Falls


There is no reason to presume the figure in the UK would not be similar. The best estimates hold that over 70 per cent of people living in long term care have varying degrees of dementia, either diagnosed or undiagnosed.9


It is clear that these impairments lead to an increase in falls.10


One study found


that someone with dementia is about eight times more likely to fall than a peer without dementia.11


Another found older


patients with dementia fall between two and three times more than patients without dementia.12


This is not surprising. While walking


becomes automatic as one exits infancy, it still involves executive function and brainpower, not just reflex. If your working brain capacity, which is compromised with dementia or other cognitive or sensory impairment (CSI), is now also preoccupied interpreting the environment it can get cognitively and sensorily overwhelmed and distracted. As “gait is no longer considered merely automated motor activity but rather an activity that requires executive function and attention as well as judgment of external and internal cues,”13


it can lead to falls without any


obvious physical obstacles being apparent. Unfortunately, it is not generally understood that it is not just physical obstacles in the environment that can cause


an individual to fall but also other seemly benign design and environmental features. Many falls happen where people have no recollection of the fall, with no obvious cause of the fall found. Elements within an environment and the pressure the overall design puts on the remaining cognitive abilities need to be understood if we are to reduce the falls risk in care and health settings. The impact of the environment should not be underestimated. To do so results in a missed opportunity to design for greater independence and mobility for residents in our care. We should not restrict people’s rights


to freely move around to reduce their fall risk; however, we do need to ensure the environment is designed to support their remaining abilities and additional needs. The physical, visual, and auditory environment must be considered. Only


Too often care homes look nice, claim to be inclusive and ‘dementia friendly’, but in reality have very little functional and cognitive knowledge designed in


when we understand how CSI impacts a person’s relationship and engagement with the environment, and how this contributes to falls, can we design and build to reduce the prevalence of falls in our older population.


Cognitive Impairments Reduced cognitive ability can result in difficulties with memory, reasoning, judgement, planning, focus, and decision making. This can lead to a person experiencing difficulties in finding their way around and engaging with their environment and the people within it. Being aware of the challenges that


cognitive impairment poses for people, we can design to support their needs and reduce the stress, anxiety, and cognitive overload they experience in poorly designed environments.


Poor design can accelerate both functional (ability to cope with everyday living) and cognitive decline which can severely affect a person’s independence, dignity, and autonomy.


Sensory Impairments Sensory impairment can affect sight, hearing, taste, smell, and touch. This can impact how a person experiences and interacts with their environment. The general perception is that we engage with our environment through sight, but we underestimate the input we rely on from our other senses to interpret the world around us. For example: blind and partially sighted


people rely on other senses to compensate for their visual impairment, to make sense of the world, and to help navigate it. They use aids such as canes and guide dogs to extend their cognition. Eighty per cent of the visually impaired can use their remaining sight to interpret spaces if they are designed to support visual understanding.14


Through inclusive design


interventions, we can support all the senses to assist and ease understanding. Eight years of research in the field of design for CSI has shown me that while each individual may have their own unique symptom, there are two primary design principles that benefit all. It should be noted that the principles may appear simple and obvious, but the execution and science to achieve optimum outcomes is complex and multifactorial. Light reflective values and contrast are starting points but reducing falls can


February 2023 www.thecarehomeenvironment.com 25


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