Home safety is important for everyone, but this is especially true if you are caring for someone living with Alzheimer's disease or a related dementia. The need for a comprehensive safety plan becomes increasingly important as the disease progresses.
Currently, there are more than 6 million Americans living with Alzheimer’s disease. In addition, there are more than 11 million unpaid family caregivers overseeing care for these individuals. Unless new treatments are advanced, the number of Americans living with Alzheimer’s is expected to reach nearly 13 million by mid-century.
Alzheimer’s disease is a progressive, fatal brain disease and the most common form of dementia. Hallmarks of Alzheimer’s disease include the abnormal build-up of two proteins in the brain – Beta-Amyloid and Tau. Beta-amyloid forms plaques to disrupt neuron connections between brain cells. Tau forms tangles that disrupt neuron connections inside brain cells. Both Amyloid and Tau damage and kill brain cells causing memory loss, personality changes, and the ability to carry out daily living activities.
The brain changes associated with Alzheimer’s and other dementia affect each person differently and can pose new safety concerns and considerations that may have not existed previously. These include changes in physical ability (having trouble with balance), judgment (forgetting how to use household appliances), and behavior (becoming easily confused, suspicious, or fearful).
“In the wake of an Alzheimer’s or dementia diagnosis, caregivers need to reevaluate the home environment through a new lens,” said Monica Moreno, Senior Director of Care and Support, Alzheimer's Association. “Previously, you may not have worried about your loved one wandering off, using the stove, or driving a car, but these can be potential concerns for people living with dementia. It’s important for family caregivers to educate themselves on potential hazards and work to mitigate them before a crisis occurs.”
Moreno says taking measures to improve safety can prevent injuries, help a person with dementia feel more relaxed, less overwhelmed, and maintain his or her independence longer. She says it is important for families to re-evaluate safety plans as the disease progresses and safety issues change. The Alzheimer’s Association offers a home safety checklist with steps to keep your loved one safe, including these:
Evaluate your environment – A person with dementia may be at risk in certain areas of the home or outdoors. Pay special attention to garages, basements, and outside areas where there are more likely to be tools, chemicals, cleaning supplies, and other items that may require supervision.
Be prepared for emergencies – Keep a list of emergency phone numbers and addresses for local police and fire departments, hospitals, and poison control helplines. Have working fire extinguishers, smoke detectors, and carbon monoxide detectors.
Install locks out of sight – Place deadbolts either high or low on exterior doors to make it difficult for the person to wander out of the house. Keep an extra set of keys hidden near the door for easy access. Remove locks in bathrooms or bedrooms to prevent the person with dementia from locking themselves in.
Keep walkways well lit – Add extra lights to entries, doorways, stairways, areas between rooms, and bathrooms. Use night lights in hallways, bedrooms, and bathrooms to prevent accidents and reduce disorientation.
Remove tripping hazards – Keep floors and other surfaces clutter-free. Keep extension cords tucked away. Remove throw rugs or smaller furniture items such as magazine racks and coffee tables that can be tripping hazards.
Avoid safety hazards in the kitchen – Use appliances that have an auto shut-off feature. Prevent unsafe stove usage by applying stove knob covers, removing knobs, or turning off the gas when the stove is not in use. Remove decorative fruits, sugar substitutes, and seasonings from the table and counters.
Place medications in a locked drawer or cabinet – To help ensure that medications are taken safely, use a pillbox organizer or keep a daily list and check off each medication as it is taken.
Avoid injury in the bathroom – Install walk-in showers. Add grab bars to the shower or tub and at the edge of the vanity to allow for independent, safe movement. Add textured stickers to slippery surfaces. Set the water temperature in sinks and bathtubs at 120° F or less to prevent scalding.
Improve laundry room safety – Secure and lock all cleaning products such as detergent, laundry packets, and bleach. Prevent access to the washer and dryer. If possible, keep the door to this room locked.
Assess safety hazards in the garage and/or basement –Limit access to large equipment, such as lawn mowers, weed trimmers, or snow blowers. Keep poisonous chemicals, such as gasoline or paint thinner out of reach. Lock and properly store ladders when not in use to prevent tripping or climbing hazards. Remove access to car keys if the individual with dementia is no longer driving. Install a motion sensor on the garage door.
Remove or secure firearms and other weapons – The presence of a weapon in the home of a person with dementia may lead to unexpected danger. Dementia can cause a person to mistake a caregiver for an intruder or lack the cognitive abilities to use a firearm safely.
One of the more challenging safety issues families face during the early stage of Alzheimer’s are decisions about driving. Changes in perception, reaction time, impaired judgment, along with memory can make driving unsafe. Still, many individuals struggle with the decision to hang up their car keys as it represents a loss of independence and autonomy.
The Alzheimer’s Association encourages families to broach this sensitive topic early and before a crisis occurs. Discuss transportation alternatives, transition plans that limit driving to certain distances and hours, and warning signs that will signal the need to stop driving. Having these discussions early can help get families on the same page, giving the person input into the decision, while also reducing the stress experienced by family members when tougher decisions need to be made.
The Alzheimer’s Association offers online tools to help families discuss this sensitive topic, including signs of unsafe diving and transportation alternatives when it becomes unsafe to drive.
Wandering behavior is extremely common for people living with Alzheimer’s and other dementia. It is estimated that 60% of people with dementia will wander and become lost at some point, and many do so repeatedly. If not found within 24 hours, as many as half of wandering individuals will suffer serious injury or death.
While the term “wandering” may suggest aimless movement, individuals who wander have a destination and a purpose. For example, a person who wanders may have a personal need such as going to the bathroom. Since people living with dementia can become disoriented even in a familiar place, this simple task can become a challenge. This might prompt a person to wander around the house, looking for the bathroom and maybe even open the front door.
To combat wandering, establish a daily routine which provides structure for the individual. Activities and exercise, which can reduce anxiety, agitation and restlessness, may also help. Additionally, ensure all basic needs are met, e.g., using the bathroom, eating a meal, etc. Avoid highly congested places which can trigger disorientation and confusion. Provide supervision at all times; do not leave a person with dementia at home alone or in a place like a locked car during an errand.
If a family member does wander and get lost, begin your search immediately. Start by searching the immediate vicinity, including less-traveled areas in your home. Outside the home, search the yard and nearby surroundings. Most wanderers are found within a half mile of their homes or starting location. If, after 15 minutes, the person is not located, call 911 to file a missing person report. Ensure a swift response by alerting the police that the individual has Alzheimer’s disease and is a vulnerable adult.
Many states have implemented Silver Alerts which can be used to inform law enforcement agencies, media outlets, and the public about missing older adults, especially those with dementia or other cognitive impairments.
In wake of an Alzheimer’s or dementia diagnosis, it is important for caregivers to educate themselves about the disease and the accompanying changes that can occur as the disease progresses. Anticipating these changes will enable caregivers to implement stage-related safety measures that keep loved ones safe, while creating a home environment that encourages social interaction and independence for as long as possible.
Alzheimer’s Association Resources for Caregivers
The Alzheimer’s Association free 24/7 Helpline (800.272.3900) is staffed by specialists and master's level clinicians 365 days a year to help caregivers and family members navigate various disease related challenges.
The Association’s caregiving pages (alz.org/care) contain information and resources to support caregivers across the caregiving continuum.
