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What is the natural course of ambulation for dementia patients? Are falls part of the progression?

This study examines the natural course of ambulation in dementia patients, exploring the relationship between functional decline, falls risk, and cognitive impairment stages. It discusses interventions, risk factors, and a case study highlighting falls management.

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What is the natural course of ambulation for dementia patients? Are falls part of the progression?

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  1. What is the natural course of ambulation for dementia patients?Are falls part of the progression? Diane W. Healey November 18, 2008

  2. Functional progression of dementia: FAST Scale • 1 No functional decline. • 2 Personal awareness of some functional decline. • 3 Noticeable deficits in demanding job situations. • 4 Requires assistance in complicated tasks such as handling finances, planning parties, etc. • 5 Requires assistance in choosing proper attire. • 6 Requires assistance dressing, bathing, and toileting. Experiences urinary and fecal incontinence. • 7 Speech ability declines to about a half-dozen intelligible words. • Progressive loss of abilities to walk, sit up, smile, and hold head up.

  3. Cycle of frailty ? Dementia

  4. Falls risk • Gait and balance disorder • Psychotropic drug use • Arthritis • Visual impairment • Orthostasis • Neurologic disease • Cardiovascular disease • Hypovitaminosis D

  5. Falls risk for dementia vs no dementia • 1017 people fell 5,438 times during the 2-year study • Rate of falls: 4.05 per person-year with dementia, 2.33 per person-year without dementia (P<.0001) 1.74relative risk (95% confidence interval (CI)=1.34-2.25) • Van Doorn C, et al. J Am Geriatr Soc 51(9):1213-1218, 2003.

  6. Stage of dementia and falls risk • Unimpaired (*scoring 0-1) were less likely to fall Mild or moderate cognitive impairment (*scoring 2- 4) RR=0.67, 95% CI=0.49-0.92 Severe cognitive impairment (*scoring 5-10) no more likely to fall than residents with mild or moderate cognitive impairment (scoring 2-4) (RR=0.99, 95% CI=0.80-1.21)*MDS cognition scale • Van Doorn C, et al. J Am Geriatr Soc 51(9):1213-1218, 2003.

  7. Injurious falls per person-year • *Dementia : 1.61 • Non-dementia: 0.99 • (P<.002) *This is related to the number of increased falls with dementia patients, not that each fall is more injurious Van Doorn C, et al. J Am Geriatr Soc 51(9):1213-1218, 2003

  8. Interventions for falls • Treat postural hypotension • Modification of environmental hazards • Minimizing psychotropic medications • Cardiovascular disorder treatment • Muscle strengthening and balance training • Tai Chi • No data specific for dementia

  9. Mrs. R • 78 yo WF with >5 year history of Alzheimer’s disease, taken care of at home by her husband • Previously has been an avid swimmer, hiker and biker • No longer able to do her own ADLs • Not sleeping well • 8/11 husband admits her to the healthcare center of the CCRC where they have been residing in an independent home

  10. Medications on admit: • Irbesartan (Avapro) 150mg daily • Memantine (Namenda) 10mg bid • Galantamine (Razadyne ER) 16mg daily • Simvastatin (Zocor) 60mg daily

  11. Admission • Weight 101 lbs, thin • Gait slightly unsteady, with forward center of gravity, leaning to the left, takes short steps, and looks to the floor when walking • No focal neurologic findings • Pt appears fearful, aphasic • Plan: Physical therapy evaluation due to falls risk

  12. Pt. not sleeping day or night: concern for increased risk of falls due to fatigue. Gait becoming more apraxic. • 9/5 ramelteon (Rozerem) started • Falls: 9/8, 9/13,14,15,15 • 9/16 ramelteon discontinued • Fall: 9/17 • 9/19 Melatonin started • Falls: 9/26, 30, 10/13, 17

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