Falls are due to medical or environmental causes
Once you consider all the different reasons that individuals may end up falling, it’s actually remarkable that it doesn’t happen more frequently. Falls are no laughing matter. When someone falls and breaks a hip, it all too frequently leads to a downward spiral ending in disability and possibly even death. Below are just some of the reasons that older adults might fall even if they don’t have dementia.
- Medication side effects
- Poor vision
- Dizziness, vertigo, and inner ear disease
- Muscle weakness
- Strokes affecting balance or walking
- Parkinson’s disease and related disorders
- Forgetting to use cane or walker
- Poor judgment of when it is safe to walk
- Needing to move quickly, such as to the bathroom
- Fainting or near fainting from any cause, including standing up too quickly
- Heart problems
Environmental and other causes
- Reaching for items on top shelves
- Carrying heavy items
- Dim light
- Clutter on the floor
- Polished or wet floors
- Rugs or carpets that are loose
- Improper footwear
- Stairs, particularly if dark or uneven
- Uneven ground
- Ice, mud, and other slippery ground
Individuals with dementia are at increased risk for falls for many reasons. They may have strokes or symptoms of Parkinson’s disease. They may forget to use their cane, walker, or other assistive device. They may have poor vision. They may have poor judgment leading them to reach for items on top shelves when they shouldn’t, wear improper shoes, walk on slippery surfaces, and venture out in dim light. They may be on medications to control behavior that often have the side effect of making them unsteady on their feet. They may be drowsy because of medications or for the reasons we discuss below. Lastly, they may have urinary urgency causing them to move quickly to avoid an accident.
Walking difficulties are common in dementia due to a variety of disorders
We generally don’t consider how involved a process walking is, but our ability to stand erect, keep our balance, and move forward—all without thinking about it—is truly remarkable. The brain “machinery” that enables walking is actually quite complicated, and it can breakdown in dementia leading to falls and loss of mobility in many different ways. Here we will mention two of the most common ways that dementia affects walking. However, because there are so many ways that walking can be impaired, if your loved one is having difficulty with their walking make sure you speak with their doctor about it.
Some individuals have problems walking due to dementia with Lewy bodies. These disorders typically disrupt the functioning of the basal ganglia. The basal ganglia are a part of the brain important for procedures, habits, and motor skills, so perhaps it won’t surprise you to learn that they are important for the motor skill of walking as well. When the basal ganglia are dysfunctional, walking can become slow, and is generally accompanied by shuffling or scuffing of the shoes. Falls can be in any direction, but are more often forward.
Small or large strokes may also affect the basal ganglia and its connections, leading to these same difficulties in walking in some patients with vascular dementia. Lastly, the basal ganglia may be affected in the severe stage of almost any type of dementia, so many individuals show these types of walking difficulties at some point in the course of their dementia.
The frontal lobes help to govern and coordinate walking, and when they or their connections through the white matter tracts are damaged, walking breaks down leading to slow and small (not shuffling) steps, multi-step turns, poor balance, and a tendency to fall backwards. Individuals with this type of walking problem are sometimes said to have a “magnetic gait,” because when you watch them walk it appears as if their feet are magnetically attracted to the floor. This type of walking problem is most typically seen in a disorder called normal pressure hydrocephalus when there is too much fluid in the brain but may also be seen in vascular dementia and other causes of dementia.
My father has fallen four times in the last month, the last time landing on his head. How do I figure out what the cause is?
- One way to start is by looking through the list of medical, environmental, and other causes of falls in this blog post. Consider whether each could be a reason why he is falling. Note that several causes may be contributing, so make sure to consider everything on the list.
© Andrew E. Budson, MD, 2020, all rights reserved.
Budson AE, O’Connor MK. Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It, New York: Oxford University Press, 2017.
Budson AE, Solomon PR. Memory Loss, Alzheimer’s Disease, & Dementia: A Practical Guide for Clinicians, 2nd Edition, Philadelphia: Elsevier Inc., 2016.