In plain English
People with dementia have around twice the falls rate of older adults without dementia. Falls are a leading cause of injury and loss of independence. Structured falls prevention, available through the NHS, reduces risk substantially.
Why falls are more common in dementia
- Gait changes (shuffling, magnetic gait, short steps);
- Reduced visuospatial judgement of obstacles, stairs, distances;
- Reduced attention to environment while moving;
- Slower reaction to imbalance;
- Side effects of medication (sedatives, anticholinergics, antipsychotics);
- Cardiovascular causes (orthostatic hypotension, arrhythmia);
- Sarcopenia (reduced muscle mass) and frailty;
- Vision problems;
- Foot problems and poor footwear.
Falls prevention
Strength and balance
Evidence-based exercise programmes substantially reduce falls. UK options include:
- FaME (Falls Management Exercise): 24-week group programme;
- Otago: home-based individual programme;
- Tai chi: balance-focused, often available locally;
- Local NHS Falls Service: individual referral, often via GP.
Medication review
Several medication classes contribute to falls. A GP or pharmacist review of:
- Sedatives (Benzodiazepines, Z-drugs);
- Anticholinergic medicines;
- Blood pressure medicines causing postural drops;
- Antipsychotic medicines;
- Opiates.
Vision
Annual sight test. Avoid bifocals when walking outdoors; single-vision distance glasses are safer.
Home environment
- Remove loose rugs;
- Good lighting in hallways and stairs;
- Grab rails by stairs and bath;
- Bedside lamp within reach;
- Night lights;
- Tidy walkways;
- Non-slip mats.
Footwear
- Supportive shoes with non-slip soles;
- Avoid slippers without backs;
- Indoor shoes are safer than socks alone on hard floors.
Bone health
Vitamin D supplementation is recommended. Where osteoporosis is confirmed, treatment reduces fracture risk after a fall. DXA scan via GP.
After a fall
- Check for injury, particularly head injury and hip pain;
- Same-day medical assessment for any new head injury, suspected fracture, loss of consciousness or significant pain;
- Falls clinic referral after any fall in an older adult;
- Telecare personal alarm or fall detector for living alone.
Gait patterns
Specific gait patterns can point to specific causes:
- Magnetic gait (feet appearing stuck): suggests Normal Pressure Hydrocephalus;
- Parkinsonian gait (slow, shuffling, reduced arm swing): suggests Parkinson's Disease or Dementia with Lewy Bodies;
- Apraxic gait (clumsy, looks "as if forgotten how"): seen in moderate dementia;
- Cautious gait (slow, wide-based, holding the wall): often fear-related, treatable with exercise programmes;
- Stepwise decline in walking: suggests vascular causes.
New or substantially changed gait warrants medical review.
For Carers
Falls are a major source of anxiety. Practical steps:
- Personal alarms (Lifeline and similar);
- Telecare with fall detectors;
- Visible reminders to use mobility aids;
- Avoid restraining or over-protecting; reduce falls through environment and exercise rather than restricting movement.
Frequently asked questions
Will exercise really reduce falls?
Yes. Evidence-based exercise programmes reduce falls by around a third. The benefit accrues over months of regular practice.
Should we use a wheelchair to prevent falls?
Generally no. Restricting mobility accelerates deconditioning and is associated with worse outcomes overall. Falls prevention through exercise, environment and medication review is preferred.
What is a falls clinic?
An NHS service for assessment of recurrent falls. Multidisciplinary teams include geriatrician, physiotherapist, occupational therapist and sometimes cardiologist. Referral via GP.
Is Vitamin D worth taking?
Yes. Vitamin D 800 IU daily reduces fall risk modestly and supports bone health. Most older adults will benefit.
Are pendant alarms useful?
Yes, particularly for people living alone. Modern fall detectors automatically alert a call centre or family if a fall is detected.
References
- NICE CG161: Falls in older people: assessing risk and prevention.
- Sherrington C et al. Exercise to prevent falls. Cochrane Database 2019.
- Public Health England. Falls and fractures consensus statement.
- Royal Osteoporosis Society.