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Meet the expert: Dr Louise Allan on dementia and falls

Interview between Dr James Frith and Dr Louise Allen on the links between dementia and falls.
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Hello. Thanks for joining us for another Meet the Expert video. I’m here with Dr. Louise Allan, who is a consultant physician and a researcher at Newcastle University. Hello, Louise. Hello, James. Have you ever been effected by falls? Perhaps not so much a fall but fainting. I was always a fainter in my youth. And when you asked me about that, the first thing that comes to mind is a faint I had on holiday in Thailand, where I came down some steps, caught my ankle, which caused a sudden pain and caused me to faint. What I remember most is waking up and lots of people around me.
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And they were all trying to get me up again, which of course made me dizzy again, and I was worried that I would faint. So that was rather unpleasant. You’re an expert in dementia and cognitive impairment. But you have also worked and done research in the field of falls. Yes. Can you tell us what is dementia, and what is cognitive impairment before we move on to talk about falls? Cognitive impairment is more of an umbrella term that covers all grades of severity of impairment. And dementia within that is the more severe end of the range. So cognition is the word we use for the higher functions of the brain. People think of memory firstly.
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But there are other functions that can come under that umbrella. Language is one– being able to use words appropriately. Another is recognising objects– being able to process them, that sort of thing; attention and orientation– knowing where you are, and also the ability to plan and carry out tasks and what you want to do; and also movement. And planning and carrying out of complex movements comes under that. So cognitive impairment can be mild. But at the more severe end of the range, and when it’s getting worse and it’s affecting people’s ability to look after themselves– it’s at that stage that we start to use the word “dementia.”
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In the Falls Clinic, we see a lot of people who have dementia that are affected by falls. Is it a big problem? Yes, it is a big problem in dementia. And some of the research we did here showed that people with dementia were 8 to 10 times more likely to fall than older people without dementia. So it is a very common problem, yes. And are there any characteristics that are different with the falls in people with or without dementia? Yeah. Well, people with dementia can be affected by the problems that other older people are. But there are also some particular problems for people with dementia.
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The most common cause of falling is probably difficulties with walking and with balance, which can be affected in dementia if the parts of the brain controlling movement are affected. But also, people with dementia find it difficult to do more than one thing at once. So walking and talking can be difficult for people with dementia. Also, dementia can affect the nerves that help us control our blood pressure, particularly when we stand up. So people with dementia can be more likely to get dizzy when they stand up. Also people with dementia are often on more medications than other older people. Some of those can affect blood-pressure control as well and make people more dizzy.
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Also, people with dementia are often on drugs that can make them sleepy. And for some of those drugs, it is important that we only use them for as short a period as possible, as they can make people more likely to fall over. Often, we find that friends, family, and carers are very worried about someone who has dementia and their falls. Is there anything that they can do to help? Well, the general advice that applies to all older people is important, so for instance, making sure the home is as safe as possible– removing any tripping hazards and keeping it well lit. Use of walking aids is important, so helping the person to use the aids they have appropriately.
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That can be more difficult as people become more impaired, and they may forget how to use a walking aid. Also, if somebody is getting episodes of dizziness, that’s something to watch out for, and it would be worth going to see the family doctor about that, particularly asking for a review of medications the person’s on in case any are making the blood pressure drop and also asking for a review of any sedative drugs that might make somebody more sleepy. And have you got a top tip for us to share with people about how to prevent falls? Yes.
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I think that trying to keep as active as possible would be my top tip for everyone but also for people with dementia because that probably helps us maintain our balance for longer. Lovely. Thank you very much, Louise. Thanks for joining us.
James is joined by Dr Louise Allan, an expert on dementia who also has a special interest in falls. In this ‘meet the expert’ video, James and Louise discuss how and why falls are common in people with dementia and whether there is anything that can be done to help.
Louise, who has now moved to Exeter University, recommends keeping active as one method to stay healthy and help prevent falls. Below there is a link to a website by the Alzheimer’s Society that describes different ways of keeping active for someone with dementia. It is useful because it contains advice for people at different stages of dementia.
If you would like to learn more about dementia you may be interested in our free Dementia Care: Staying Connected and Living Well course.
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