Safety in the patient environment
Edited by: Ayelet Saar - Occupational Therapist. (The article was published in Bulletin No. 21 of the Alzheimer's Israel Association)
Often, a person with dementia cannot recognize and remember where they are and may even see their surroundings as threatening because they are unfamiliar to them. They will feel confused and afraid and may even act violently towards others. Usually, the cause of this is not the environment but a feeling of disorientation in place and sometimes even time. These are familiar feelings that accompany the disease.
While most people are able to identify and differentiate between different sounds, noises, shapes, or colors in a room, a person with Alzheimer's will often feel startled, confused, and even threatened. This type of overstimulation can make them fearful and even hostile.
For these reasons, the therapist must create a safe, calm, familiar, comfortable, and enjoyable environment. Creating such an appropriate environment helps the patient feel more relaxed and less "emotionally overloaded." In this way, problems such as anger, aggressive behavior, or wandering can be resolved.
When you try to assess the home environment, try to see it through their own eyes, not yours. A person with Alzheimer's is unable to understand the meaning of behaviors and activities around them. For example, they may not always remember why they should wear warm clothes when it's cold, or why it's unhealthy to eat stale food. Something as simple as rearranging the furniture in the living room or visiting a neighbor's garden can cause them anxiety and confusion. A well-organized, safe, and familiar environment will help them and those around them.
Principles of caution
Before implementing precautionary principles in the residential environment , the following points should be noted:
- Emphasize prevention rather than learning.
Instead of trying to teach or "train" how to do things safely, it is better to invest efforts in preventive activities. For example, to prevent fires or burns, you can remove the control knobs on the stove or oven.
You need to adopt a mature approach and maintain adult-level communication. You need to help him understand safety risks, such as smoking, and only then can you work with him on changing dangerous behavior and habits. It will likely be necessary to keep cigarettes, lighters, or matches away, as he may forget the risks associated with fire.
It should be remembered that many accidents occur when a person is rushed. A task that seems simple to us, takes a person longer to perform because of the difficulty in understanding the task (where to go, what to do). As the disease progresses, the time it takes to perform the same task – no matter how easy and everyday it may be – will be longer.
It is important to simplify the process.
Remember, many accidents occur in the area of personal care, such as showering, toileting, dressing, or eating. Accidents can be prevented by simplifying processes, providing guidance using a “step-by-step” process, and allowing sufficient time to complete the task.
The importance of permanence.
We must strive for permanence in the person's life and routine. We must help him maintain a connection to his past through familiar objects, a familiar and beloved chair, a lamp, favorite clothing items (a bathrobe that the person loves to wear), and the like.
- Do what you think is right.
The therapist can rely on their common sense and act in the best interest of the person. Sometimes, a middle ground must be found in balancing the person's safety with respect for their privacy and desire for independence.
Be logical and realistic in your approach to safety.
We can never anticipate every risk and prevent every problem, and we must also remember that we will not be able to experience the world as that person with Alzheimer's or other dementias did.
Building an emergency plan.
A list of emergency phone numbers and addresses should be prepared for the police and fire department. It is a good idea to include phone numbers of hospitals in the immediate area.
Taking precautions
There are several steps you can take:
1. Be careful about oral substances . Since a person with Alzheimer's does not understand the significance of swallowing foreign substances, poisoning and choking are real dangers. A person may forget that they have taken the correct dose of medication, and take double the amount, or, conversely, not take it at all.
2. It is advisable to purchase locks for kitchen cabinets that contain toxic substances , such as cleaning products. You can also move these substances to other places in the house that will be more difficult to access.
3. It is necessary to keep a clean refrigerator , containing fresh and washed products. A person does not always distinguish between stale and spoiled food and healthy food. There may be cases where he will "taste" sand, small stones, leaves, flowers and even candles. Such things have happened in the past and can certainly happen again. Sometimes, it is important to remove from his living area plants whose leaves or flowers are poisonous and may cause him harm.
4. The temperature of food should be checked before serving it, to prevent burns and other injuries. The patient is not always able to distinguish between hot and cold, and between cold and hot.
5. Be careful about medicine cabinets and first aid kits . It is advisable and desirable to keep them out of the person's reach.
6. Be careful with plants. You can use houseplants for decoration – especially if they were part of your past, but make sure that these plants are not poisonous. You can turn the backyard or part of the porch into an additional, safe activity area, where he can do simple gardening or wander around for pleasure without danger and under supervision.
7. Supervision regarding incontinence. If the person suffers from incontinence, avoid using an electric sheet or blanket. A hot water bottle will be equally effective and of course safer.
8. It is important to remove weapons from the house. Even if the person has used a gun or other weapon (hot or cold) in the past, it is necessary to remove them from him, whether by locking them in a safe place or even by removing them from his house. It is forbidden to leave such weapons within his reach, due to the danger of accidents.
9. Alcohol control. Alcohol can have a very negative effect on the body. Therefore, the amount of alcohol consumed should be monitored and a doctor should be consulted. Drinking alcohol is prohibited while taking certain medications.
10. Supervise the use of knives, electrical appliances and other devices. A person who previously enjoyed working in the kitchen, study or garden may not remember the safety problems and dangers associated with operating various devices, such as a toaster, oven, blender, vacuum cleaner, lawnmower, saw, can opener, etc. He should be prevented from working alone and without supervision. It is advisable to remove risk factors, such as knives, unplug electrical appliances that are not regularly needed (mixer, electric can opener) and remove the gas and oven knobs that are not in use.
11. Gas and electricity. It is advisable to disconnect the gas and electricity in places where access is easy and could cause an accident.
12. Fire and burns. It is advisable to install several smoke detectors in the rooms of the house, purchase small household fire extinguishers, and store them in a safe place.
13. Be careful about heat/cold. It should be remembered that a person with Alzheimer's does not correctly judge heat and cold. Sometimes, he is even able to forget the dangers inherent in an oven, heater, iron, etc. In addition, he may develop a different sensitivity to heat and cold, or react to them too slowly. In order to prevent burns, precautions should be used, such as checking the temperature of the water before entering the shower, unplugging household appliances from the electricity, such as an iron, and keeping them out of reach, and connecting a net or protective screen to the heater, to prevent burns. It is also advisable to remember that the person is not young, and tends to cool down more quickly than before. It is important to ensure, especially in winter, that the patient's environment is protected and sealed against the cold.
14. Take precautions in the bathroom. It is important to remember that mirrors or particularly shiny surfaces, such as glass, may cause anxiety in a person with Alzheimer's. Mirrors can be covered to reduce the degree of confusion, and a shaver can be used instead of a razor. It is advisable to unplug and remove electrical appliances (hair dryer, portable heater) from the bathroom when they are not in use. It is important to install assistive devices such as support bars, a bathtub seat, etc., to reduce the risk of falling and injury.
15. Camouflage measures to prevent wandering. Various methods can be used to prevent the person from leaving their immediate and safe environment. Effective measures are: locking doors in an unconventional place (at the bottom of the exit door), a black mat in front of the entrance (which may appear to the patient as a "hole" that cannot be safely passed through), a decorative curtain on the door, which will become a "window" in the person's eyes in their home, an alarm (for nighttime operation), and the like.
16. Use the right color and contrast. It is advisable to plan a calming effect through color. Instead of relying on strong basic colors such as white, yellow, orange or red, it is better to use soft pastel colors, such as peach, ivory, beige, pink and light shades of blue, green or purple. In addition, it is advisable to use matte and non-glossy paint, or oil paints, to prevent shine. It is advisable to use contrasts. A person may not be able to distinguish between a wall painted in beige and a door or railing in similar colors. For this reason, it is better to paint walls in a light color, compared to doors, railings or handles that will be a darker color.
17. Pay attention to the flooring and floors. It is advisable to keep the floor free of patterns and drawings. For example, a black-and-white mosaic floor, despite its beauty, may give the impression that the black squares are actually dangerous pits or cracks. It is better to design a non-glossy floor, since the shine may cause a person not to notice obstacles in his path. In addition, one should be careful of excessively smooth tiles. It is advisable to use carpets to muffle noises and voices, or to prevent slipping. Due to problems with controlling fasteners, experts should be consulted regarding carpets that are more durable and easier to clean. It is advisable to attach thin rubber strips to the inner edges of the carpet, which will stick it to the floor in a kind of "vacuum" - this will prevent collisions and causing damage.
18. Reduce distractions. Distractions should be limited and noise should be controlled. This can be done by using soothing background music and even familiar and beloved songs. In addition, it is advisable to avoid changing television channels too often and frequent phone rings. Lighting should be avoided, which casts shadows and may cause restlessness. It is better to use natural light when possible – and focus it on the required area.
19. Special furniture. It is advisable to purchase furniture that does not absorb liquids, or to cover existing furniture with an appropriate cover. If a special chair is purchased, make sure that its backrest is strong and stable and that its seat is long enough (beyond the seat's reach) to allow the person to get up from their seat comfortably, easily and safely.
20. Orientation of the person. Use stickers, pictures and numbers, which may help in knowing the time and place where he is. Be responsible for the issue of safety. Leave corridors and passages open and free of obstacles, such as rugs and inappropriate furniture. Also, use locks on doors and cabinets and hidden operation buttons for the oven, gas and other stationary household appliances, which pose a risk.
21. The problem of the "inter-evening" period. It should be remembered that many people suffer from this phenomenon, which causes increased confusion and restlessness, and a decrease in the ability to concentrate - due to the change in the amount of light in the afternoon hours. It is important to keep the person busy with a specific task that will distract him (such as folding laundry, sorting work, music, etc.). It is also possible to increase the lighting in the room where the person is, in order to dim the feeling of "inter-evening".
22. Hanging wall decorations. It is advisable to use items made of different textures, such as wool, rope, velvet, etc. Alzheimer's patients enjoy touching these textures. Also, these materials are less threatening than items made of mirrors and glass. It is advisable to avoid wallpaper with small, undefined patterns and prints. Prints, such as flowers, may make the patient want to "pick" them. In one case, patients believed that the ivy-patterned wallpaper in the room was a snake's nest, and began to hit the wall. Therefore, it is important to try and see how a certain decoration would look to the person.
23. Pets. It is beneficial and desirable to keep pets as part of one's environment. Many people with Alzheimer's find great pleasure in caring for songbirds, ornamental fish, and of course dogs and cats. Make sure that these activities are controlled and supervised, such as a locked cage and a covered, stable aquarium. Also, remember that a person is not always able to care for pets alone, and that it is necessary to supervise their ongoing care.
24. Locking valuable drawers and documents. It is advisable to lock such documents out of the person's sight and reach. Mail, financial statements, insurance/medical documents and other important documents may disappear, be torn, etc. Due to a person's judgment problems, important papers may disappear without leaving a trace, and even if we come to him with complaints and requests for their return, he will have no idea where he put them. It is also advisable to lock all drawers that are not frequently used.
25. Spare emergency items. Keep an extra key to your house, in case the person locks you out. They may not know how to open the front door for you or may not want to. It is a good idea to have a spare set of dentures, glasses, hearing aids, medications, and other important items in case one of them is lost.
26. Check the trash. If possible, it is advisable to check the trash bags and cans before emptying them into the public trash, because it is not possible to monitor human actions at all hours of the day. It is advisable to make sure that the things thrown into the trash are indeed supposed to be there.
Finally, it should be remembered that a person with Alzheimer's is usually an older person and is therefore at a higher risk of accidents in their home. This is due to the fact that balance and reaction speed are slower in old age. The person may be more stiff in their gait, may lose balance and misjudge distances.
In addition, various physical disabilities may arise, such as a fractured shoulder or hip, or problems with blood circulation in the extremities (for example, in the case of diabetes) that may slow down the person without any connection to Alzheimer's disease. These facts should be taken into account when it is necessary to change the person's environment.
As a primary caregiver, you must make changes in the home to make it easier for the person with Alzheimer's.
But remember, you also live in the same place and the same environment should preserve your abilities and strengths. In order to build an effective and safe environment, you must examine what is best for both of you, while trying to think long-term. It is possible, and even advisable, to consult objective professionals.