Home Modification: Ensuring safety and independence in Persons with Dementia

Kris Tong DL Occupational Therapist Rehabilitation Medicine National University Hospital

Dementia


a progressive decline of mental abilities (memory, reasoning, thinking and planning skills)

Can change his/her behaviour or personality (e.g, restlessness, agitation, wandering, sleep-wake reversal, and suspicious) Can affect the ability to care for self safely Tendency to fall more often than normal elderly.

 

WHY persons with dementia are prone to falls??

Fall Risks
   

decline in vision decreased balance sense slower protective reflexes problematic walking pattern

use of medications can lead to drowsiness, poor balance and postural hypotension.

Lack of safety awareness, restlessness and wandering.

Environmental Fall Hazards



Falls usually occur in places where older persons spend a large amount of time in. Within the home:
Living room 30% Bathroom/toilet 23% Dinning room 14.4% Bedroom 12.3% Kitchen 8.6%
Taken from 1300 subjects >65 years old in Hong Kong

LW Chan et al., (2005). Incidence and predictors of falls in the chinese elderly. Vol 34 (1), Annals Academy of Medicine.

Falls Guaranteed!

Problems In the House



3 basic types:
Hazards leading to falls Physical problems and barriers Lack of supportive features/ equipment

Contributes to accidents, reduce activities and foster unnecessary dependence.

Home Modification

converting or adapting the environment to make performing tasks easier, reduce unsafe activities and support independent living.

Creating A Safe Home Environment



Persons with dementia often cannot remember where they are and sometimes see their surroundings as threatening. Avoid changes to the areas where they are familiar with. Keep noise level to minimal. Best to ensure that your home is calm and quiet so your loved one to be safe and as independent as possible.

 

Remove Hazards


Lock up or remove dangerous household items. Clear clutter and electrical cord away from walkway. Ensure ample walking space (~ 1m) Use double-sided tape at carpet edges. Remove loose scattered rug.

Provide Good Lighting



Ensure sufficient lighting. 100 watts for room lighting

Leave lights on in rooms or walkways that you walk through after dark. Can use night lights (energy saving).

Use lights that are difficult to knock over or that are affixed to the wall.

Secure the Kitchen



Remove the knobs of the stove when not in use. Or turn off the main gas inlet.

Keep dangerous objects away under lock and key.

Put away kitchen appliances when not in use.

Make the Bedroom Safe



Place necessities (esp a phone) near the bed.

  

Add night lights and bedside lamp. Avoid getting up of bed quickly. Sit at edge of bed for a while before getting up to walk.

Ensure height of bed is not too low.

Make the Bedroom Safe



Bed guard may prevent falls from the bed.

 

Ensure clear walking space. Place a commode by bedside.

Create a Safe Bathroom

   

Remove locks from the bathroom door. Place only the essentials in the toilet. Keep the floor dry at all times. Encourage sitting on a stable chair or commode for showers. Use non-skid mats at the shower and at the entrance.

Safe Bathroom Contd..  Install grab bars in the shower and around the toilet.

Safe Bathroom Contd..



Use of raised toilet seat

Increases the height of toilet bowl. Allow ease in getting up from sitting. Good for elderly with lower limb weakness, arthritis and previous hip surgeries

Use of instant toilet bowl over squatting toilet.

Lock Or Secure Doors and Windows



Place latches or locks higher or lower than eye level on doors and windows. Lock and put keys away.

Disguising doorways to discourage wandering.

Paint the door the same colour as the wall. Or use wallpaper. Hang a curtain over the door frame.

Be Prepared for Emergencies



Paste the important numbers near the phone.

Or use a portable phone with emergency numbers stored in.

Have your loved one wear an bracelet or put a card in his wallet with his/her name, address, and phone number. If he or she cannot respond to emergency situation, DO NOT leave him/her at home alone!

Day-to-Day Care


Ensuring quality of life for the persons with dementia as the disease progresses.

Promoting self-esteem and reducing problematic behaviours.

Preventing decline in physical and mental capabilities.

General Guidelines


Try to schedule daily activities which your loved one has done before and maintain a routine.

Allow the person to do his/her self-care as much as possible. Be ready to take over or help with a step that he/she cannot perform.

Talk to your loved one and tell him everything you are going to do.

Simply each task to encourage participation and success.

Do the initial steps and cue him/her to finish. Give step-by-step instructions or demonstrations. Place hand over his or hers and guide with the task.

Never scold if he/she is unable to participate in the activity or task. Praise him/her frequently.

Be flexible and creative. Try different approaches.

Be sure your attitude is kind, non-demanding and patient. Ensure positive verbal and non-verbal communication.

Use distraction (singing, food, talking) to prevent agitation or restlessness.

Always remember that difficult behavioural response usually occur for a reason. Take time to investigate what triggers the behaviour.

Consult doctor when necessary.

Assisting With Showering



Shower your loved one in accordance to his/her previous preferences. Ensure safety at all times. Bring all the necessary items before showers. Try giving the shower while the person is in sitting. Help from the side/front so that he/she can see you at all times. Do not rush.

  

Dressing


Simplify his/her closet or wardrobe. Buy clothes that are easy to wear and a size larger with the elastic waistband.

Lay the clothes out in the order he/she is to put them on.

Ensure wearing of clothes in sitting for safety.

Toileting
Label the bathroom door.

Remove distractions from the bathroom.

Remove items that might be confused with toilet.

Place a commode at the bedside.

Managing Urinary and Bowel Incontinence



Set a schedule to remind or take the person to the toilet. Keep record of when he/she wets him/herself.

Change clothing and incontinence pad immediately after soiling.

Encourage 6-8 glasses of water daily.

Eating
  

Prepare food that he/she is familiar with. Set a routine for mealtimes. Do not rush. Eat with him/her so that he can copy you to feed by him/herself.

Do not try to feed the person if he/she is restless, or sleepy.

 

Use plates with sides or bowls. Try using spoons with large handles with grasping is difficult.

Avoid using utensils that break easily.

Remove distractions. Minimise noise.

Have the food contrast with the plate/bowl.

Caregiving Can Be FUN!



Include fun activities that your loved one will enjoy.

Activities can:
Promote positive behaviour. Help maintain physical and mental health. Give sense of purpose and dignity.

Tips To Planning Successful Activities

     

Write down the activity plan for each day. Have a routine. Plan activities that he/she can participate. Simplify activities into small tasks. Prepare all the materials you need in advance. Try doing something different if certain activities agitate him/her.

Activity Ideas
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Sort Mahjong tiles. Watch a favourite movie. Listen to old songs. Look at photographs of friends and relatives or past events. Fold clothes or towels. Help out with meals preparation. Manicure Aromatherapy Go for excursion Exercises Share memories

In Conclusion


Elderly people with dementia are very prone to falls due to declining body and mental functions. Appropriate modification to your home environment and caregiving process can help to prevent falls and allow your loved ones to be as independent and happy in the house.