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Alzheimer’s Disease and Related Dementias (ADRD)

Safe at home with Alzheimer’s Disease and Related Dementias(ADRD)

As Home safety concerns related to the cognitive and behavioural symptoms of ADRD are particularly worrisome to caregivers, here are some suggestions from occupational therapy that may help.

Wandering

The person with ADRD may attempt to wander out of the home.

Register with the national Alzheimer Wandering Registry. This is a national service developed by the Alzheimer Society of Canada with the RCMP. Vital personal information is stored on a confidential police database. If the person should wander, this information can be accessed by police anywhere in Canada. For a one time fee of $25 the Alzheimer Society provides a medic alert bracelet, a Caregiver Handbook and ID bracelet. For more information contact the local Alzheimer organization or call 1-800-616-8816.

Support the emotional need behind the wish for experiences like going to work or finding one’s mother by talking about those things.

Provide plenty of exercise and stimulation during the day, so the person feels ready to rest at home during the evening.

Provide an accepting environment that encourages staying in one place and provides an “emotional shelter”.

Provide a safety-proofed area for pacing and wandering in the home or yard.

Put away coat, boots and other items that may cue the person to go out.

Talk to neighbours and local stores about your concerns, taking a photo as necessary, so that others may contact the caregiver if the person wanders off. This can provide an excellent opportunity to educate others about ADRD.

Have the person wear an identification bracelet or necklace with caregiver contact information. Presenting this as a special gift can encourage it to be used.

Secure the doors, disguised in a way that won’t frustrate the person and lead to a sense of being locked in. The following are some suggestions:

  • Extra locks, slide bars or dead bolts, at the top and bottom, two-step locks, camouflaged to blend in to the surroundings. For safety reasons, these devices must also be easily managed by the caregiver.
  • Childproof door handle covers (available at toy stores or children’s departments).
  • Camouflage the whole doorway with fabric, painting, or artwork (e.g. a mural which includes the door, frame and surrounding wall).
  • Alarm systems, which can be simple (e.g. bells on the door handle or above the door or an inexpensive welcome mat that plays a tune when stepped on) or complex, that will signal when the person is leaving.
  • Keep a current picture of the person for identification, if she/he should wander off.
  • Keep a couple of unlaundered items of personal clothing in a plastic bag in the freezer. These can be used by tracking dogs for scent identification.

Wandering into areas of the home where there are safety risks or where the person may disrupt the activity of other family members is also a concern.

Some of these suggestions may help:

Provide stimulating sitting or “work” areas where the person will be cued to stay and to do things.

Use half-doors in areas such as the kitchen or bedroom, so that the person can still look in or out at other family members.

Fabric “cues” in a bright colour, velcroed across certain doorways, may be enough to cue the person where or where not to go. Yellow plastic safety tape may also work. Note that childrens’ safety gates, especially around stairs, are not recommended as the person usually sees these as an unnatural obstacle and may try to climb over and subsequently fall.

General safety suggestions
(special consideration should be given to the kitchen and bathroom)

Out of sight is out of mind. Remove and lock up all hazardous materials like tools, knives, cleaning supplies, medication, poisonous plants (poinsettia and dieffenbachia are two common house plants that are poisonous), firearms, small appliances, car keys, alcohol, or foods and condiments that may be harmful if eaten in large quantities.

Place safety catches on cabinets and drawers. At the same time, provide a “junk” drawer or other place, for safe materials that the person may sort, rearrange and carry about.

Limit access to drawers by notching the bottom edges so that two actions are required to open the drawer: lifting up and pulling out.

Turn down the temperature of the water heater.

Make sure that potential danger areas, like the top of stairs, are well lit, and use lighting to eliminate shadows, which can be frightening and may be misinterpreted.

Put tape across the bathroom door latch, to prevent the person locking her/himself in.

Limit access to unsafe areas, such as the basement or the garage.

Remove sink stoppers to prevent a flood, should the water be left on. Some caregivers actually turn off the valve on bathroom sinks to prevent this problem.

Add decals to sliding glass doors for visibility.

Disable the stove by removing knobs or fuses or installing a control switch. This is not automatically necessary, especially if the person has never used the kitchen. It must be considered, though, particularly if the person spends any time at home alone. The entire stove top may also be covered with an aluminum cover, so that the person loses track of where the stove is.

Use small appliances (e.g. electric kettle) with automatic shut off switches.

Remove sharp-cornered objects or furniture and pad the corners of countertops.

Leave doors all the way shut or all the way open, so the person won’t walk into an edge.

Slide a bolt from a closet door into the floor, to prevent access or rummaging.

Excerpt from
Canadian Association of Occupational Therapists & Alzheimer Society of Canada. (1998). Living at home with Alzheimer’s disease and related dementias: A manual of resources, references and information. Ottawa, ON: CAOT Publications ACE.

The Second Edition is available from CAOT at 1 (800) 434-2268, ext. 242 or by e-mail.

Other excerpts from the book appear on the following skills for the job of living tip sheets:

Related consumer tip sheet: Reducing Caregiver Stress

Quotes:
Leave the beaten track occasionally and dive into the woods. Every time you do so you will be certain to find something you have never seen before.Alexander Graham Bell
How many cares one loses when one decides not to be something but to be someone.Coco Chanel
To reach a port we must sail, sometimes with the wind and sometimes against it, but we must not drift or lie at anchor.Oliver Wendell Holmes
All limits are self imposedIcarus
No one is ready for a thing until he believes he can acquire it.Napoleon Hill
Do not let what you cannot do; get in the way of what you can do.John Wooden
Occupational Therapy builds skills for the job of living.
Man from the use of his hands as they are energized by mind and will, can influence the state of his own health.Mary OReilly
Occupational therapy – the difference between life and living.
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