Can falls in patients with dementia be prevented?

The annual incidence of falls in patients with dementia is 40-60% [1, 2], twice the rate of the equivalent cognitively normal elderly population [1]. Serious injury is more common and one-quarter of patients with dementia who fall sustain a fracture: three times the age-adjusted figure for expected fracture incidence [1, 3, 4]. In addition, patients with dementia who fall have a poorer prognosis than cognitively normal elderly fallers. They are less likely to make a satisfactory recovery from injury [5], five times more likely to be institutionalized [2] and, after fracture neck of femur, have a 6-month mortality of 71%—more than three times that of cognitively intact patients [5]. It is often assumed that falls are a normal part of the dementing process, that patients with dementia will be unable to co-operate with investigations, that there is no effective treatment for falls in dementia and that, even if there was, patients would be unable to cope with the necessary interventions. The prevalence of dementia in the UK is about 5% of the population aged over 65 and 15% of those aged over 80 [6, 7]. With changes in ageing demographics [8], the problem of falls in patients with dementia cannot be ignored.