Although a number of behavior and sensory problems may accompany Alzheimer's disease, not every person will experience the disease in exactly the same way. As the disease progresses, particular behavioral changes can create safety problems. The person with AD may or may not have these symptoms. However, should these behaviors occur, the following safety recommendations may help reduce risks.
Wandering
- Remove clutter and clear the pathways from room to room to allow the person with AD to move about more freely.
- Make sure floors provide good traction for walking or pacing. Use nonskid floor wax or leave floors unpolished. Secure all rug edges, eliminate throw rugs, or install nonskid strips. The person with AD should wear nonskid shoes or sneakers.
- Place locks on exit doors high or low on the door out of direct sight. Consider double locks that require a key. Keep a key for yourself and hide one near the door for emergency exit purposes.
- Use loosely fitting doorknob covers so that the cover turns instead of the actual knob. Due to the potential hazard they could cause if an emergency exit is needed, locked doors and doorknob covers should be used only when a caregiver is present.
- Install safety devices found in hardware stores to limit the distance that windows can be opened.
- If possible, secure the yard with fencing and a locked gate. Use door alarms such as loose bells above the door or devices that ring when the doorknob is touched or the door is opened.
- Divert the attention of the person with AD away from using the door by placing small scenic posters on the door; placing removable gates, curtains, or brightly colored streamers across the door; or wallpapering the door to match any adjoining walls.
- Place STOP, DO NOT ENTER, or CLOSED signs in strategic areas on doors.
- Reduce clues that symbolize departure such as shoes, keys, suitcases, coats, or hats.
- Obtain a medical identification bracelet for the person with AD with the words "memory loss" inscribed along with an emergency telephone number. Place the bracelet on the person's dominant hand to limit the possibility of removal, or solder the bracelet closed.
- Place labels in garments to aid in identification. Check with the local Alzheimer's Association about the Safe Return program.
- Keep an article of the person's worn, unwashed clothing in a plastic bag to aid in finding someone with the use of dogs.
- Notify neighbors of the person's potential to wander or become lost. Alert them to contact you or the police immediately if the individual is seen alone and on the move.
- Give local police, neighbors, and relatives a recent picture, along with the name and pertinent information about the person with AD, as a precaution should he or she become lost. Keep extra pictures on hand.
- Consider making an up-to-date home video of the person with AD.
- Do not leave a person with AD who has a history of wandering unattended.
Rummaging/Hiding Things
- Lock up all dangerous or toxic products, or place them out of the person's reach.
- Remove all old or spoiled food from the refrigerator and cupboards. A person with AD may rummage for snacks but may lack the judgment or taste to rule out spoiled foods.
- Simplify the environment by removing clutter or valuable items that could be misplaced, lost, or hidden by the person with AD. These include important papers, checkbooks, charge cards, and jewelry.
- If your yard has a fence with a locked gate, place the mailbox outside the gate. People with AD often hide, lose, or throw away mail. If this is a serious problem, consider obtaining a post office box.
- Create a special place for the person with AD to rummage freely or sort (for example, a chest of drawers, a bag of selected objects, or a basket of clothing to fold or unfold). Often, safety problems occur when the person with AD becomes bored or does not know what to do.
- Provide the person with AD a safe box, treasure chest, or cupboard to store special objects.
- Close access to unused rooms, thereby limiting the opportunity for rummaging and hiding things.
- Search the house periodically to discover hiding places. Once found, these hiding places can be discreetly and frequently checked.
- Keep all trashcans covered or out of sight. The person with AD may not remember the purpose of the container or may rummage through it.
- Check trash containers them before emptying them in case something has been hidden there or accidentally thrown away.
Hallucinations, Illusions, and Delusions
Due to the complex changes occurring in their brain, people with AD may see or hear things that have no basis in reality. Hallucinations come from within the brain and involve hearing, seeing, or feeling things that are not really there. For example, a person with AD may see children playing in the living room when no children exist. Illusions differ from hallucinations because the person with AD is misinterpreting something that actually does exist. Shadows on the wall may look like people, for example. Delusions are persistent thoughts that the person with AD believes are true but in reality, are not. Often, stealing is suspected, for example, but cannot be verified.
It is important to seek medical evaluation if a person with AD has ongoing disturbing hallucinations, illusions, or delusions. Often, these symptoms can be treated with medication or behavior management techniques. With all of the above symptoms, the following environmental adaptations also may be helpful.
- Paint walls a light color to reflect more light. Use solid colors, which are less confusing to an impaired person than a patterned wall. Large, bold prints (for example, florals in wallpaper or drapes) may cause confusing illusions.
- Make sure there is adequate lighting, and keep extra bulbs handy in a secured place. Dimly lit areas may produce confusing shadows or difficulty with interpreting everyday objects.
- Reduce glare by using soft light or frosted bulbs, partially closing blinds or curtains, and maintaining adequate globes or shades on light fixtures.
- Remove or cover mirrors if they cause the person with AD to become confused or frightened.
- Ask if the person can point to a specific area that is producing confusion. Perhaps one particular aspect of the environment is being misinterpreted.
- Vary the home environment as little as possible to minimize the potential for visual confusion. Keep furniture in the same place.
- Have the person with AD avoid watching violent or disturbing television programs. The person with AD may believe the story is real.
- Do not confront the person with AD who becomes aggressive. Withdraw and make sure you have access to an exit as needed.
Special Occasions/Large Gatherings/Holiday Safety
When celebrations, special events, or holidays include large numbers of people, remember that it is possible that large groups may cause a person with AD some confusion and anxiety. The person with AD may find some situations easier and more pleasurable than others.
- Large gatherings, weddings, family reunions, or a Fourth of July picnic may be cause for anxiety. Consider having a more intimate gathering with only a few people in your home. Think about having friends and family visit in small groups rather than all at once. If you are hosting a large group, remember to prepare the person with AD ahead of time. Try to have a space available where they can rest, be by themselves, or spend some time with a smaller number of people, if needed.
- Consider simplifying your holidays around the home and remember that you already may have more responsibilities than in previous years. For example, rather than cooking an elaborate dinner at Thanksgiving or Christmas, invite family and friends for a potluck dinner. Instead of elaborate decorations, consider choosing a few select items to celebrate holidays. Make sure holiday decorations do not significantly alter the environment, which might confuse the person with AD.
- Holiday decorations, such as Christmas trees, lights, or menorahs, should be secured so that they do not fall or catch on fire. Anything flammable should be monitored at all times, and extra precautions should be taken so that lights or anything breakable are fixed firmly, correctly, and out of the way of those with AD.
- As suggested by most manufacturers, candles of any size should never be lit without supervision. When not in use, they should be put away.
- Try to avoid clutter in general, especially in walkways, during the holidays.