Dementia & accidental falls: major causes of disability among the elderly

By Dr. Dilhar Samaraweera

It is hard to overstate the impact that COVID has had across our society and communities. The ongoing pandemic has brought to light the gravity of numerous other secondary chronic medical conditions and gaps in healthcare; in particular our care of the elderly who is a segment of the population most at risk by the virus. With a 12.5% section of the country’s population classified as geriatric – individuals over the age of 60 years – it has become vital that they have access to knowledgeable caregivers and quality geriatric care.  The most prominent of the conditions that plague this group of people are dementia and accidental falls.

‘The silent sufferers’

Dementia is a syndrome in which there is deterioration in intellectual capacity which includes memory, judgement, behaviour and the ability to perform routine activities of daily life independently. Although dementia mainly affects older people, it is not a normal part of ageing. Worldwide, around 50 million people have dementia, with nearly 10 million new cases diagnosed every year. With a rapidly ageing population in the country, there is an increase in the percentage of dementia patients here as well, but there is a lack of data to relay it.

Caregivers are able to identify the onset of dementia when a patient starts repeating the same questions, gets lost in familiar surroundings, keeps things in inappropriate places, accuses others for stealing their items, displays difficulty in completing familiar tasks, does not remember dates & times, and cannot identify familiar persons.  As the disease advances, the patient will eventually find it difficult to even attend to personal care.

In turn, it is then absolutely essential that caregivers are increasingly tolerant and observant as dementia patients often lack insight to the disease and find it difficult to express themselves. This is a reason why over the years, these patients have garnered the name “Silent sufferers”. A regular care giver could identify a patient’s needs by the keen observation of facial and verbal cues as well as the movement of patients with advanced dementia.

Although age is the strongest known risk factor for dementia, it is not an inevitable consequence of ageing and does not exclusively affect older people. Numerous scientific studies show that people can reduce their risk with regular exercise, not smoking, avoiding the excessive consumption of alcohol, proper weight control, a healthy diet, and maintaining normal blood pressure, cholesterol and blood sugar levels. Also, activities which stimulate cognition such as engaging in puzzles, Sudoku, and scrabble as well as actively participating in healthy conversations and social activities should be encouraged to help prevent deterioration in intellectual capacity.

‘Accidental falls’

Accidental falls have been identified as a leading cause of disability and death among the geriatric population. Each year 28-35% of people over 65 years and 32-42% of people over 70 years fall prey to accidental falls. A hospital-based study conducted among the elderly in the district of Colombo found that 23% of the people who were over 65 years have these unfortunate accidents each year.

Falls are preventable and consequences of falls could be disabling and could even result in death. Frail elderly persons with brittle bones, lack resilience and are vulnerable to even minor stresses in the environment. Thus even falls from standing height could result in fractures of hip and spine, depriving of their mobility and independence.

Falls occur due to deficiencies in the intrinsic capacity, a combination of physical and mental capacity, of a patient. Improving vision and hearing, walking and balance, as well as increasing patient vitality by proper nutrition and exercise and mindfulness with cognitive stimulation contribute to prevent falls. Improvement of the environment with good light, reduced cluttering of furniture, avoiding slippery floors, installing grab bars, and wearing of appropriate footwear will prevent falls in this vulnerable population.

Caregivers need to pay close attention to identify patients who are at risk and take steps to avoid these accidents. They need to be aware of the daily life cycle of their elderly patients and provide assistance pro-actively. A history of previous falls, presence of incontinence, postural instability, hearing and vision deficiencies, decreased memory and intellectual impairment, presence of other diseases and being on multiple inappropriately prescribed medicines are factors which indicate high risk of falls.

 Why mental health matters?

Caregivers and family members need to understand and be aware of not only the physical needs of their geriatric loved one but their ideas, emotions and concerns as well. The caregiver and the patient should put work together to maintain a positive mindset. Identifying the low mood of the patient by symptoms of depression such as hopelessness, lack of motivation, lack of interest even in activities that the patient used to enjoy, expression of dissatisfaction with life, loss of appetite and sleep disturbances should be done proactively by family members and health staff. Symptoms of depression may be erroneously attributed to ageing and seeking medical advice avoided but it is the critical to do so in these scenarios.

Mental health has a direct impact on physical health and vice versa. For example, older adults with non-communicable diseases such as heart disease, stroke, diabetes mellitus, chronic renal diseases, osteoarthritis, asthma and cancers have higher rates of depression than those who are healthy. Additionally, untreated depression in an older person with chronic diseases can negatively affect its outcome.

Finally, it is essential to be aware of the risk factors of these medical conditions, learn to identify them in loved ones, gain access to quality geriatric healthcare and most importantly exercise patience and vigilance in dealing with our elderly loved ones.

[The writer is Dr. Dilhar Samaraweera, Consultant Physician specialized in Geriatric Medicine– Hemas Hospitals Thalawathugoda and Consultant Physician, Geriatric Unit, Colombo South Teaching Hospital, Kalubowila]