Falls Are Disasters With Lewy Body Dementia. Avoid Entirely or Lessen Potential Harm.
The condition of your loved one with Lewy Body Dementia (LBD) depends upon the prevention of falls and the resulting loss of mobility, diminished activity levels, trauma, hospital visits, and the ensuing behavioral problems, delirium, and, potentially, worse.
Falls Are Catastrophic: Especially Falling Backwards.
For the frail or elderly, a fall is almost always catastrophic. It typically results in a hospital visit. This is frequently for an extended period, with potenti
al surgery and all the related downsides. Worse still, sedatives or anaesthetics may be needed which are commonly a recipe for disaster with LBD. If this type of medication is required, make sure everyone knows that most drugs will have profoundly negative impact with Lewy Body Dementia, and that Neuroleptic Sensitivity can be fatal with some medications.
Falling backwards is especially dangerous, since the person will often not know they are falling until they’ve hit the ground. Their lack of defensive moves then frequently results in profound injuries to the head, neck, spine and hips.
If your loved one is not frail, the falls can still result in a catastrophe. Behavioural problems frequently result from pain, reduced mobility and lack of exercise during the recovery period. Aggressively prevent falls!
Test and Prepare for Postural Instability.
A hallmark of Dementia with Lewy Bodies is the rigidity from Parkinsonism and the loss of fine motor control. Balance is also compromised, and the ability to remain stable is often drastically reduced while standing, and sometimes even while seated. This needs to be actively compensated for. It seems that there is a tendency for people with LBD to mistakenly believe they are leaning forward, when they are, in fact, leaning backwards or perilously close, which makes for dangerous instability.
Your neurologist or another specialist may do a test where they will have your loved one stand, with something cushioned, but solid behind and beside them. They will then push the person to try to put them off balance. This may be shockingly easy. A light tap will often be enough to push a person with LBD right over: particularly backwards.
If this test has not been performed, it might be worth asking for it. Testing it on your loved one is dangerous, of course, even if you are highly attentive to making sure there is something safe, soft and solid to land upon when the person does lose their balance. But if you are exceedingly careful, you may get a surprising view of your loved ones’ level of balance.
Constantly Analyze Potential Tripping Hazards in The Home.
Lewy Body Dementia can make mundane things hazardous. Look critically at your surroundings to make sure there are not elements that have “been there forever”, but which have now become a tripping hazard. Analyze the floors and whether there are risks created by the junctions of different flooring surfaces, such as tile to hardwood to carpet to area rugs. There are often differences of height, texture, resistance, and slipperiness between these areas, and they may need to be adjusted.
The potential for distracting or confusing hallucinations increases with the progress of LBD. In addition, visual acuity decreases and there are often issues of inaccurate depth perception, double vision, tunnel vision, inattentiveness, loss of motor skills, coordination, and more.
Prepare a Soft Landing.
Falling on a tile or hardwood floor is almost guaranteed to cause trauma, break or sprain something. Hopefully, falling on something a little softer will lessen the negatives.
Many Occupational Therapists (OT) say to avoid broadloom and area rugs. From my own personal experience, I do not totally agree. I think it is prudent to make a well-padded environment whenever there is a person who is at risk of falling. That might mean having a well-underpadded carpet throughout, or having suitable soft-furniture to land upon if instability happens unexpectedly or spontaneously. Putting thin, waterproof mats in locations that might have hygienic issues from spills or leaks, such as bedside or eating areas, may allow you to keep things safe and sanitary.
Ask an OT to assess your living spaces, and suggest options. The widely and wildly varying cognitive clarity that accompanies LBD will need to be explained and emphasized to anyone making recommendations.
Grab-bars Are Not Perfect.
One has to remember to grasp a grab bar to reap any benefit from them. If the cognition of your loved one is compromised, or if they do not recognize a moment of instability or impending fall, grab bars will likely be useless.
Having them in the bathroom is, nevertheless, worthwhile — particularly since they may be able to be “cued” for use if your loved one has help in the lavatory. Other very useful places to have them are in the most frequently used spots in the home: by the fridge (the door swings if you grab it, so it won’t help for stability), their favourite seating area, beside doorways, and by the bed are all places worth considering extra stability supports.
Reduce the need to use stairs as much as possible. The greater potential falling distance increases the possible trauma. Navigating stairs is highly risky and bannisters or railings are only a precaution, not a sure solution.
Good Lighting and Contrast Is Critical.
Keep a light on, or install motion-activated night lights in areas that are traversed in darkness. It’s best to have have low-, or medium-intensity lights everywhere so that ones eyes do not need to become accustomed to a light that goes on as you enter an area. An added benefit is if one is half asleep or confused, the illumination will enable quicker recognition, familiarity and orientation, as well as safety.
Where there are different floor surfaces, make sure there is enough light to show the change in elevation or texture. This can be emphasized with contrasting colours, or patterns, although some patterns can be mistaken for something else entirely, particularly if hallucinations are common.
Our Story: Catastrophe In The Kitchen.
Our loved one had been diagnosed in 2008. Things progressed fairly slowly, with periodic setbacks, including a major heart attack in 2010. However, the biggest setback came in July 2012, when she fell backwards in the kitchen, with no attempts to grab any of the items that could’ve steadied her, because she didn’t know she was off balance, and didn’t recognize she was falling until far too late. Her head hit the wall close to the floor, hard enough to break the solid wood trim with her skull. She also fractured her T7 vertebrae, and broke a rib and her sternum from the impact and contortion of the impact with the wall and the hard kitchen floor.
This needed an ambulance to the hospital, multiple tests, treatments, and an extended stay to stabilize her condition. The typically occurring Hospital Induced Delirium also kicked in — horrifically — which is similar to a worst-ever Lewy episode on steroids. After a week in a major trauma hospital in Toronto, she had three more weeks in a rehabilitation facility.
She has never fully recovered from that fall. We have to hold on to her at all times while upright, and her cognition declined profoundly.
She has done remarkably well since then, but had we known the true danger of potential falls, we would’ve made many, many changes. I think she would’ve had a much greater quality of life in the subsequent years had that particular fall been avoided. Other setbacks would have occurred, but averting that one would’ve bought her some more happiness, health and independence.
And after all, isn’t that what we all want for our loved ones? More happiness, health and independence. If so, you need constant vigilance: aggressively prevent falls!
Strength to you!