Episode 137

Fall Prevention Strategies for People Living with Dementia-Related Illnesses

Falls are one of the most common—and preventable—risks for individuals living with Alzheimer’s and other dementia-related illnesses. In this episode, Lisa dives into the critical topic of fall prevention and how caregivers can create safer, more supportive environments for their loved ones.

Drawing insights from the Fall Prevention Foundation, Lisa explores why people with dementia are more prone to falls, what environmental changes can make the biggest impact, and how physical health, medication management, and cognitive support all play vital roles in maintaining safety and independence.

Listeners will gain practical, real-world strategies to reduce fall risk—covering everything from home setup and lighting to daily routines, balance exercises, and communication techniques that keep those living with dementia calm and confident.

Key Takeaways:

  • Why dementia increases fall risk and what caregivers can do about it
  • Simple home modifications that dramatically reduce hazards
  • How exercise, balance, and physical therapy support mobility and confidence
  • The importance of reviewing medications regularly
  • Cognitive and behavioral strategies to guide safe movement
  • How to design a personalized fall-prevention plan that evolves with disease progression

Quote from Lisa: “Fall prevention isn’t just about safety—it’s about preserving dignity and independence for the person living with dementia.”

Resource Mentioned: This episode was inspired by the article “Fall Prevention Strategies for Dementia Patients: A Comprehensive Approach to Safety and Support” published by the Fall Prevention Foundation

Listen now to learn how to make the home—and the caregiving journey—safer, calmer, and more compassionate

About the Host:

Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.

Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.

So many people today are heavily impacted by Alzheimer's disease and related dementia. The Alzheimer's Association and the World Health Organization have projected that the number of people who will develop Alzheimer's disease by the year 2050 worldwide will triple if a treatment or cure is not found. Society is not prepared to care for the projected increase of people who will develop this devastating disease. In her 30 years of working with family members and caregivers who suffer from dementia, Lisa has recognized how little people really understand the complexities of what living with this disease is really like. For Lisa, it starts with knowledge, education, and training.

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Transcript
Lisa Skinner:

Lisa, hello everybody. Welcome to another

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new episode of the truth lies in Alzheimer's show. I'm Lisa

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Skinner, your host, and as we are entering the winter season,

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I wanted to share with you fall prevention strategies, and this

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really is specific to people living with dementia. They are

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at a much, much higher fall risk than their counterparts who are

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not living with dementia. And this is from an article that I

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found that was published at fall prevention foundation.org, so

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you can find it there if you're interested. So I want it starts

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off by saying, understanding the link between dementia and fall

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risk. As we know, dementia is a progressive condition that

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affects memory, cognition, behavior and physical

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functioning. Now, as the brain deteriorates, people may have

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difficulty with spatial awareness, decision making and

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balance these cognitive impairments significantly raise

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the likelihood of falls, particularly in unfamiliar

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environments or during transitions such as standing up

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or walking, some of the factors that contribute to fall risk and

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people living with dementia include that they have poor

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depth perception and are going through visual changes, that

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they have impaired judgment or impulsive behavior. They have a

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difficulty interpreting their surroundings, they typically

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have weak muscles and poor coordination, and then you have

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to factor in the side effects from medications they may be on,

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for example, sedatives or anti hypertensives. They also tend to

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wander or become quite restless, and a lot of folks living with

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dementia are incontinent, which leads to frequent, hurried

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bathroom trips. So understanding these underlying factors can

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help family members and caregivers implement targeted

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fall prevention strategies tailored to each individual

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stage of dementia and their personal physical condition.

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Creating a safe and navigable environment is one of the most

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effective steps in preventing falls since dementia often

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impairs the ability to perceive hazards or respond

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appropriately, proactive adjustments in the living space

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become essential. So these are some things that you should pay

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attention to and take care of if they exist in your person's

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environment. So you want to remove clutter and hazards, you

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can clear the hallways and rooms of low objects, electrical

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cords, throw rugs and items that may cause tripping. Keep the

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furniture layout consistent and predictable to reduce confusion,

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secure carpets and floorboards to prevent uneven walking

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surfaces. Number two, improve the lighting in their

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environment. Install bright, non glare lighting throughout the

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home, especially in the hallways, bathrooms and

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staircases. Use night lights to guide the way to the bathroom or

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the kitchen at night. Motion Activated lights can help reduce

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disorientation during nighttime movement. Use visual cues and

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signage. You can label doors with both text and pictograms to

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reduce confusion. For example, label the door to the bathroom

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bathroom with an icon. You want to contrast the colors on the

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walls, floors and furniture, because this can improve depth

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perception and make obstacles more noticeable and avoid busy

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patterns on carpets or furniture that may appear distorted or

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confusing to somebody with dementia. You can also install

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assistive features. Temperatures, like handrails and

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they're best used along hallways and stairs, providing support

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during movement. Grab bars are great in the bathroom near the

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toilet and in the shower, this can prevent slipping. Non Slip.

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Mats and tubs and showers do reduce the risk of falls during

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hygiene routines and raised toilet seats or shower chairs

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can definitely help those with balance difficulties. And then

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the last thing is organized, daily use items strategically.

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What does that mean? Well, you can keep essential items like

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glasses, medications and frequently worn clothing within

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easy reach, reduce the need to climb, bend or search all of

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these which can increase their fall risk, maintaining physical

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strength, coordination and balance also plays a central

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role in fall prevention strategies for people living

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with dementia, even modest exercise can improve the

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stability and confidence in movement. So encourage daily

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movement activities such as walking, stretching or seated

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exercises, helps preserve muscle tone, short, regular walks

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around the home or garden, support balance and circulation.

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Simple balance movements such as standing on one foot while

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holding a chair, can be adapted for safety chair yoga or tai

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chi, offered in modified formats. Of course, can improve

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coordination in people living with dementia. Therapists can

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design individualized mobility plans based on the person's

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current abilities and their medical history. They may

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suggest equipment like walkers or foot orthotics to support

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safe movement. So you also want to monitor nutrition and

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hydration, you want to make sure that they're getting adequate

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protein, calcium and vitamin D intake, because this is vital

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for muscle and bone strength. Dehydration, which is extremely

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common in the elderly population, leads to dizziness,

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increasing the likelihood of falls. And then, of course,

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address vision and hearing impairments. You can schedule

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regular eye exams to correct vision problems with glasses or

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other treatments, and, most importantly, ensure hearing aids

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are functioning as poor hearing can affect spatial awareness and

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response to environmental cues. Medication management, critical

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for fall prevention, many people living with dementia take

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multiple multi medications to manage symptoms of memory loss,

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also mood changes and other chronic conditions. Some

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medications, particularly sedatives or antipsychotics and

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blood pressure drugs increase fall risk. So what you want to

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do is review their medications regularly and consult with their

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healthcare provider or pharmacist, and they can conduct

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routine medication reviews to identify combinations or dosages

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that might contribute to dizziness or instability

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minimize their high risk medications where possible,

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reduce reliance on medications with sedating or cognitive side

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effects, monitor closely when introducing new prescriptions,

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and then establish a routine administer medications at

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consistent times to avoid skipped or doubled doses, which

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can cause confusion or balance issues, and then store the

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medication securely to avoid accidental ingestion or

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mismanagement. Now, something else that I read very recently,

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and of course, it reoccurred to me that this population

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typically has more than one physician. They've got, you

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know, cardiovascular doctors and other specialists.

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That they're seeing to manage other health conditions that

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they have, besides the dementia. So the point to that is, you've

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got a handful or multiple doctors prescribing a multitude

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of medications. So one of the things that I wanted to point

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out is, if that's the case with your loved one or the person

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you're caring for, make sure that all the doctors are aware

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of the other medications the other doctors are prescribing,

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and then make sure that they're not on too many that do cause

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dizziness and balance problems and maybe they need to be

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readjusted. So just food for thought. There. Here are some

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cognitive strategies to help prevent falls, because dementia

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does affect decision making and behavior. Fall prevention

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strategies must also include cognitive support and behavioral

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reinforcement. So how do you approach that? Well, one of the

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ways is to establish predictable routines, so consistent

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schedules for waking, meals, activities and bedtime reduce

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confusion and wandering, and as I've mentioned before, in

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previous episodes, consistent schedules also work best for

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behavioral Management. Familiarity can help the

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individual move through their day with less stress and fewer

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unexpected hazards. That's true for behaviors too supervised

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transitions assist them during higher risk activities like

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getting in and out of bed, using the bathroom or walking

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outdoors, consider using transfer belts for safer

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assistance during movement, and then you can use visual prompts

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and visual verbal cues to minimize fall risk. You can do

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this by guiding the person gently with a calm voice, using

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instructions or visual prompts when encouraging the movement,

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avoid startling or rushing the individual as this can lead to

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panic or sudden unsafe movement. People living with dementia do

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not like to be approached from behind. It's frightening to

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them, and it startles them. Always approach from the front

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and then implement technology aids, which some of them include

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door alarms, motion sensors and fall detection devices. These

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can alert caregivers if the person wanders or falls, and the

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GPS enabled wearables are really helpful if the person has a

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tendency to walk off unsupervised. I'm going to go

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over the best practices for fall prevention by caregivers. And we

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all know that caregivers are critical and essential to

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implementing and maintaining fall prevention strategies for

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people living with dementia, their knowledge, preparation and

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awareness can make a substantial difference in safety outcomes.

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So here are the same things that are recommended that they pay

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attention to and implement that they conduct daily risk

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assessments, you want to observe the signs of fatigue, dizziness,

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unsteadiness or noticeable behavioral changes. Note

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variations in their gait, their posture, even their facial

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expressions that may signal discomfort or disorientation.

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Stay calm and encouraging. Use a very patient reassuring tone

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when guiding their movement or redirecting them. Reacting with

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frustration or urgency can increase the person's agitation

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and lead to risky behaviors. Why is that? Because they will

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absorb and mirror your frustration, your nervousness,

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your urgency, you. Monitor their footwear and clothing. Shoes

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should be well fitting with non slip soles, and please avoid

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slippers or flip flops. Loose clothing that drags on the floor

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can also pose a trip hazard, and then pay attention to

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overstimulation that includes loud noises, a cluttered

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environment, even too many people around can confuse or

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startle a dementia patient, increasing the likelihood of an

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unsafe reaction keep spaces calm and simple, especially during

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transitions or caregiving tasks provide them with mental and

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emotional support. You can do this by engaging in

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conversation, playing music and or gentle activities to reduce

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agitation and restlessness emotional distress can trigger

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impulsive actions or attempts to leave the home unsupervised. Now

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here are some of the ways that you can design a fall prevention

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plan for your Dementia Care. Every person living with

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dementia is a unique individual. So the most effective fall

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prevention plans are those that combine personalized observation

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with expert input. So step one would be to consult a medical

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professional, involve the primary care doctor, the

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neurologist or the geriatrician, in assessing physical and

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cognitive health of your person, get a home safety evaluation.

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Occupational therapists or aging in place specialists can

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identify hazards in the home and suggest modifications, things

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that you might not even are aware that are a safety hazard.

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Again, create a daily routine and include time for meals,

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rest, exercise, personal hygiene and safe recreational activities

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and then document changes that you see and notice. Keep a diary

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or a fall even just a specific fall diary to record near misses

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or incidences, noting what happened, where, and the

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possible causes of that near incident and train all of the

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caregivers who are involved in this person's life, whether

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professional or family, all caregivers should understand the

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individual's specific needs and how to prevent unsafe situations

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as dementia progresses, fall prevention strategies will need

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regular reevaluation. It stands to reason because it's forever

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changing as the disease progresses through the stages.

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What works during the early stages may no longer be

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effective in the mid to latter stages of the condition,

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consider assistive technologies such as hospital beds with side

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rails or full body harnesses for those with severe instability,

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environments may need To shift from home to assisted living

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facilities with specialized dementia, friendly

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neighborhoods. Caregiving schedules may expand to include

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nighttime support or additional trained personnel. In

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conclusion, implementing fall prevention strategies for people

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living with dementia is a multifaceted effort that

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combines environmental safety, physical health, cognitive

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support and caregiver attentiveness, while the risk of

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falls can never be entirely eliminated, taking proactive

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steps can significantly reduce the frequency as well as the

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severity of the accidents, more than just physical safety, these

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strategies foster dignity, independence and peace of mind

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for both the individual living with dementia and those who care

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for them through compassionate care and thoughtful planning,

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the home or care environment can be a secure space where mobility

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can be encouraged and.

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Also falls are minimized. That was some great, great helpful

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information. Thanks again for fall prevention foundation.org,

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for publishing that very informative article. For those

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of you who are interested in checking it out, you can go to

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their website, fall prevention foundation.org, so that

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concludes this episode for the truth, lies and Alzheimer's

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show. I just want to mention one other thing, because this is

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really important, and I forgot to mention it. This is something

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that geriatric medicine has known for decades. So I think

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this is really going to be helpful for all of you to be

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aware of this, 10 plus medications. If you're the

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person you're caring for or your loved one is on 10 plus

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medications that increases their fall risk seven times medication

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factors cause 30 to 40% of senior falls. Yet medication

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review happens in fewer than 15% of their assessments. So another

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reason to make sure those medications, especially if they

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have multiple doctors and specialists managing their care,

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to be aware of what that to make sure that the other doctors are

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aware of all of the prescriptions that are being

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prescribed. So just wanted to remind you all that if you want

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to check us, check out our website. You can find us at

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minding dementia.com we're always putting up new resources

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and helpful information to make your life through this dementia

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journey much easier to navigate, so that'll do it for today.

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Thanks again for being here. I always appreciate you showing up

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and being involved in my show, the truth, lies and Alzheimer's.

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I'm Lisa Skinner, your host, and as always, I will be back next

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week with another new episode. So I wish everybody a happy and

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healthy week ahead, and I will see you back here next week.

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About the Podcast

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Truth, Lies & Alzheimer's

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About your host

Profile picture for Lisa Skinner, CDP, CDT

Lisa Skinner, CDP, CDT

Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.
Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Skinner’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle they can have a better-quality relationship with their loved ones through education and offering workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.