It’s a terrible topic to write about but needs to be addressed.  Sooner or later your demented relative will have a fall.

I hear that SMIL has had yet another fall, this time she has a black eye and cuts to her face, her daughter is feeling guilty and cried when she visited her mother upon seeing the injuries.

If you are the carer, falls are not something to feel guilty about, it is practically impossible to prevent them.

My mother fell before she was diagnosed with dementia and it was certainly a straw in the wind.  She had numerous falls and, amazingly, never broke a bone.  I was living in dread of her doing so; she was a holy terror whole, in a cast she would have been utterly unmanageable.

My mother’s first fall was outside, on top of my father, on the doorstep of her home.  It was Christmas and cold.  They had just had a substantial lunch and decided to walk it off.  When you eat a big meal the blood in your body will rush to your stomach to aid digestion.  Unfortunately where it is rushing from, is your brain, because of gravity.  Add a sudden change from a centrally heated house to a cold doorstep and a drop in blood pressure will do the rest.  Many elderly men suffer from heart attacks going from warm houses onto snowy drives with a shovel.  In this instance my mother had not had a heart attack, it was my frail and thin father who suffered the damage; he looked as if he had been in a boxing match and lost.

Several of her subsequent falls happened after meals.  On one occasion she thoroughly smashed the arm of the dining chair and the leg.  As this was well into dementia, she was upset by the damage and didn’t know who had done it.  I tried to get it mended but could not do so, it was too smashed.  I rearranged the chairs instead.  The obvious practice to adopt here if you are the carer for a demented person is to institute a regime in which you sit for a little while after a meal and get up slowly, ideally holding on to something.

A walking stick, frame or other balance aid is a good idea, however, giving a stick to someone who is frequently aggressive is not.  SMIL’s stick has been taken from her because she threatened other residents with it.  My mother threatened to hit me with her stick on a few occasions.  Fortunately as she was cared for at home there was no need to remove the stick and I learned to get out of the way, or arrange matters so that the stick was not too near if she was aggressive.  In a residential home, with many elderly people to care for, keeping an eye on one dangerous lady armed with a stick is not so easy.

Another cause of falls is postural hypotension.  A sudden drop in blood pressure causing fainting or a fall can be due to a change in position, such as getting up from lying in a bed quickly or a fault with the pumping of the heart for example.  The S&H used to feel giddy if he got up too quickly at the stage where, as a teenager, he had outgrown his strength and was very thin.  Sitting on his bones in a firm chair compressed the blood vessels in his legs, as he stood the blood rushed back into the vessels, he had pins and needles and felt faint.  Demented people almost always lose weight at some stage and can become dangerously thin.  My mother-in-law did this and was positively skeletal by the time she died. My mother lost two stones in weight in three weeks when she forgot to eat.  I did manage to help her regain weight by becoming an expert in cake making, but in a home where lots of people are eating at once, who is able to observe which residents are eating and which are not, especially when some will need assistance with feeding anyway?

Another cause of falls is simply the degeneration of the working of the brain in dementia.  It is, after all the faulty working of the brain which is the most observable characteristic of the disease.  The centres for balance are just as likely to be affected as any other area of the brain.

In a healthy person movement assists blood to flow around the body and to the brain, it helps with digestion and regulating various bodily functions.  In a demented person, being seated immobile for many hours will hasten the disease process.  In Alzheimer’s disease, for example, the build-up of amyloid plaques disrupts the normal functioning of the brain and the systems that clear waste matter generated by the usual working of the brain.  Whether this disease process is hastened by immobility is currently being studied in various locations but the entire body works on the principle of use it or lose it.

Falls are frightening to the fallen. I speak as someone who has tripped twice, once over my fitness equipment, vacuuming the ceiling when I was trying to live in two houses at once, care for my recently widowed and obviously sick mother and keep fit and keep my house  like a new pin despite leaving two men unsupervised to live there during the week.  I broke my left forearm on that occasion.  The lesson to learn from my mistake if you are a new carer is only to do what is doable.  Sufficient unto the day is the vacuuming of the ceiling.

The second time I tripped over the cat, who was dashing for the cat door as I was walking the other way, laden with a pile of cat food dishes that I couldn’t see over.  This was the one that resulted in the second worst break the hospital had ever seen, and five big bits of metal still in my arm.

You do feel foolish after a fall, and you do hurt, quite a lot.  One of the rare advantages that demented people have after a fall, is loss of memory, after a day or two or less, they won’t be able to explain the bruises, and will not be living in fear of the recurrence of a episode they do not remember.  They will still be hurting, if you are the carer it is worth keeping on with the painkillers and obviously getting the demented person an Xray, unless you are absolutely certain there is no damage.  Some fractures are not instantly apparent.  I have two bent toes that testify to the truth of that.

If you are the carer at home all the obvious aids to staying upright such as uncluttered floor spaces, moving with assistance to keep muscles strong, moving slowly and carefully and so on will all help.  Instituting safety measures from the outset, such as grab rails in the shower, handrails by the staircase and really simple rules such as not dashing to answer the phone or the door, letting someone else carry the tray with the bowl of hot soup on it and just in general starting to move carefully, will all help.

If the worst happens don’t improve the shining hour if you are the carer by beating yourself up mentally.  Know how you can get your demented person to the hospital in a crisis and remain calm because it helps them.  (Though there is no need to do what the OH did when I broke my first arm and have a shower, wash your hair and have a cup of coffee before taking the broken to hospital, having inserted the broken arm into an elastic bandage, misaligning the bones, first.)

We are all subject to gravity.  If it adversely affects your demented person the most helpful attitude to take is practical and then assist them to continue to live their lives themselves.

Be glad it’s not you.  Be kind.  Be cheerful.


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