Factors Influencing the Fall Experience of People with Dementia

1
Factors Influencing the Fall Experience of People
with Dementia
2
Reason for Interest

• Experience of working with people with dementia
  in residential care in the UK.
• A visit to Denmark in 2000.
• An increased concern about the loss of autonomy a
  person with dementia experiences.

3
How big is the problem of falls in long term care?

• One out of two people living in a nursing home
  can expect to fall in a year (Cryer 2001).
• A Glasgow audit indicated that the incidence of
  falls in nursing homes is 2.1 per bed year.

4
Literature review themes

• Incidences of falls in care homes.
• Causes of falls.
• Issues about risk.
• The response of older people and people with
  dementia to the fall experience.
• How do staff respond to falls.
• Consultation with people with dementia.

5
Methodology

• Consent.
• Data collection - Staff
• Residents
• Documents
• Research instruments.
• Data analysis.

6
Findings (people with dementia)

• Forgetting falls.
• Perceptions of the causes of falls.
• - Avoidable.
• - Self blame
• Reactions to falling
• - Embarrassment
• - Feeling foolish

7
Findings (people with dementia, contd)

• Fear of falling and stigma.
• Language of falls - trips v. falls.

8
Findings - Staff

• Self blame.
• Perception of blame from carers.

9
Findings - documentary

• In 47.3 of cases, the cause was unknown.
• In 56.1 of cases, no action to prevent further
  falls was documented.
• The most strongly recommended prevention was
  increased observation (96 of those for which a
  recommendation had been made).

10
Conclusions.

• For both people with dementia and staff, falls
  are associated with self blame.
• Blame reflected in the most common preventative
  strategy increased observation.

11
Recommendations

• Regular audit of falls.
• Action in response to audit results.
• Falls and their prevention should be included in
  the staff education programme.
• Causes and prevention of falls should be a topic
  for discussion at carers support groups.
• Autonomy and consent.

12
Further research

• The effect of staff/carer relationships on the
  person with dementia.
• The inclusion of people with dementia in further
  research into the fall experience.

13

• No one but the client can be the clients
  voice. (Barnett, 2000)

14
References

• Cryer C (2001) What works to prevent accidental
  injury amongst older people. Report to the
  Health Development Agency. June 2001. Senior
  Research Fellow, University of Kent
• HEBS (2001) The construction of the risks of
  falling in older people lay and professional
  perspectives. Health Education Board for
  Scotland.
• Tinetti M E and Williams C S (1997) Falls,
  Injuries Due to Falls, and the Risk of Admission
  to a Nursing Home. New England Journal of
  Medicine. 337 1279-1284
• Shaw F E et al (1996) Consequences and Causes of
  falls in people with dementia. Journal of
  Dementia Care. Sept/Oct 1996 28,29
• Downton J H (1993) Falls in the Elderly. London
  Edward Arnold
• Luukinen H et al (1995) Risk Factors for
  Recurrent Falls in the Elderly in Long-Term
  Institutional Care. Public Health 109 59-65
• Kemshall H (2002) Risk, social policy and
  welfare. Buckingham Open University Press
• Wright B A et al (1990) Frequent Fallers.
  Journal of Gerontological Nursing 16 4 15-19
• Barnett E. (2000) Including the Person with
  Dementia in Designing and Delivering Care.
  London Jessica Kingsley Publishers