Just the Facts and More: Safety

Sometimes the patient with Alzheimer's disease may feel confused and frightened. By creating safe and comfortable surroundings, you can help the person feel more relaxed and less overwhelmed. Keep in mind that the individual's behavior can influence the safety and security of other family members and residents. By adopting a safety first attitude, everyone feels more comfortable and secure. As you assess the environment, try to look at the world through the patient's eyes. A person with Alzheimer's can't understand the meaning of many actions and behaviors. For example, the patient might not remember why it's important to dress warmly in cold weather or why eating moldy foods is unsafe. Before you introduce specific safety precautions into your living area, consider the following points:

Focus on prevention, not teaching.

Rather than trying to teach or retrain the person to do things safely, you might be more successful by taking preventive action. For example, to guard against fires or accidental burnings, you may want to remove the knobs from your stove.

Take an adult approach.

Keep communication on an adult level. Help the person understand such safety hazards as smoking, and then work with him to change his dangerous behavior. You may need to take action by removing cigarettes or lighters, as the Alzheimer patient may forget how smoking can be dangerous.

Be patient and slow down.

Keep in mind that many accidents occur when the person with Alzheimer's is rushed. It takes time - sometimes more than a minute - for the person to understand or remember what to do or where to go. As the disease progresses, basic activities of daily living will probably consume even more of your time.

Simplify routines.

Keep in mind that many accidents occur in the area of personal care, involving activities of bathing, toileting, dressing, or eating. You can help avoid accidents by breaking down complicated procedures, guiding the person through a simple, step-by-step process, and giving the individual enough time to complete each task.

Create emergency plans.

Prepare a list of emergency phone numbers and addresses for the local police and fire departments. Include numbers for hospitals and poison control helplines.

Do what you think is best.

Rely on your common sense and do what you think is in the individual's best interests. Tradeoffs may be necessary in balancing the person's safety versus fulfilling the patient's privacy and need for independence.

Be reasonable in your approach to safety.

Be realistic about what you can do. You'll never be able to anticipate every risk or prevent every problem. In addition, there's no way you can experience the world in the same way as the person with the disease.

Action Steps

Be careful about any substance taken through the mouth.

Because the person with Alzheimer's doesn't understand the consequences of ingesting or eating foreign substances, poisoning or choking is a real threat. A patient might forget when medication was taken and, as a result, take twice as much medication or not take the medication at all. There are several steps you can take:

• Purchase locks for kitchen cabinets that contain dangerous substances such as cleaning fluids; or move these substances to another location. Secure garages, basements and workrooms where toxic chemicals are kept.
  
  
• Maintain a clean refrigerator. Keep in mind that the individual may not be able to distinguish between rotten food and edible food. Be prepared for the unusual. People with Alzheimer's have been known to eat such items as small rocks, dirt, and plants, flowers, and bulbs. Some caregivers remove toxic plants such as poinsettias or mistletoe from the home.
  
  
• Recognize that people with Alzheimer's are unable to distinguish hot from warm or cool from cold. To prevent burning, test the temperature of food before serving it.
  
  
• Be cautious about the bathroom medicine cabinet and toilet articles. Lock all medications away from the person.

Rid your house of guns.

Although a person with Alzheimer's might have once been able to handle a gun, serious accidents can occur. The best course of action is to lock the gun in a cabinet or drawer, or remove the gun from the house. Don't allow the patient unsupervised access to a gun.

Control alcohol.

Alcohol can have a variety of negative effects on an Alzheimer patient. Monitor the person's alcohol intake and contact your physician for advice. Alcohol should not be taken with certain medicines.

Be cautious about knives, appliances and electrical devices.

• The person who once enjoyed working in the kitchen, basement or woodshed may no longer remember how to safely operate such appliances as a toaster oven, stove, coffee maker or such equipment as power tools, lawn mowers, or the barbecue. For example, a person who can't remember how to use a can opener may pick up a knife and start to jab at the can.
  
  
• Try to distract the person from working in the kitchen alone or encourage him to come in when you are working or preparing food.
  
  
• Many caregivers have learned that taking such bedtime precautions as locking up knives and taking the knobs off the stoves prevent accidents. If the person can't see a device or appliance, it may not pose a problem.
  
  
• You might also want to turn off the gas and electricity in areas that could be dangerous.
  
  
• Perform monthly checks of fire extinguishers and smoke alarms.

Take precautions about temperature, heat and cold.

Keep in mind that the person with Alzheimer's can't judge temperature. Often the individual may forget about the dangers of stoves, curling irons, or space heaters. In addition, the person might have a different sensitivity to heat or cold, and might not react to heat or cold quickly enough to prevent an accident. To avoid scalding, consider setting your home water heater at 140 degrees and help the person mix hot and cold water for bathing.

Take special precautions in the bathroom.

Mirrors, high-gloss surfaces, and glass can be frightening to the person with Alzheimer's disease. Some caregivers choose to cover mirrors to reduce the person's feeling of confusion. Use an electric razor for safety precautions. To reduce the chances for electric shock, remove all remote electrical appliances from the bathroom. To prevent falls, use such devices as grab bars, bath seats and commode chairs.

Use camouflage and other devices to prevent wandering.

To discourage the person from leaving an area, consider using such devices as safety door knobs, locks that are placed high and out of the patient's sight, a black rug on the floor in front of a door, a cloth or drape hung over a door, a Dutch-door, or electronic alert alarms.

Resources

One of the best places to turn for additional help is the Alzheimer's Association. The Alzheimer's Association has more than 83 Chapters and 1,600 support groups nationwide, where family members of people with Alzheimer's disease or a related disorder share their experiences, provide each other with emotional support, hear practical suggestions and learn to rebuild their lives.

The primary resource for this fact sheet was Lisa P. Gwyther, ACSW, educational director of the Joseph and Kathleen Bryan Alzheimer's Disease Research Center at Duke University, Durham, North Carolina. Special thanks to the following Chapters of the Alzheimer's Association: South Central Michigan and Cleveland, Ohio.

Other resources include:

• Alzheimer's Association, Atlanta Chapter, Guide to Home Safety for Caregivers of Persons with Alzheimer's Disease. Atlanta, GA, 1990.
  
  
• David L. Carroll. When Your Loved One Has Alzheimer's Disease: A Caregiver's Guide. New York: Harper and Row, 1989.
  
  
• Donna Cohen, Ph.D. and Carl Eisdorfer, Ph.D., MD. The Loss of Self: A Family Resource for the Care of Alzheimer's Disease and Related Disorders. New York: Norton and Company 1986.
  
  
• Lisa P. Gwyther. Care of Alzheimer's Patients: A Manual for Nursing Home Staff. Washington, DC: American Health Care Association, and Alzheimer's Disease and Related Disorders Association. 1985.
  
  
• Nancy L. Mace and Peter V. Rabins, MD. The 36-Hour Day. Baltimore: The Johns Hopkins University Press. 1991.

For further information about Alzheimer's Disease or related disorders, contact the Alzheimer's Association at:

• Alzheimer's Association of the Great Plains, 402-420-2540 or 1-800-487-2585 (Helpline)
• Midlands Chapter, 402-572-3010 or 1-800-309-2112 (Helpline)