Challenges of Reducing the Risk of Falls in Community-dwelling Elderly with dementia : The Double Jeopardy

Although persons with dementia, living in the community, have an increased fall risk, assessment and management of fall risk is not routinely part of standard clinical care.  A multi-disciplinary collaborative representing Public Health, Sociology, Occupational Therapy, Neurology and Rehabilitative Medicine, has adapted an evidence-based fall prevention program (PROFET) for delivery to community-dwelling elderly diagnosed with mild to moderate dementia who have not experienced a fall-related injury.  Program participants are enrolled through an outpatient neurology clinic. Intrinsic risk factors indicative of poor functionality (cognition, gait, balance, grip strength, polypharmacy) -- elders diagnosed with mild to moderate dementia,  and extrinsic risk factors (hazards in home environment) are identified through a comprehensive clinical assessment and home visit and an individualized fall risk reduction protocol developed for each participant (N=8). Implementing fall prevention programs prior to an injury-sustaining event can delay or prevent unintentional injuries among community-dwelling older adults. This becomes more complicated when there is a new diagnosis of dementia.  During the small window when learning new skills to prevent falls is opportune, the primary focus of the family is directed towards identifying longer term supported, safe living environment.  Expanding the reach of fall prevention efforts to include at-risk clinical populations, such as those with mild to moderate dementia, could substantially reduce healthcare costs and sustain the health and functioning, but will require other resources to attend to the pressing challenges of early diagnosis.