FINDING BALANCE ALGORITHM
Age-associated changes in cognition can adversely affect balance and mobility as well as perception and judgment. As part of the assessment of an older person for falls risks it is recommended that a standardized brief cognitive test be administered. There is no evidence to advocate for one test over another at this time.
An estimated 10% of people over the age of 65 and 50% of those over the age of 80 have some form of cognitive impairment, ranging from mild deficits to dementia. Even mild forms of impaired cognition can be associated with an increased risk of falls among older persons. For example, a study of community-dwelling seniors at risk of falling found that the likelihood of falls increased incrementally as Mini-Mental State Examination scores declined from 30 to 22. Subtle cognitive deficits might increase the risk of falling because of impairments in judgement, attention, or executive function.
People with dementia have 2-3 times the risk of falling. Well-known risk factors such as motor impairments show particular characteristics in those with dementia. For example, balance, lower extremity coordination, walking speed and stride length are adversely affected in those with dementia.
Behavioural disturbances (e.g., risk-taking behaviour) contribute to a higher risk for falling in this population. As well, there is a higher prevalence of many other risk factors in those with dementia, including the use of psychotropic medication, orthostatic hypotension/syncope, and lower activity levels.
Clients with dementia are often unable to comply with risk factor management strategies. Assessment therefore must identify all possible risk factors for falls, including biological, behavioural, social-economic and environmental factors. The latter are important to understand as circumstances surrounding falls can explain some of the variation in falls among those clients with dementia.