By: Beth Hutchason, MN, ARNP
Beth has been a registered nurse for 33 years and a nurse practitioner for 25 of those years. She spent the past 14 years doing palliative care, a branch of medicine focused on improvement in quality of life and relief of suffering. During these years, she had the opportunity to interact with hundreds of people with dementia and their families. They have taught her a great deal, which she hopes to share. Beth lives with her husband David, rescue dog Katya and about 60,000 largely unnamed bees in Poulsbo, WA.
It is estimated that over 6 million Americans are living with dementia. As family caregivers provide support to these individuals, issues surrounding safety invariably arise. Here, I will highlight some common safety concerns and some suggestions to improve security for people living with dementia. There are undoubtedly many more options than I can cover in one article. My intent is to open the discussion and give you some options to consider as your loved one’s disease progresses.
Falls are a primary concern as dementia progresses and cognitive, as well as physical decline, occurs. Falls, particularly with injury, decrease quality of life. If major surgery, such as hip repair, is required, there is an increased risk of death within the year (Bai, 2018). A simple way to reduce fall risk is to remove barriers to free movement. Remove all throw rugs to eliminate tripping hazards as gaits become more “shuffling” with disease progression. Clear pathways, especially those used frequently. A clean, clear path reduces physical barriers and presents a less “cluttered” view for the mind to process. Install grab bars and safety rails to provide extra security in and by showers, toilets and stairs. If you need help installing these items, there are often groups willing to do this for free. If you purchase an alert pendant or wristband, be sure it has an auto-alert feature. These alarms will trigger automatically if a person falls and cannot press the button.
Sixty percent of people with dementia will wander at least once; many will do so repeatedly (Wandering, 2021). This behavior carries risks of injury, or even death, and weighs heavily on the minds of caregivers. Providing structured activities and reassurance can be helpful but may not be enough. Families should also consider safety measures. If a person with memory loss is still driving, make sure they have a GPS in the car with a “home” programmed that they know how to use. A device that can be worn and tracked anywhere can be very reassuring also. Door alarms are readily available online, inexpensive and easy to install. Locks applied to doors should be placed high or low on the door to be out of sightline, which narrows as the disease progresses. Consider using camouflage or visual barriers at potential exit points. Cover door handles so that they are the same color as the door or cover the whole door to make it look like a bookcase.
In mid-stage disease, the kitchen becomes full of pitfalls that can pose serious safety risks. Stoves are a frequent issue, with burners left on and items left to burn in the oven or on the stovetop. Disconnecting appliances is often the answer, and switching to other options, like the microwave, can be helpful. Meal delivery services like Meals on Wheels provide not only microwaveable meals but also social contact.
Medications are necessary for almost every person as we age. Managing these is a balance of independence versus safety. Initially, a medication reminder of some type may be adequate: a timer, a pillbox with alarms or a phone call. Later, a medication dispensing device can be filled by a trusted caregiver. These are more expensive but can delay requiring even more costly caregiving support. In later stages, someone will need to assume medication management completely. It is beneficial along this route to have a conversation with your primary care provider (PCP) about which medications are still necessary or appropriate. Pill burden is a significant issue and can often be reduced by some open conversations.
Agitation, Hallucinations and Resistance to Care
These are probably some of the most challenging challenges for people with dementia and caregivers. It is important to remember that safety also includes the safety of spouses and caregivers. A health care provider should always evaluate a sudden behavioral change to rule out a medical cause. Providing reassurance, calming presence and space, if needed, can be a helpful start. Consider the reason behind the outburst as the person may well be unable to tell you outright. Are they overtired or overstimulated? Are they hurting? Has their environment or schedule changed? Looking at the patterns can be invaluable in solving the puzzle to help them.
Hallucinations can be auditory (heard), visual (seen), olfactory (smelled) or tactile (felt). If they do not upset the person experiencing them, they do not require treatment. There is no reason to correct the person or tell them that they are not real; as to them, they are indeed very real and will only put you in opposition to what they “know.” Ask them to tell you about the hallucination. If the hallucinations are causing distress, then you should discuss this with their PCP or neurologist.
This article only touches on some options for safety when caring for people with memory loss. There are many, many resources available to you. I suggest talking to your PCP and any nurses you have contact with, such as through home health or in clinics. The Alzheimer’s Association (alz.org) provides a variety of programs and services for individuals and families facing any type of dementia, including: support groups, dementia education, care consultations, a free 24/7 Helpline (1.800.272.3900) and more. Contact your local hospice or home health agency and see if palliative care programs could be helpful; these programs have extensive experience with people who have dementia.
Alzheimer’s Association. (2021). 2021 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dementia 2021, 17(3). https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf
Bai, J., Zhang, P., Liang, X., Wu, Z., Wang, J. & Liang, Y. (2018). Association between dementia and mortality in the elderly patients undergoing hip fracture surgery: a meta-analysis. Journal of Orthopaedic Surgery and Research 13, 298 (2018). https://doi.org/10.1186/s13018-018-0988-6
Wandering. (2021). Retrieved June 19, 2021, from https://www.alz.org/help-support/caregiving/stages-behaviors/wandering