May 8, 2009 -- After someone is diagnosed with Alzheimer's disease, the first thing the patient and their loved ones want to know is how to treat this progressive, degenerative brain disease.
But the next thing they want to know more about is safety -- a huge issue, since adults with Alzheimer's and dementia have a much higher risk of injuring themselves around the home than their healthier counterparts.
Although safety becomes a primary concern, people often don't know where to begin or the practical things they can do in their homes. Plus, making a caregiver aware of these options can be a challenge.
"We need to find a balance between not scaring a caregiver about what could happen when a loved one has Alzheimer's disease and supportively making them aware of what to be thinking about and watching for," said Scott Trudeau, project director for a home safety study of people with dementia funded by the Department of Veterans Affairs.
Fortunately caregivers usually don't need to make elaborate and costly modifications to their homes, as there are simple things they can do to help their loved one remain safe -- and live more happily as well.
"The goal is to structure the environment to be as supportive as possible for the person with Alzheimer's disease to continue to do what they like to do," explained Margaret Calkins, president of IDEAS Inc., a company that specializes in designing supportive environments for older adults, in Kirtland, Ohio.
Making Alzheimer's Adaptations in the Home
Adaptations in the home become appropriate when a person is diagnosed with Alzheimer's and as their thinking skills decline.
"I look at what changes there are in the brain, then look at how the environment can be designed to compensate for that so in enables the person to function," said Paul Raia, vice president for clinical services for the Alzheimer's Association of Massachusetts and New Hampshire.
Regardless of the stage of the disease, increasing the lighting in the home is an important first step, Raia advised. Boosting the wattage on bulbs or adding a fixture or another outlet to a room goes a long way in creating a safer environment.
According to Raia, Alzheimer's patients at mid-stage of the disease need 50 percent more light to see at the same level of acuity because their retinal function goes awry.
More lighting during the day can also reduce sundowning, a worsening of behavior -- usually an increase in agitation and irritability -- seen in the late afternoon and early evening.
Adapting the Bathroom
Bathrooms can be particularly hazardous places for a person with Alzheimer's disease -- and not just because of their slippery surfaces.
Many bathrooms are monochromatic, with white tubs, white sinks, white toilets, white doors, and very often white or opaque flooring, walls and tiles. Being surrounded by all that white makes it hard to see the edges of objects for those whose sight is not 100 percent.
As a further complication as the disease progresses, a sufferer might lose the ability to see certain colors -- mostly pastels, which are seen as grayish, explained Raia. "But a person's ability to see bright primary colors remains intact," he said.
The solution, then, may be to use bright red, yellow or blue to draw a person's attention to the relevant features in the environment that you want them to use. This could mean painting the trim of the bathroom door red, for example, or pinning up some red fabric on it to distinguish it from say, a closet door.
"Or you can put on a dark color toilet seat or seat cover, so it pops visually," suggested Raia. "In that way, the environment is thinking for the person with Alzheimer's."
Calkins recommended putting colored non-skid tape on the floor of the shower and top edge of the tub so it stands out. Tape can also be placed around the sink and toilet if color contrast is lacking in these areas.
Another safety option is to install a tub bench and a hand-held shower device to make bathing easier, pointed out Trudeau, who also proposed replacing a glass shower door with a curtain. Grab bars by the tub and toilet are also a good idea to help prevent slips and falls, and cushioned protectors on the edges of the sink countertop act as a further safeguard against falling injuries.
Rethinking the Kitchen
After the bathroom, the kitchen -- with its array of electrical appliances, sharp implements, and heat-generating surfaces -- is the second most dangerous room in the home for the person with Alzheimer's.
Just as you would with children in the home, access to hazardous items needs to be restricted: Keep sharp knives, cleaning supplies and medications out of sight, recommended Trudeau, by stashing them in a safe place and locking them up.
Remove any appliances or products that might be dangerous if easily accessible, whether it's the garbage disposal, fire extinguisher, toaster or food processor.
Minimizing the potential for harm in the kitchen also means eliminating the risk of fires and burns. One way to accomplish this, said Trudeau, is by placing safety-proof covers over the knobs of the stove or removing the knobs so only the posts are exposed.
For those who have Alzheimer's but who still enjoy spending time in the kitchen, small adjustments to the environment that may help them avoid confusion.
As memory falters, kitchen cabinets and drawers can be labeled with signage using words -- in big block lettering -- or pictures to indicate their contents, such as plates, spoons or dish towels. It may also be a good idea to arrange food, such as boxes and cans, so they are easily visible and less likely to be confused.
Modifying the Living Room
Getting rid of clutter -- whether in the form of piles of old magazines, stacks of papers or loads of knick knacks -- not only clears space, but it's less visually stimulating to the person with dementia. And paring down the furniture in some rooms can make for clearer and wider walking paths.
The aim is to simplify the environment and to not have too much going on in a room, since a person with Alzheimer's disease has less capacity to screen out the relevant information from the less relevant, Raia said.
By this same token, solid-colored upholstery, walls or drapery might be less confusing than bold, patterned designs. Likewise, too much detail or lots of patterns in carpets and flooring can be disorienting and result in falls.
"A person with Alzheimer's disease might perceive a dark area of flooring surrounded by white as a hole that they need to step over," explained Raia, adding that glare on shiny floors might be seen as water or ice on the floor, which a person with Alzheimer's may try to avoid.
For all older people -- not just those with dementia -- it makes sense to eliminate throw rugs anywhere in the home that may slip or pose a tripping hazard. Covering up sharp edges on furniture is another wise idea.
Changing the Bedroom
"The bedroom shouldn't be a place for the Alzheimer's patient to hang out because there is a tendency to self isolate," advised Raia.
Make sure that the bedroom is comfortable and offers a good place to sleep. He also recommended using a brightly colored quilt to visually define the bed and keeping the number of items on top of a nightstand or bureau to a minimum.
Simplifying Closets to Make Dressing Easier
The bedroom closet can be overwhelming to the Alzheimer's patient who has difficulties with making decisions. So, one solution is to limit the number of choices.
"Take a good deal out of the bedroom closet," suggested Raia, "leaving just four or five outfits for the person to wear." And when you pull out clothing for the day, give the person a choice of two outfits.
To make changing clothes easier, he also recommends that caregivers lay out the garments in the order that the person would be putting them on, and to verbally cue the person while they dress to reinforce this sequence.
What's more, there should be good nightlights throughout the home, but especially to mark the path between the bedroom and the bathroom. Trudeau recommended that people invest in photosensitive night lights, which automatically go on as darkness falls and shut off as more daylight enters a room.
Securing Exits and Stairs
In the early stages of the disease, caregivers are often most concerned about their loved one walking away and getting lost and potentially injured, a process known as wandering.
"It actually happens not as often as you would think, given the press that it gets," pointed out Calkins.
Still, it's said to occur in 60 percent of those with Alzheimer's disease. And when it does, it can be extremely frightening.
Besides registering for a nationwide program such as the Alzheimer's Association Safe Return Program, which provides identification jewelry to participants registered in their database and helps coordinate search and rescue efforts, experts also advise installing slide bolt locks on all exit doors in areas where the person is less likely to see it.
"Put the lock higher up on the door if the Alzheimer's patient is shorter and lower for those who are tall," advised Trudeau.
In addition to the locks, he also encouraged the use of a motion sensor on the door so the caregiver is warned if the person is leaving.
Stairs can also become a problem for those with Alzheimer's as their depth perception wanes. Trudeau offered one inexpensive solution -- mark the steps with a contrasting color duct tape or carpet tape so they can be more easily seen.
Ultimately, the goal is to enable the person with Alzheimer's disease to remain in the home for as long as possible.
"Although there is no such thing as a safe home," said Trudeau, "all we can hope to do is make things safer."
------- For more information on memory, brain health and Alzheimer's disease, visit the OnCall+ Alzheimer's Center at ABCNews.com.