Hello, I am Caroline Hayden-Wright. I am an Occupational Therapist and run Camtrain, a Training Consultancy. I have over 30 years of experience as an Occupational Therapist and have run my own management and training consultancy since 2000.
Camtrain focusses on training related to older people, prevention and management of falls, living well with dementia and dealing with vulnerable customers. We deliver training across the UK (including Channel Islands) and work with our customers to design bespoke and relevant training programmes.
As part of our training we offer experiential learning exercises for training participants using glasses which simulate common eye conditions and our aim is to develop understanding and increase empathy
I am writing this blog and sharing information to enable more people to learn about these topics as they have an impact on so many people due to an ageing population. With information and knowledge it is possible to care for your family and friends more effectively and seek out relevant services or equipment. I have chosen to write this first article on dementia and falls as it pulls together two key areas and people living with dementia may experience injury and distress as a result of a fall.
We have recently delivered falls training for the NHS in a specialised hospital for people with dementia and mental health problems and there were clear messages from the staff working on the wards. The importance of a dementia friendly environment with good lighting, uncluttered corridors and clear signage was raised. People living with dementia may not remember that they need to use a walking aid and therefore get up to use the bathroom and attempt to walk unaided. This may result in a fall. They may also forget to put on their shoes and slip on the polished hospital floor. The care team on the ward monitor and observe and try and assist where required but people living dementia may be impulsive or unpredictable in their behaviour.
Older adults living with dementia are twice as likely to fall as those without the condition.
People living with dementia are more likely to experience problems with mobility, balance and muscle weakness. The impact of dementia on the brain affects their movement and strength and they may not be aware of their limitations.
They may be disorientated and have difficulty finding their way around. Due to damage to the brain the person living with dementia may have difficulty interpreting visual information and learning new routes and layouts. This is particularly a problem in a new environment such as a hospital or a new care home.
Many people living with dementia have falls in hospital due to disorientation.
They may be unable to find the bathroom or remember their way back to their own bed. This causes anxiety and distress and the person will be more at risk of falling due to their emotional state and fatigue.
This raises anxiety and frustration for the person living with dementia and also for their family and friends.
The layout of the ward to include clear signage, good lighting and supervision from the ward staff are all important to reduce the risk of falls. Dementia friendly environments have clear, bold colour schemes which make it easier for the person to locate their own bed and bathroom.
People living with dementia often have visual problems which include loss of peripheral vision and difficulties with depth perception.
Many people living with dementia have difficulties processing what they see and reacting to situations. They may have difficulty interpreting shapes and shadows and require good lighting to help them find their way and negotiate hazards when walking.
If they have problems with depth perception where for example a black mat appears like a hole in the floor the person may take avoiding action to step over it and risk falling.
A person living with dementia may have difficulty expressing their needs, thoughts or feelings which can lead to distressed behaviour.
When a person is feeling distressed they are more likely to fall as their focus is on the emotion they are feeling and they are not able to concentrate or attend to the environment they are walking in.
An example would be rushing across a room to reach the doorway as a response to wanting to go for a walk and feeling trapped in their care environment.
A person living with dementia may experience side effects from medication that is used to manage agitation/aggression.
This medication often has the effect of sedating the person and making them feel drowsy and dizzy and therefore more at risk of falling over.
Medication which is required to treat high blood pressure may also cause dizziness if blood pressure drops too low.
People living with dementia, particularly vascular dementia are at much greater risk of experiencing depression.
This has the impact of reducing awareness, changing body posture (stooped, head down and unmotivated to walk around and take part in activities). This increases the risk of falls.
People living with dementia may forget to eat and drink and risk becoming dehydrated.
Therefore reminders to eat and drink can make a big difference in maintaining hydration levels. When people are dehydrated they feel dizzy and may have low blood pressure when standing up from a lying position.Therefore they may fall when standing up from their bed in the morning or at night when getting up to go to use the bathroom.
This is described as orthostatic hypotension and is a major cause of falls.
People living with dementia in their own homes may be finding it difficult to maintain their living space and they may hoard belongings.
This increases the risk of falling because of living in a cluttered environment and having to negotiate lots of trip hazards when carrying out daily activities.
Early intervention to provide assistive technology and support to organise the physical home environment can make a positive difference to reducing falls.
People living in their own homes may benefit from assistive technology that prompts the person to have a drink or eat some food as due to their dementia they may forget when they last drank or ate.
I will write more about living with dementia in your own home in a future blog as there are many pieces of equipment and strategies of support that can help to maintain independence for as long as possible.
If you would like to read a bit more about this topic I have included some useful links below;
https://www.nice.org.uk/guidance/cg161/evidence/falls-full-guidance-190033741
https://www.rcot.co.uk/practice-resources/rcot-practice-guidelines/falls
Author: Caroline Hayden-Wright
MSt Primary and Community care, BSc (hons), Dip COT
Registered Occupational Therapist HCPC
Member of Royal College of Occupational Therapists
Caroline has been an Occupational Therapist since 1986 and worked at Addenbrookes Hospital in Cambridge for 14 years. She worked with people living with dementia, people with cognitive difficulties, neurological conditions, and those with a range of long-term conditions such as arthritis, heart disease and stroke.
This was followed by four years as a community Occupational Therapist working with people in their own homes, enabling people with physical and cognitive difficulties to live as independently as possible.
Caroline has more recently worked as a Training Consultant for several major charities who provide services for older people and people living with dementia. Caroline is also currently working as a Lecturer in Occupational Therapy for Anglia Ruskin University in Cambridge, working on the development of a new pre-registration MSc course in Occupational Therapy.
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