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Adapting the Home for People with

Confused and Disoriented Seniors
Present Danger to Selves and Others
By: Carol Canada, RN, CCM

What kinds of home adaptations are necessary?

If a person with Alzheimer's disease or some other form of dementia lives at home, caregivers must adapt the environment to ensure the safety of the senior and other household residents. It is important, of course, to take all the usual precautions, such as having smoke alarms and a fire extinguisher; making sure appliances and heaters function properly; and keeping extra food, flashlights and blankets on hand in case of earthquakes, power outages or other emergencies. However, people with Alzheimer's and dementia often do not recognize obvious dangers.

These structural and design changes will help keep them safe:

  • In the bathroom, install safety locks on cabinets containing medicines, household cleaning agents, razors and other potentially dangerous items. You can also move these items to a padlocked toolbox or elsewhere.

  • In the kitchen, put safety locks on drawers or cabinets containing matches, liquor, knives, household cleaning agents, scissors and any other potentially dangerous items.

  • Put safety knobs on your stove, or install a timer so the stove can only operate during certain hours.

  • Lower the temperature on the water heater to 120 degrees and label all hot-water faucets clearly with large, red letters. All seniors are at greater risk for scalding because of thinner skin and slower reaction times, and a person with dementia who may not recognize the danger even more so.

  • Remove locks from bathroom and bedroom doors. A senior with Alzheimer's might lock a door and then not remember how to unlock it.

  • Remove all clutter, throw rugs and other potential obstacles. Make sure hallways are clear and easy to navigate.

  • Decorate with solid colors whenever possible. Patterns can confuse someone with Alzheimer's

  • Keep the home well-lighted at night. Waking up in total darkness can disorient a person with Alzheimer's.

  • Place additional locks on doors a senior might use to leave the house and wander off. Locate the locks high up on the door or somewhere else difficult for the senior to find.

  • Place solid black mats on the floor in front of doors leading outside. These can appear as deep holes to people with Alzheimer's and may keep them from passing through the door.

  • Check outside the house for potentially dangerous items such as saws, lighter fluid, power tools and paint. Put such items in a locked garage or tool shed.

  • If you have a swimming pool, take precautions to prevent the senior from falling or wading in. Install a firm pool cover or put up a fence with a locked gate.

Other safety considerations

In addition to home adaptations, keep in mind a few other safety considerations when dealing with seniors suffering from Alzheimer's or dementia:

  • Do not allow them to smoke unattended.

  • Make sure the senior wears an ID bracelet containing medical information and a phone number. Sometimes police find Alzheimer's or dementia patients wandering far from home and are unable to immediately identify the person and locate the family.

  • Determine whether it's time the senior stopped driving. Someone in the earliest stages of Alzheimer's or dementia may still be able to drive relatively safely, but at some point you will likely have to step in and prevent them from continuing. This may involve the drastic step of removing the keys or even disposing of the car. Ask a physician for guidance in making the decision and talk with the senior about this potentially difficult transition.

  • It is important for seniors to stay engaged and involved in activities of interest to them as long as possible, but a moment will arise when not just driving but other tasks - such as shopping or going to appointments alone - must simply be deemed too dangerous. Because the illness follows a different course in each individual, it is part of the caregiver's responsibility to continually reassess the situation and determine when a senior can no longer safely perform a particular function.

Balancing the senior's need for independence with legitimate concerns about their own and others' well-being is one of the most heartwrenching aspects of caring for someone with Alzheimer's. The constant vigilance can exhaust even the most attentive and loving caregiver. Physicians, nurses and other professional caregivers - as well as family members, friends and others in the caregiving support network - can help you make these assessments as the diseases progresses.