Alzheimer ’s disease, the most common form of dementia, poses a particular set of challenges in the home environment. According to the Alzheimer’s Association, 5.3 million Americans have Alzheimer’s disease, and it weighs in as the 7th leading cause of death in America. Home safety issues pose dangers to people with Alzheimer’s disease that you or I would not generally consider. Think about how many household functions require depth perception, sequential thought, short-term and long-term memory, and the ability to initiate activities.
Alzheimer’s related complications often involve the home-environment – falls and fires are two of the most common. Beyond preventing injury and death, the home environment affects the quality of life of someone with Alzheimer’s. Rosemary Bakker, MS, is a certified interior designer, dementia specialist, and Research Associate in Gerontologic Design in Medicine at Weill Cornell Medical College. She is also the Director of ThisCaringHome.org, a project of Weill Cornell Medical College. In an interview with me this week, she discussed strategies for reducing home risks and improving quality of life for people with Alzheimer’s disease. Bakker said, “The environment is so important to a person with Alzheimer’s. They’re much more sensitive to their environment, so there’s a lot they can do to make it safer for them, and to give them a greater quality of life.”
Making Stairs Safer for Someone with Alzheimer’s Disease
Depth perception is a serious problem for people with Alzheimer’s . According to Bakker, “They may not notice a glass door and try to walk right through it. If there’s a low cocktail table, particularly if it’s glass, they may not even see it and walk right into it. Climbing stairs can be a really big issue because if the riser and the tread are the same color, the person may not know how high to lift one’s feet, and therefore falls can occur and can be terrifying to try to walk the stairs.”
- Color contrast: “If you’re totally redoing your stairs, you can use a different color wood for the tread than for the riser,” said Bakker. “Or you can put a 2-inch color tape or even paint – I’ve known people who have even painted stripes on their carpeting going up and down the stairs – making sure that the color of that stripe is a lot brighter than the surrounding color. That can make a huge difference in function.”
- Hand rails: “People with Alzheimer’s tend to have mobility issues. It can be age related, for example arthritis, or it can be due to neurological changes in the brain. So having really good hand rails [on both sides] gives them a safe anchor to hold on to as they walk up and down the stairs,” said Bakker. “It can reduce their fear of stair climbing and it really can increase function.”
Bakker cautioned, “Walk up and down the stairs. Really hold on to those rails and make sure they are firmly attached. Sometimes an adult child may be visiting a parent, and they don’t use the hand rails. They don’t really know if they’re well-installed or not. So try to test things out. Many hand rails are just screwed into sheet rock."
The Best Lighting for People with Alzheimer’s
People with Alzheimer’s are very susceptible to glare, and to sudden changes in light levels. According to Bakker, “There can be tendency to hallucinate or to see things that aren’t really there. For example, in dim lighting if there’s a large leafy plant, it may look like a person crouching. So you want to make sure that things are evenly lit and that they’re not going from an overly lit room to a dark room. You really want to make sure that the lighting is kind of even. For some people with Alzheimer’s, they get afraid of dim areas. ”
- The best kind of lighting is glare-free: “Glare can cause confusion as to what type of surface they may be walking on, and it can also cause confusion in terms of what they’re actually looking at,” said Bakker. “So if there’s a lot of glare on a table, or there’s a lot of glare on a surface, it can distort visual perception,” she said. Bakker recommends avoiding bare light bulbs, and making sure that all lamps have lamp shades.
- Install more outlets: “Make sure there are not too many extension wires going across the room,” cautioned Bakker. Extension cords pose a trip and fall threat to people with Alzheimer’s, but don’t let a lack of outlets limit lighting in the house. “It’s really important to get those extra outlets installed so you can plug in more lamps,” she said.
- Avoid sharp changes in light levels: As we get older, our eyes change the way they adapt to light and dark. Bakker said, “They might not see something on the ground because the person could be temporarily blinded going from a dimly lit room to a bright room, and vice versa. It can kind of blind their vision, particularly at night.”
- Steer clear of bright lights at night: Besides being temporarily blinded by sudden bright light, bright lights at night can confuse someone with Alzheimer’s as to what time of day it is. “So they may think, ‘Oh, the lights are on. I have to go to work.’ It can cause problems with them getting dressed at 3:00 in the morning. When you don’t understand this, you just can’t imagine that these things can happen,” said Bakker.
Floors Mean More When Alzheimer’s is in the House
- Avoid polished floor surfaces: Polished floor surfaces cause two problems for people with Alzheimer’s disease. The first problem is perceptual issues. Bakker said, “Even walking in a room with a lot of glare on the floor can get them confused as to where to place their foot. You want to make sure that the floor doesn’t look like a skating rink. I’ve actually had a few people tell me that the floor was wet, and it wasn’t. It was just that there was a lot of glare on it so they didn’t want to walk on the floor.” The second problem with polished floors is that they are slippery, which poses a risk for people who shuffle when they walk. Bakker said, “I don’t recommend polished marble or polished floor surfaces anywhere in the home, especially in the foyer and in the bathroom.”
- Remove doorsills: “A lot of people with Alzheimer’s start to develop a shuffling walk later on. They don’t pick up their feet enough, and as I mentioned they can also have visual issues with depth perceptions, so they might not even see the rise of the door sills. It can be a common cause for tripping. Whenever possible, I tell homeowners to take up the doorsill,” said Bakker.
- Remove area rugs: Bakker said, “They pose a risk for tripping and falling, particularly if a person walks with a shuffle. Instead of discarding them, they could donate it or give it away to a favorite niece or grandchild.”
Bathroom Renovations for Aging with Alzheimer’s
The bathroom affects the quality of life of the caregiver as much as the family-member with dementia. Bakker said, “Bathing is really a big issue. If you’re planning on renovating your house, or you’re planning on renovating a bathroom, why don’t you think about taking out a nearby closet and getting two or three feet of space from the adjacent room and put in a walk-in, wheel-in shower. It will make a huge difference later on, and it’s also helpful for everyone.”
- Make the bathroom more wheel chair accessible: Bakker said, “Put in a sink that you might be able to sit at. It makes it much easier to give care later on if you have either a height-adjustable sink or one that you can sit at. Higher height toilets are terrific, too.”
- Keep the bathroom design simple: “It gets harder and harder for them to even remember the body movements they need to move over on a transfer bench,” said Bakker. That's why an accessible walkin-in, wheel-in shower is so important.
Appliances Should Be Safe and Easy to Use
- Clearly mark buttons and controls: Bakker cited an example from her own mother’s bout with Alzheimer’s. “When she was living in a dementia-specific assisted living and it was 100 degrees in August, the head nurse came up to me and said that my mother had Alzheimer’s and could no longer use the air conditioner,” Bakker recalled. “I took a look and I saw that the controls were in a tiny gold font on a gold background, and I could hardly see the on and off controls myself. So I went to my computer and I printed out very large on and off labels in large black font (20 pt) on a white background, and for 3 more years she was able to use her air conditioner. You want to make sure that the labels are easy to read,” she said.
- Bright colors help: “If you have a very complicated microwave, you may want to highlight the instant reheat button, or whatever it is that they use a lot, with red nail polish, or you can get a type of red paint that you put on appliance buttons. You want to make sure controls are really easy to use, and if they are not, apply labels,” said Bakker.
- Smart or passive safety technologies: Bakker suggests installing a device that turns off the stove if it senses no motion. Some devices come with a preset factory setting of six minutes, but they allow you to adjust the timer before the stove turns off. She also suggests installing an automatic fire-extinguisher under the range hood.
Outdoor Spaces for Ease of Alzheimer’s Care
- Create boundaries around the home: Bakker said, “You need to think about how you can give a person freedom within the home, but make sure that they’re safe within that home and they don’t extend far beyond a boundary when it is no longer safe for them to do so. We have more new technologies coming out. Some of them work better than others depending on the environmental interferences.” She suggests installing monitors on the doors that trigger a chime when needed.
- Prevent trip and fall hazards: “You want to be sure that if a person does go out the door, that the stairs are really safe for them to use,” said Bakker.
- Install good outdoor lighting: Bakker emphasized lighting the path to the front door well.
Reduce Symptoms of Agitation with Noise Control
“You want to be real careful of sound control in your environment. You want to be sure the person is not being agitated by really noisy dishwashers or blenders,” said Bakker. “That can bring on really agitated outbursts. They’re hypersensitive to sound.” Bakker cited lawn-mowers and hair-dryers as other household appliances that commonly agitate people with Alzheimer’s. “The caregiver should take a look and see when they start getting agitated. That’s key. When the person gets agitated, look what happened right before it. That’s the trigger,” she said.
Clutter Control for the Chronic Hoarder with Dementia
“We don’t really know why it occurs,” said Bakker. “Is it neurological changes that are taking place? Part of it is just terrible confusion that they have because a lot of people with Alzheimer’s don’t quite know they have Alzheimer’s. For example, they may think that people are stealing their things if they don’t know where they placed them, and so they get paranoid and then they start hoarding things.”
- Clear clutter slowly: “Take care of the safety issues first. Make sure there’s not tons of newspaper right next to the radiator. Look at your fire issues here. Look at your fall issues. If they’re going to have a psychiatric episode if you get rid of everything, you shouldn’t. Try to box things up. Put them along the walls. Try to clear out slowly. To reduce their anxiety, get involved and give them a project to do. Usually they’re missing something. One of the best things you can do is say, ‘Can I help you find something here?’ Sometimes that helps go through some clutter,” Bakker said.
- Send belongings to relatives: “I’ve had caregivers of people with dementia help pack up and ship boxes of things to a niece somewhere because they feel like their goods are going to be safeguarded. They’re not really getting rid of them,” she suggested.
- Check out Rosemary Bakker’s guide to clutter, hoarding and rummaging on her Web site.
Finding the Positive
Making the home easy to navigate, providing plenty of visual clues, and tuning into triggers seem to be the best ways to make a home hospitable for someone with Alzheimer’s disease. “There is a lot of decline with dementia, but you can help the person function better by adapting the environment to meet their unique needs. There is still growth for life and the ability to love remains,” said Bakker. “You just have to know how to enter the person’s world and not really resist it or challenge it. Adapting the home is key to experiencing less stress and, hopefully, a calmer day,” she said.