Alzheimer's Disease & Home SafetyWe are very fortunate to have access to great tools, checklists, and resources related to Home Safety for people with Alzheimer’s Disease (AD).  To celebrate National Home Safety Week, I thought it would be important to validate the emotional side of Alzheimer’s safety issues. We also have an opportunity to learn more about the cause of safety issues. I am hoping this resource helps people with Alzheimer’s Disease and their family / professional caregivers to better understand safety issues and develop best practice approaches to ensuring their safety and quality of life.

Agnosia – Inability to recognize the purpose of objects

“It is as if I have been taken to another world where nothing makes sense.  Everything looks foreign.  I know things should make sense – but they don’t. I stare at items in the bathroom and have moments where I don’t know what to do.”  Person with Alzheimer’s Disease

Our Challenge

Think about how difficult life would be if you were unable to understand the meaning or purpose of objects in your environment. This is a common symptom of Alzheimer’s called Agnosia.

Real story

I worked with one client who wanted to boil water to make pasta.  The client understood that they needed to cover the pot, but used a newspaper instead of the lid.  This caused a small fire that (thankfully) was noticed and quickly extinguished.

The Emotional Side

Some people with Alzheimer’s Disease have insight into their condition and become very anxious when they realize that they are not able to make sense of their physical environment.  This often causes isolation, anxiety, and depression.  Family caregivers are often shocked by agnosia because it is so unusual for an adult to misunderstand the purpose of objects.

When a person cannot understand the purpose of objects, safety issues can include:

  • Fire hazards
  • Eating or choking on non-food items
  • Ingesting hazardous materials or chemicals
  • Missing or misunderstanding traffic signals and road signs

What’s Behind the Symptom?

The Parietal lobe of the brain controls our ability to process and understand the purpose of physical objects and cues.

Alzheimer’s Disease Safety Solutions & Toolkit

  • In the early stages of Alzheimer’s Disease when a client can still read, written signs and/or labels can trigger memory and help a person to recognize objects and their purpose.
  • As AD progresses, the person loses the ability to read, so it is important to remove / hide all objects that could cause physical harm.
  • The following tool from the National Institute on Aging can help you to ensure that all risky objects are removed or hidden throughout the house:

Wandering  – A Search for Something Familiar

“These things can happen any given time. All it takes is a caregiver who’s working really hard to turn around for a second and the person can wander,” Beth Kallmyer, Vice President of Constituent Services at the Alzheimer’s Association.

Our Challenge

What would you do if the people and places around you were unfamiliar?  In this situation, many of us would leave the area to look for something or someone familiar.  This is a common and dangerous symptom of Alzheimer’s Disease called wandering.

Wandering can be life-threatening due to injury, traffic accidents, hypothermia (during winter months), drowning, dehydration, and missing important medications. It is also important to know that people can wander by car, train, bus or plane if they retain these skills and feel they are needed in another location due to past / perceived work or family commitments.

Alzheimer’s also causes repetitive symptoms such as restlessness and pacing.  Some people with Alzheimer’s Disease pace because they have a constant, repetitive urge to move. This can cause dehydration, exhaustion, falls, and weight loss.

Real Story

During my time as a Recreation Director in a nursing home, one of our residents (Mary) wandered from the facility.  We checked every room, closet, and office and could not find Mary.  It is always a very difficult phone call when you inform family that a loved one is missing. A family caregiver noted that Mary’s childhood home was only a few miles from the facility.  We went with the family and found Mary sitting on the front porch of her childhood home.

The Emotional Side

Take the time to reflect on the last time you were lost. The difference between yourself and someone with Alzheimer’s Disease is that you eventually find the people, places and “world” you are looking for.  As AD progresses, those who struggle with the disease go back in time. The people and the world they are looking for no longer exists.  They may not recognize current pictures of their spouse and adult children. However, they do recognize older pictures of their spouse and children.  This causes anxiety for the person with Alzheimer’s and a great sense of loss for family caregivers.

What’s Behind The Symptom?

The prefrontal cortex of the brain controls our orientation to person, place and time.  The frontal lobe controls movement. Alzheimer’s Disease can damage brain cells in these areas, causing a person to become disoriented. This is a common trigger for wandering.

The hippocampus controls our short–term memory and is often the first part of the brain impacted by AD.  Damage to this area can cause repetitive symptoms such as pacing.

Alzheimer’s Safety Solutions & Toolkit

  • Wandering and pacing can be very frustrating for the person with Alzheimer’s Disease and family caregivers because it is difficult to manage.
  • Recent research has shown that the best approach for wandering is to provide a safe walking path. However, this is very difficult to do in a typical home environment.  It can help to set up “rummaging stations” with familiar work or hobby-related items that would engage the person with AD and connect them with past roles.  This can also provide periods of rest for the person with AD and family caregivers.
  • Here are tools that can help you to manage wandering and pacing:

<u “>Falls – Depth Perception, Balance and Coordination Challenges

“Ever since my mother fell, I cannot get the sight and sound out of my head.  I feel like I can’t turn my attention away or sleep for a second.  Of course, this is impossible…but I try anyway.” Family caregiver quote

Our Challenge

One of the most frightening symptoms of Alzheimer’s Disease is falling.  Changes in the brain due to AD can impact vision, depth perception and motor coordination. Falls can be very serious and often lead to fractures and head trauma. At the same time, people with AD are often driven to move.

Real story

During my time as an Alzheimer’s Special Care Center Director, the Department of Health did not allow us to use the term “fall prevention” in resident care plans.  The rationale was that falls are so difficult to predict/stop, that the more realistic phrase was “reducing the risk” of falls.

The Emotional Side

It is difficult to capture in words the anxiety and fear that fall risk creates for people who have AD and their caregivers.  Recent research has shown that fear and anxiety impair coordination and can actually increase the risk of falls. Family caregivers are often exhausted from trying to prevent falls.

What’s Behind The Symptom?

The frontal lobe and cerebellum control our movement, balance and coordination.  The occipital lobe controls our vision and depth perception.  When damage occurs in these areas, a person with Alzheimer’s Disease can become a fall risk.

Alzheimer’s Safety Solutions Toolkit

Driving  – Vision, Judgment and Reflexes

“It was very difficult giving up things such as a car when I’m still working…without my wife taking me to work in the morning and a driver taking me home in the afternoon, I would be pretty much stuck in the house every day,” Person with Alzheimer’s Disease – Voices of Alzheimer’s Disease – Alzheimer’s Association Town Hall Meeting

Our Challenge

Driving is a key aspect of our freedom and independence.  One the most challenging aspects of Alzheimer’s Disease is assessing driving skills and “giving up the keys.” Driving issues can be due to impaired depth perception, judgment, and reflexes. Some people with AD may not have insight into their condition, so they deny that a problem exists and refuse to give up driving.  This is a very difficult issue for clients, families, and healthcare providers to manage. Some people with AD do have insight into their condition and agree to stop driving.This takes great strength and acceptance.

Real Story

I worked with a client who had several minor driving accidents due to AD.  This client could not accept that he had driving issues and continued to drive even after his family and healthcare provider told him to stop.  The family finally decided to remove the keys and move his car to another location.  This client was resourceful enough to purchase a car from a dealership over the phone using a credit card.  The dealership delivered the car to his home, and he drove for 3 hours until he ran out of gas.  Sadly, he was unable to tell people where he was from.  After three days in a hospital three states away from home, he remembered his daughter’s phone number and was returned safely to his home.

What’s Behind The Symptom?

Successful driving involves all lobes of the brain. The prefrontal cortex in the brain controls our executive function and judgment. The frontal lobe controls our movement and reflexes. The parietal and temporal lobes control our ability to read and understand traffic signals and signs.  Damage to any of these areas can create driving issues.

Alzheimer’s Safety Solutions Toolkit

 A Few Final Thoughts

The benefits of rehab and geriatric care management

Physical therapists, occupational therapists, speech therapists and geriatric care managers can play an important role in ensuring home safety for people with Alzheimer’s Disease. These are licensed/certified professionals who are formally trained to assess and modify the home setting for people with AD.  Ask your healthcare provider about rehab professionals and geriatric care managers near you. You can also find a therapist or care manager using the tools below:

 Peer-to-peer learning through support groups

Some of the most useful home safety strategies can be found through support groups.  Here are links that can help you to find support groups in your area.

Symptoms vs. Behaviors

You will notice that I have avoided the term “behaviors” throughout this blog.  This is intentional, because I feel the term  – although commonly used – alludes to intent or “misbehaving.”  When a person has chest pain due to heart disease, we use the term “symptom”.  When a person has shortness of breath due to lung disease, we use the term “symptom.”  I think we should use the term symptom with Alzheimer’s Disease as well.  This will help to drive the empathy, patience, and support that is key to quality of life for people with Alzheimer’s Disease and their family / professional caregivers.

For more information, please review our Home Safety Resources.

  • Mike Townsend

    Wow, this was such a well organized and meaningful post. The resources you listed for all different conditions are definitely the best out there.