, and dining chairs with wide wooden arms. None on castors. Half the falls are missing the chair when sitting down, more often the lounge chairs. He sits on the arm then slides down it into the chair. He doesn't lower his bum enough and line himself up straight to sit down properly. Actually the chairs being too low might be part of the issue although they are standard height.

He is double incontinent now. And now onto a 2 staff required to change him so no chance of falling off the toilet.

He can't wear shoes with laces as he was undoing them and they were a hazard. These were stopped a while ago. He either wears slippers with a wide Velcro strap or the sturdy walking sandal type shoes with Velcro and clip straps.

He is now also non verbal so although reading his body language we can Guage some of his understanding (and there is some) but it is limited.

Last time I asked about hip protectors we were told we would have to buy them ourselves. I looked into it but didn't know what to get. Think I will print out some options for this meeting.

I think why he hasn't broken anything yet is because sadly he is only 71 so fairly young for his advanced stage of dementia.

[carmelsundae]

I'd maybe also enquire about his medication, if it's been changed recently, or how many different pills he's taking! I'd try to rule out any intrinsic factors like meds, sight, low blood pressure etc! It sounds like the home are doing a good job at the moment, their risk assessment will include things like frequent observations, high/low beds, appropriate seating, use of sensors etc! Sadly it may be progression of dementia and not much that can actually be done to minimise his falls risk. RE: hip protectors, I'm sure there was a large study done years ago which evidenced they weren't actually effective in minimising hip fractures which is why funding was pulled from them!

[Fresh01]

Carmel, that's an interesting comment about the hip protectors. I'm going to print a few images and take the to the meeting so we can agree if it is worth a shot.

Initially the falls were when he had a urinary infection but now he just falls anyway. He is on about 15 medications a day but I know his GP has recently reviewed them as we had requested that and it was done.

I had asked about his sight but how do you check it in someone who is non verbal?

I think his footwear might not be helping but not sure what else he could wear....

[fabulousathome]

There is a make of shoe and slipper called Cosyfeet which have good grip and are for the elderly.