Blood thinners help prevent dangerous blood clots and strokes, but they also increase the risk of serious bleeding following an injury.
For someone living with dementia, extra caution is important. Falls may go unwitnessed, and your loved one may not remember hitting their head or be able to describe symptoms. Bleeding inside the skull can occur without obvious immediate symptoms. Even subtle new confusion after a fall may signal a serious injury requiring emergency evaluation.
Fortunately, simple precautions can reduce these risks while helping your loved one remain safe, active, and independent.
Use Blood Thinners Safely
Give the medication exactly as prescribed.
Do not stop or change the dose without medical advice.
Ask the healthcare team before using aspirin, ibuprofen (Advil/Motrin), naproxen (Aleve), or new supplements.
Keep an updated medication list available.
Tell all healthcare providers, including dentists, about blood thinner use to help prevent bleeding and harmful drug interactions.
If your loved one takes warfarin (Coumadin/Jantoven), follow instructions for INR monitoring.
Ask the pharmacist what to do if a dose is missed. Instructions vary by medication.
Prevent Falls and Injuries
Keep floors free of clutter, loose rugs, and electrical cords.
Use nightlights in bedrooms, hallways, and bathrooms.
Encourage supportive, nonslip shoes rather than walking in socks.
Install grab bars and use a nonslip surface in the shower.
Encourage use of a walker or cane if recommended.
Encourage slow position changes, especially when getting out of bed.
Avoid ladders, step stools, and activities with a high risk of falling.
Report new dizziness, weakness, or balance problems to the healthcare team.
Reduce Cuts and Bruising
Use an electric razor instead of a blade.
Use a soft-bristled toothbrush.
Wear gloves when gardening or working with sharp objects.
Use caution with knives, scissors, and nail clippers.
Avoid contact sports and activities likely to cause injury.
Apply firm, continuous pressure to minor cuts until bleeding stops.
Know When to Get Medical Help
When to get an Emergency Department evaluation:
Any suspected head injury, including an unwitnessed fall when a head injury cannot be ruled out.
When to call 911:
Heavy bleeding that will not stop.
Vomiting blood or material resembling coffee grounds.
Black, tarry stools, which may indicate internal bleeding and require immediate emergency evaluation.
Sudden severe headache, new confusion, weakness, difficulty speaking, or fainting.
Serious injuries, particularly involving the head, abdomen, or back.
Falls require special attention
Any fall involving a head injury – or an unwitnessed fall when head injury cannot be ruled out – requires immediate emergency evaluation even if your loved one seems fine.
Call 911 if there are concerning symptoms, significant injuries, or it is unsafe to transport your loved one.
For a fall without suspected head injury or concerning symptoms, contact the healthcare team promptly for guidance. Do not dismiss a fall simply because your loved one appears unharmed.
Urgent Medical Attention — Same Day
Contact the healthcare team immediately for same-day evaluation of:
Blood in the urine or stool, even if the amount appears small.
Frequent nosebleeds or unusual gum bleeding.
Large or unexplained bruises.
Persistent bleeding from minor injuries.
Do not wait for a routine appointment. If the healthcare team is unavailable, seek urgent medical evaluation. Heavy, recurrent, or uncontrolled bleeding requires emergency care.
Special Considerations for Someone Living with Dementia
Family caregivers should pay particular attention to:
Unwitnessed falls: Your loved one may not remember falling or hitting their head. If a head injury cannot be ruled out, seek emergency evaluation.
Changes in behavior: New confusion, unusual sleepiness, agitation, headache, or changes in walking or balance following a fall may indicate an injury.
Medication management: Memory problems may lead to missed or repeated doses. Watch for this issue, even early in the illness. Begin providing supervision as needed and gradually assume full responsibility for medication administration as the disease progresses.
Unsafe activities: Evaluate the need for supervision with stairs, bathing, outdoor activities, and other situations that increase fall risk.
Changes in mobility: Report increasing falls, dizziness, or unsteadiness. A medication review, physical therapy, or mobility aid may help reduce risk.
Important: Never assume that new confusion or a change in behavior following a fall is simply part of dementia.
Remember: Blood thinners can be lifesaving. The goal is to use them safely. Do what you can to prevent injuries. Watch for unusual bleeding. Take every head injury seriously.