One of the most common safety problems in a long-term care setting are falls. Residents with Alzheimer's disease (AD) are at an increased risk. If caregivers, both professional and family, are aware of the issue of fall prevention, some accidents can be avoided.

Falls can have many causes. One example might be a 75-year-old woman with AD sitting in a chair outside her room when she realizes she needs to use the bathroom. She forgets her cane and to turn the light on in her room. As she hurries toward the bathroom, she catches her foot on a chair and falls. Did she fall because it was dark or because she was moving too quickly? Could she have prevented the fall if she had her cane?

• Age. While age itself does not cause falls, it does result in a slower reaction time and less efficient balanace systems. Often, older adults in nursing homes get little physical activity and become weakened and out-of-shape.
• Health Problems. Arthritis, Parkinson's disease, foot problems, dizziness when getting up or any health condition affecting walking or balance can be problematic. Visual impairments can also increase the risk of falling.
• Environment. Proper lighting, nonslippery floors, the presence of grab rails, the use of supportive footwear, lowered beds and clear walking paths are good preventive measures for decreasing falls in long-term settings.
• Medications. Blood pressure medications, water pills, tranquilizers or sedatives, and some antidepressants and antihistamines can increase the risk of a fall.

Individuals with AD and other dementias may have some additional problems that place them at an even higher risk of falling. The brain cell loss association with AD often causes a slower reaction time. Poor depth perception or trouble with visual-spatial relations can result in misinterpreting the environment such as missing a step. Some people with dementia have apraxia, or trouble coordinating movements and walking. Memory loss can result in getting lost, forgetting walking aids or difficulty remembering how to use them correctly.

Health-care facilities want to prevent all falls, but this goal is not realistic. We have to remember that one-third of older adults who live at home also fall each year. However, there are several things we can expect from a facility to keep our loved ones as safe as possible, such as:

• Walking paths and rooms should be safe and free of obstacles.
• Residents wear supportive shoes, receive regular exercise and walking to maintain strength.
• Physicians and occupational therapists are available, as needed, to address mobility issues.
• Falls are thoroughly investigated, and steps taken to decrease risks.
• Restraints are rarely used; the restrictions they cause only increase weakness. For instance, drugs or chemical restraints can cause harmful interactions with existing medications. Other restraints can cause health problems such as incontinence, pressure sores or depression. Research suggests they may not prevent falls.

If you have any concerns about falls by a loved one in a nursing home, discuss them with the staff. They should be willing to discuss your concerns and help find ways to decrease your loved one's risk of having a fall.