1. Advanced Dementia in Long-Term Care: Avoiding the Pitfalls of Fall Prevention
- Author
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Eran D. Metzger, Annie M. Racine, and Sharon K. Inouye
- Subjects
Male ,medicine.medical_specialty ,MEDLINE ,Poison control ,Suicide prevention ,Article ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,Injury prevention ,medicine ,Humans ,Dementia ,030212 general & internal medicine ,Intensive care medicine ,Aged ,030214 geriatrics ,business.industry ,Palliative Care ,medicine.disease ,Long-Term Care ,Nursing Homes ,Psychiatry and Mental health ,Long-term care ,Quality of Life ,Accidental Falls ,Geriatrics and Gerontology ,business ,Fall prevention - Abstract
Falls are viewed as a preventable cause of injury, functional loss, and death in older adults with dementia, and have been used as a marker of quality of care in long-term care facilities. Despite intensive intervention around fall prevention in these settings, falls and injury remain frequent, particularly among residents in the advanced stages of dementia. In this clinical review, we consider the common challenges and pitfalls in both the management of falls and the provision of palliative care in advanced dementia. We then describe a palliative approach to falls in advanced dementia that involves identifying individuals who would benefit from this care approach, framing falls and loss of mobility as a quality of life issue, and devising an individualized symptom assessment and management plan. A palliative approach can lead to recognition and acceptance that recurrent falls are often symptomatic of advanced dementia, and that not all falls are preventable. We conclude that falls in the advanced stage of dementia can be sentinel events indicating the need for a palliative approach to care. Rather than replace falls prevention activities, a palliative approach to falls prompts us to select dementia stage-appropriate interventions with a focus on symptom management, comfort, and dignity.
- Published
- 2018