Table.

Approach to evaluation and management of falls for persons with advanced dementia in long-term care

Strategy	Involvement
Preferences: á priori discussion to establish goals of care and priorities of patient and family	Patient, family, care team
• Regular, ongoing communication with patient and family
Environmental strategies: lower beds, padding on floor, arm supports/rails	Care team
Evaluation: targeted search for readily reversible etiologies, such as medications, infection, metabolic derangements, dehydration, agitation	Care team
Management: Nonpharmacologic approaches*	Patient, family, care team
• Purposeful (Hourly) rounding
• Management of psychomotor agitation: therapeutic activities, relaxation, massage, music, rocking chairs, caregiver/family training
• Management of pain/discomfort: heat/cold, massage, relaxation
• Avoid physical restraints, bed/chair alarms, bedrails
Management: Pharmacologic approaches	Care team
• Reserve sedation for severe agitation, used in conjunction with intensive nonpharmacologic approaches (as above). SSRI recommended as first-line treatment.
• Pain: use around-the-clock acetaminophen, lidocaine patches, and other opioid sparing approaches where possible

SSRI = Selective Serotonin Reuptake Inhibitor

^*Evidence-based nonpharmacologic approaches for delirium and fall prevention in dementia patients in long-term care can be found at: www.hospitalelderlifeprogram.org and in the following references: Boockvar KS et al. J Am Geriatr Soc. 2016; 64:1108–1113; Kolanowski A et al. J Am Geriatr Soc 2016; 64:2424–2432.