Hosted Chat - Making Your Home Safe for Those with Alzheimer's Disease
Lillian O'Cane, LOTR
Occupational Therapist,
Touro Infirmary

<Q> Ms. O'Cane, what is the first thing I need to look at in safe guarding my home for my 80 year old mother-in-law who has moderate dementia? She's with us on weekends.

<A> The stove, especially if she's likes to move around. Also, if she is in an unfamiliar environment which your home may be to her any household product could be a source of danger or anxiety.

<Q> My mother-in-law has trouble with our front and side steps. There are about 4 steps to get into and out of our house. We do not have a hand rail. Is there anything I can do besides installing one that will help her navigate these?

<A> Make sure someone is at her side when she goes up and down the stairs. Individuals with Alzheimer's develop difficulty distinguishing one object's distance to the next. I would get yellow tape for the stairs too, to help differentiate the levels.
The yellow tape may help. The question is does she need help up and down the stairs. You want to prevent a fall.

<Q> As for going up and down the stairs, I take her hand and she hesitates, but makes it. On Halloween I took my mother-in-law trick or treating. We walked on streets that were lit with street lights intermingling with the dark of night. A couple of times she froze, uncertain how to continue. I tried to reassure her that the sidewalk was okay, was there, and took her hand to guide her. But it was tough going there for a while. When you have to be in a less than optimal situation, what can we do to help her through it?

<A> Providing the hands on contact was great. Any change in surface type or light contrast is usually misinterpreted and thus you see the frozen response which is a protective response. Did you have a flashlight?

<Q> No, but that's a good idea. There is a light outside for both the front and back steps. Maybe we need to install lights on the walkway so the steps themselves will be more visible.

<Q> What is the biggest danger in the home for a person living with Alzheimer's disease? How can we neutralize this?

<A>It depends on the deficits such as a language deficit so he/she may not be able to communicate the need for help. The individual who may not recognize there is a danger. It is important to know what the person can and cannot do so appropriate safety nets can be put in place to maintain independence.

<Q> About the danger in the home, is there a list of big do's and don'ts? Something to start with? Something you could then customize depending on how far along someone is?

<A> I would walk through the house and really look for potential dangers.

<Q> What kind of dangers?

<A> Throw rugs, anything she could trip on. Low furniture may not be seen at first, furniture like coffee tables.

<Q> What suggestions do you have for traveling with a person with AD? What should we look out for?

<A> Any change in environment may elicit behaviors from irritability to withdrawal. Take frequent breaks. This also depends on which stage of the illness your loved one is in. Hotel rooms can be very difficult because of all the mirrors and he/she may get disoriented. Take their lead. They will indirectly tell you what is difficult for them through their behavior.

<Q> What kind of behavior?

<A>Expressing that he/she wants to go home. Not wanting to leave the room, becoming more confused.

<Q> We have 2 small children, so our home is pretty well child-proofed (chemicals locked away, etc.) What else do I have to look out for when my mother-in-law comes to visit?

<A> Can she bathe herself? Will the appliances in your house be difficult for her to operate? For instance, if she attempts to shower or bathe can she figure out how to operate the faucets and adjust the water temperature?

<Q> If you only had the time and energy to do 5 things to make your house safer right away, what would you do?

<A> Lock the chemicals.
Never change appliances. Replace broken ones with the same or ones that look as close to the broken one as possible.
Never change the products they use for personal care.
Remove throw rugs.
Lower the water temperature of the water heather.
If they cannot cook, disconnect the stove.

<Q> I don't know if this is your area or not, but what about changing clothes? Peggy loves to shop, so I take her, but she has so many clothes (which often get lost somewhere) and of course, she either says she has nothing to wear or she wears the same thing over and over again.

<A> Place a few items on the bed for her to choose from. Rotate one or two of the items as need be. Purchase multiples of items she likes and just change them out to wash them. If she is not concerned about the number of items in her closet or in a certain area of her room, just put 2-3 outfits out and let her choose.
Give her a selection, but cutting down on her decisions and eliminating the re-donning of dirty clothes.

<Q> Do you have any suggestions for brushing her teeth?

<A> You may have to place the paste on the brush and brush your teeth at the same time she does. You are showing her how to do it by standing next to her. This is done side by side.

<Q> Our front room, which is where she usually comes in through, has 2 walls that are only mirrors. The room does not get direct sunlight and is usually evenly lit. There is little furniture in it, and a clear path through to the dinning room. The kitchen isn't much of an issue as she walks through it into the den, or family room. That's where I get nervous as there are toys everywhere. No matter how much I try and straighten them out, within a few minutes there's something on the floor she could trip on. Fortunately, she usually sits and folds clothes for me, mostly all weekend with the kids, her son and myself in the room with her.

<A> I would be more concerned with the room with the mirrors. She sounds rather passive in her motor behavior. Is her chair close to where she walks into this room? If it were, she wouldn't have to negotiate around the toys.

<Q> The toy bins are next to the chair where she sits. There usually is a clear path, but that's not always a given. And like I said, even if I clear it for her when she comes in, that doesn't guarantee it will be there when she has to move. Or that I will be in the room when she moves.

<A> How small are the toys?

<Q> They range in size from Tonka trucks to bits and pieces of things that can get quite small.

<A> There isn't much you can do unless you move the toy bins.

<Q> That would take some major rearranging, but I can look into it.

<A> Could she fold things at the breakfast table?

<Q> Do you have any ideas on other things or activities I could have ready for her?
I wash the laundry on Friday so it's ready for her on the weekend. But she's fast and gets through my 3 loads in no time flat. At least if she finishes things at the end of the day I can re-wrinkle them for the next day and have her fold them over again.

<A> Cutting coupons, sorting socks. I have a handout at work that has a number of things on it. I can email it to you. I cannot recall the website right now.

<Q> But what about the cutting? Aren't scissors dangerous?

<A> Use children's safety scissors.

<Q> For a family that's just dealing with the shock of diagnosis, or realizing there's a problem and then need to do something, what are a few things they could do in say, a weekend that would make the home safer for their loved one?

<A> Minimize clutter.
Clear pathways.
Keep them involved in things.
Let them help you. Think of how they may have shown you how to do something when you were little. Side by side tasks are best because you can see how they are doing and gently guide them.
Do not correct. It is a difficult thing to do, but you are trying to maintain their dignity, and self-esteem.
Be there for them. They do need support.

<Q> Could you go a little further on the "guiding" thing? I've had some experience in it, but it still feels like I'm stepping out of place. Or too harsh, or just not right, yet I know there are times when I have to step in.

<A> You are correct to step in for safety. Guiding can be done by showing, offering to start the task, introducing the next step, placing out all the supplies.

<Q> What are things families should avoid?

<A> I sometimes thing we are stepping out of place, but they are looking for guidance. Stop correcting them. Stop saying "I can't believe you don't remember." Anxiety will skyrocket and abilities crash.

<Q> Would you say be bit more that correlation? Is the impact greater, when anxiety rises, do people with AD really loose a big chunk of their ability to do the task?

<A> The impact is very severe. If you have limited cognitive abilities because of AD, and then you add anxiety, the person with AD will look significantly more impaired.

<Q> What can we do to break that anxiety once we've set it in motion?

<A> Distract, step back. Give yourself time to regroup.

<Q> Thanks.

<A> Apologize. Say you are having a bad day.

<Q> Thank you!

<A> You're welcome.

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