As people transition from the Mild to the Moderate Stage of Cognitive Impairment, they begin having issues with balance. People are more likely to fall when they are in the Moderate to Severe Stages of Cognitive Impairment (at this point called Dementia).
The reason why depends on the type of Dementia. For people with Cognitive Impairment due to Alzheimer's, they have difficulty knowing how to position their body to walk (called apraxia, which means inability to perform purposeful actions) due to abnormalities in their frontal or parietal lobes of their brain. Depending on the parts of the brain affected, they may also have slowed reaction time to objects in their way (such as a curb or step), and be more likely to fall.
People with Vascular Dementia also develop slowed reaction times due to slowed brain connections and are more likely to fall. People with Dementia can also develop "Parkinsonism", which means they don't have Parkinson's Disease, but have signs of degeneration of their brain's movement systems containing dopamine. They may develop a tremor, or may have a stiff body, pain, slowed reaction times, and slow movements. People with Parkinsonism are very likely to fall. Also, people with Cognitive Impairment due to Lewy Body Disease or Parkinson's Disease Dementia have Parkinsonism and are also very likely to fall.
Falls can be dangerous at any age, but especially for people over 65. If there is a head injury, they may develop a concussion to their brain that may be slow healing or not heal properly at all. People over age 65 are also more likely to have thin bones, as in osteopenia and osteoporosis, and are more likely to be hospitalized due to a hip fracture, wrist fracture, or any other fracture. Also, people in the moderate stages of Cognitive Impairment may be very thin because they sometimes forget to eat or are unable to finish their meals. They are more likely to have a fracture when they are too thin. Hospitalization, pain, and medications given in the ER or hospital, and not being in their home environment can worsen cognitive impairment in people with memory issues and lead to progression of their cognitive disorder. Serious injuries, hospitalizations, and progression of Cognitive Impairment due to falls are very important to prevent in people with memory issues, especially in the moderate and severe stages.
Motor coordination, balance, and reaction time can sometimes be helped by medication. Depending on the cause, this may include sinemet (carbidopa/levodopa), adderall (dextroamphetamine-amphetamine), or wellbutrin (bupropion). But these medications are best given in combination with physical therapy. Physical therapy can help strengthen leg muscles and balance. However, most insurances only cover 6-12 weeks per year of physical therapy visits. The therapist should print out the exercises, and family should make sure to do them with them at least 4 to 5 times per week to avoid muscle deconditioning. Occupational therapists can help visit the home, or ask about the home, and make sure it is adapted for a person who is at risk of falls ("fall risk"). This may include recommending a sit-in-shower, handrails, grab bars, improved lighting, and non-slip mats and treads to prevent falls.
Sometimes a person's balance is so poor (in the late moderate and severe stages), that they may require a cane, walker, or even a wheelchair at times. Walkers often come with a seat so a person can sit down and rest when they are tired in a public place. It is very difficult for people in the moderate and severe stages of cognitive impairment to remember to use a new device, when for the last 6 to 9 decades they have never used it. I would not recommend scolding them or using a derisive tone when they do not immediately reach for it. It is not their fault that they cannot remember to use a new device; it is because of their brain.
I would keep the cane, walker, or wheelchair near the person when they are sitting down, and sit with them until they are ready to stand up. If they do not reach for the device on their own, gently place the device in front of them and repeat a phrase in a cheerful manner "Walker when you walk!" or something like that. Sometimes people with memory issues can learn new procedures, especially if they learn through movement. Simply reaching for the cane or putting their hands on the walker hundreds of times may be enough for them to learn to do it eventually.
In the late moderate a severe stages, sometimes a person's brain has deteriorated so much that they cannot lift their feet enough up from the ground to avoid tripping on carpets or rugs, or they teeter so much when turning that they are about to fall, or their are so slow in reacting that they cannot climb a curb. In these cases (late moderate to severe stage), the only solution is having a caregiver with them 24/7 when they are walking to prevent falls. They will not remember how to use a walker or wheelchair on their own. This can be very expensive, but most insurances cover at at least 28 hours per week for a home health aide. Please ask me or your PCP for a prescription for home health care or home care.
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