Alzheimer’s Fact

8/12/2019 Alzheimer’s Fact

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Alzheimer’s disease (AD) is the mostcommon cause of dementia in the UnitedStates. AD is the 6th leading cause of death

in America.Alzheimer’s disease (named after a German physician,

Alois Alzheimer) is a chronic, progressive, and degenerativedisease of the brain. Out of all the other top ten causes ofdeath, AD is the only one that is not preventable or curable.It affects every one in eight (12.5%) Americans over the ageof 65. Even a higher percentage of Americans are diagnosedwith AD (85%) over the age of 85. Overall, 5.2 millionAmericans are living with the disease. Of that 5.2 million,only 200,000 are under the age of 65. The estimated healthcost of AD is around 203 billion dollars each year. By theyear 2025, the United States expect the number to increaseby 40% or to 7.1 million patients.

Falls Safety:Alzheimer's Disease

Christina Van Onselsen Clinical Group:

Charles Anema, Sasha Bains, Flor Keen, Samantha MisslbeckEmily Reina, Cristy Santiago

MCA II



There is a higher frequencyamong people with lowersocioeconomic status and

education level and poor accessto health care. There is also a

clear pattern of familialinheritance with AD.

AD exhibits several

pathologic changes of the brain.First a patient diagnosed withAD will have an abnormallyhigh amount of amyloid plaquewithin the brain. This plaquecan develop in and disruptmultiple areas of the brain,which are vital for cognition,memory, language andreasoning. An AD patient’sbrain will also show anabundance of neurofibrillarytangles or abnormal collectionsof twisted protein threadsinside nerve cells. Thecombination of the amyloid

plaques and neurofibrillarytangles will cause loss ofconnections between neurons,death of neurons and willeventually cause the brain toshrink.

A deteriorating brain willlead to a higher risk of falls forAD patients. Patients with ADwill have trouble with mobilityand activities of daily living.These patients tend to walkcautiously. This ischaracterized by individualsshuffling or not lifting theirfeet off the ground whenwalking. Walking is

accomplished slowly with aslightly bent or flexed postureand uncertain foot placementon the ground. Both situationscan easily result in trips andslips. Due to the disturbedbalance that AD patients have.In addition, these individualsexhibit a lack of ability to

maintain stability duringpostural changes. For example,getting up from seatedpositions, reaching up for hardto obtain objects on one’s tiptoes or walking up steps canresult in poor balance.

AD has a higher incidence wiHispanics and Afric

Americans. Around 2/3 of A

patients are fema



Cognitive loss is thehallmark of AD and adverselyaffects the person’s memory,thinking, and behavior. Thiscan place individuals at greatrisk for falls. Altered cognitivefunction can result in lack ofunderstanding and awareness

of the potential for falls and theneed for assistance. Failing toremember limitations in dailyliving, such as forgetting that

they can’t walk by themselveswill lead to more collapses.Inability to ask for assistancewith mobility because of

communication problems canalso lead to falling. Refusing orforgetting to seek help withmobility or to use assistivedevices, such as canes, walkersand bathroom grab bars leadsto a higher risk to go head overheels.

At least half of all falls inclients with dementia occur in

the home and generally takeplace during ordinary activities.Walking is a cognitive processrequiring higher-level control.As stated earlier, gaitdisturbances and alteredmobility associated withAlzheimer’s means that walking

requires caution.Clients with Alzheimer’s

can show lack of ability tomaintain stability duringpostural changes. This caninclude getting up from aseating position, reaching

upwards, or walking up steps.

Individuals may forget thatthey can’t walk by themselvesand will attempt to get upwithout assistance. If they areexperiencing “sundowning”, theperson exhibits disruptivebehavior during late afternoonand early evening that canresult in falls.

The use of psychoactivedrugs to control mood andbehavior in patients with ADcan also cause the individualsto experience falls. Thesemedications can causedizziness, unstable bloodpressure, and worseningconfusion. Visual problemsand impaired depth perception

may make a person unable tosee hazards in their path ormisjudge the location of a chairor step.

Walkers and canes canhelp the client feel more

Falls are the mostcommon safety

problem in person’swith Alzheimer’s

dementia, yet they arenot a normal part ofthe disease process.



confident with walking.However, the caregiver mustremind the client to use themas well as bring the assistivedevice to the patient each timethey get up. Some assistivedevices are attached to theindividual’s clothes and the bed

or chair that is activated whenthe client gets up. Homesecurity systems chime whenan exterior door is opened, andGPS trackers can locate anindividual who has gonemissing from home.

For a patient who hasAlzheimer’s disease it isimportant to keep the patientsafe from falling. There are anumber of ways to do this bothat the patient’s home and in thehospital. If the patient is in a

wheelchair it is important to beaware of whether or not thebreak is on, especially whentransferring the patient. Insidetheir home you should firststart with assessing thepresence of stairs, if there arestairs how many are there? Isthere a steady handrail for thepatient to hold on to? If there

are stairs inside the home itshould be considered to installan automated lift to prevent theuse of the stairs altogether. Thelighting should be adequate inevery room and all throw rugs

should be removed or tightlysecured to the floor. The colorof the flooring should not besimilar enough to the color ofthe walls to cause possibleconfusion. In the restroom,tightly secured handrailsshould be installed to aid with

the transfer from sitting tostanding and if the shower doesnotAlready have a seat one can beinstalled.

All chairs with wheels inthe house should be removed.In the kitchen a non-skid matcan be

placed in front of the sink toavoid slippery floors whilewashing dishes. Frequentlyused items should be kept onlow shelves so as to prevent

unsafe climbing or reaching foritems that are too high orinaccessible. A phone should bewithin reach especially whilecooking.



Throughout the houseloose wires or cords should beremoved or secured with tapeand out of the patient’s way.The patient should always wearshoes that fit properly and donot have extra thick soles whileavoiding flimsy slippers.Slippers with firm soles can beworn but need traction toprevent from losing grip to the

floor.In the hospital, prevention

of falls is just as important as itis in the patient’s home. Thismay include keeping the floors

dry and free of any cords ordebris that the patient couldpossibly trip on. If the patientis on an IV the IV pole shouldbe kept out of reach or a breakshould be applied to avoid thepatient using the pole as anassistive device to walk with.

Should the patient need anassistive device one should beavailable in the patient’s roomand within easy reach. The bedshould be kept at the lowestpoint and side rails should beraised, but always less than 4 toavoid the use of unnecessaryrestraint. If the patient is

unable to ambulate to therestroom a commode should beavailable and within reach,otherwise the call light shouldbe within reach and alwaysvisible to allow the patient tocall the nurse for bedpan use.

The patient’s medicationsshould be monitored for

possible side effects ofdizziness or fatigue, which willincrease the patient’s risk offalling. The patient should alsobe frequently oriented to

Should a patient with Alzheimer’s fall, the most commoninjury is a traumatic brain injury (TBI). Symptoms of a

traumatic brain injury include: unconsciousness, impairedmemory, confusion, headache, dizziness, blurry vision,

nausea, vomiting, tinnitus, and dysphagia. Althoughunconsciousness is a symptom, if the patient remains

conscious emergency care should still be called to ensurean injury has not occurred after any fall.



prevent from trying to leave thebed from fear of not knowingwhere he or she is. Exercise isalso a huge piece in preventionof falls. Nurses can work withthe patient to carefullyambulate or perform range ofmotion exercises to maintain

muscle tone and preventatrophy.

Interventions that thenurse should make if thepatient has indeed fallen are asfollows: The first step isassessment. Before moving thepatient, ask what they thinkcaused the fall and assess any

associated symptoms. Checkthe patient’s vital signs and theapical and radial pulses; andcheck cranial nerves fordamage. Check the patent’sskin for pallor, trauma,circulation, abrasion, bruising,and sensation on any part ofthe patient’s body. Also, check

the central nervous system forsensation and movement in thelower extremities to make surethey didn’t damage any nerves.Assess the patient’s currentlevel of consciousness anddetermine whether the patienthas had a loss

of consciousness. Look for

subtle cognitive changes suchas difficulty speaking ordifficulty understanding.

Assess the patient’s pupilsand orientation; and note anypain and points of tenderness.

Observe the patient for hippain, shortening of theextremity, pelvic, or spinal painand the patient's leg rotation.Numbness or tingling in theextremities, back pain, rib pain,or an externally rotated orshortened leg may be

suggestive of spinal cordinjury, leg/pelvic fracture, orhead injury.

The second step is tonotify the physician and afamily member per hospitalpolicy. All other healthcareproviders should be notified toprevent a second fall. T The

third step is to monitor andreassess. After the patient hassafely returned back to theirbed the nurse should performfrequent neurologic and vitalsign assessments. Includingorthostatic vital signs; in somecases patients who have fallenhave appeared fine and were

found dead a few hours afterthe incident.

The last step the nursemust perform is to

document following thefacility’s policies and

procedures. Thoroughdocumentation helps toensure that appropriate

nursing care and medicalattention are given to the

patient.

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