Dementia - Dangers in the Home

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Sally Smith: Welcome to Age to Age. I'm Sally Smith. Let's talk. Today we're fortunate to have with us Rhonda Weichsel, who is an occupational therapist and is also in the Department of Psychiatry and Behavioral Sciences, and as such, she is particularly well-situated to talk to us today, because she is in charge of the Alzheimer's research and clinical programs. Mainly, with her work in occupational therapy, she has a real hands-on view of issues that come up with taking care of an Alzheimer's patient or a patient with dementia.

This is such a large subject and I know we will break it into smaller sections because it is sort of overwhelming, but I've read that it's more effective to change the environment than to change the behavior and patterns of someone who no longer can really think clearly or reason. You can't just explain, "Hey, watch out for the steps. They might be slippery." - or anything like that. So, what are the biggest dangers within the home if you were going to keep a demented loved one at home?

Rhonda Weichsel: First of all, you would need to start with the bathroom and kitchen. That's basically the areas that you want to keep the safest. For instance, in the kitchen, you want to have no rugs. If fire is a hazard, you want to take off the knobs off of the stove.

You want to have no sharp objects. Glass tables are a hazard. So, basically, you would want to keep all those things that could cut the skin, or burn someone. Someone in the kitchen should be wearing short sleeves, or no hanging sleeves that could catch on fire. Doors are actually a hazard in the kitchen as well, because they may have glass around the doors, or there may be locks around the doors, and you want to be able to have someone exit at their will, but in a safe place.

Sally Smith: Well, it almost sounds like, having just kept three grandchildren under the age of six for several days, it's a little bit like childproofing - good common sense.

Rhonda Weichsel: That's right. You would never want to leave them alone in a place that has hazards as well.

Sally Smith: What changes can be made to decrease these hazards? I know, in my reading, that there are many systems you can buy that are very expensive. What are some of the simple things you can try just to see if they're even going to work, like certain kinds of locks, or something like that?

Rhonda Weichsel: Basically, you would want to keep it simple, because you may have to change as your loved one changes. They may figure out how to get out of a locked door. So you want to keep it simple and inexpensive. Basically, what you would want to do is position the locks at the very top of the door - maybe a sliding lock, or if you're going to use a deadbolt, make sure you keep the key around your neck or in a safe place so that everyone, in case of a fire, knows how to get the key and get out.

Also, just using simple knobs. Lever handles are wonderful rather than knobs because a lot of times people don't have the range of motion, the dexterity to open the doors that they need to open.

Sally Smith: Wow! I had heard that one of the things in the bathroom was to make sure that they could not lock themselves in. That was interesting to me. That by mistake, they might lock the door, and that they would be caught on the other side. So, I guess that's another thing where you have to get a different kind of lock - instead of locking to be sure everybody stayed in, locked to make sure nobody gets caught.

Rhonda Weichsel: Or, you could have a lever door where it's a non-locking kind of door. You just slide it open.

Sally Smith: Oh, I see. Having a home hazard-proofed, so to speak, does it tend to make the loved one feel that they are more at home in their environment? In other words, they're not kept out of the kitchen because they might get in danger there? Is there a noticeable comfort level that, even though these things are different, and that it may be hard for them to realize they can no longer turn on the stove, or open the door, or whatever - but in general they're able to have the run of the house? It seems to me that that would be the better of the two evils.

Rhonda Weichsel: It's much more comforting for the person to be in their own comfort zone. Keeping things simple and keeping things safe? Yes. Are they going to wander less? Probably not. But they're going to be safe around their own home, because it's familiar to them.

Sally Smith: One of the things that I thought about in that degree too, is, maybe, less conflict. I know when my mother-in-law lived, because she would be just lovely, but when something agitated her, then she would catapult into a much overblown reaction to whatever she was frustrated by. And so the fewer things that, I guess, they can get into trouble with around your house, the happier your life's going to be, and theirs too.

I've heard that one of the big things in the bathroom is a non-slip rug. Somebody said that there's even something for Alzheimer's where they have mats that you could put beside the bed that would make a sound when somebody stands on them, in case the person wakes up in the night. But just a good old non-slip rug, they said, was of big importance, because I guess people are just not as careful of their own safety, and maybe their balance is slightly off.
Rhonda Weichsel: That's right. Oftentimes, in the bath, rugs are a hazard, regardless of whether they're non-slip non-skid. It is important to have a non-slip non-skid inside the shower, because that's where most of the falls happen - when they're in the shower or exiting the shower. But be very careful about having any kind of rug in the bathroom. Sometimes the best thing to do is nothing and try to make sure that the area is dry.

Sally Smith: Speaking of walking, do people put reflective tape on the stairs, or do stairs enter in as a danger point?

Rhonda Weichsel: Absolutely. Night lights are a wonderful option. Keeping a light on at all times, maybe in the hallway, is a very good option. Yes, make sure that the stairs have secure handrails and that they're bolted to the wall securely. Make sure that the stairs are not in the position where there's a rug that may slip, or that the stairs themselves are dry, and do not have toys, or do not have objects on them, so that an older person can trip and fall.
Sally Smith: Well, I know from my own mother, as she slipped toward childhood, she would move things around in the house, and she had certain little areas where things would collect and you'd think, "Oh, I bet what I'm missing is in that little cache over there behind the sofa." Is it good to have some spaces where you have your own personal bedroom, maybe, with a high lock on it, that nobody could get in but you, and certain closets? Do caretakers do this in order to protect some of their own spaces?

Rhonda Weichsel: I think everybody does that. I think that's just a natural instinct for all of us, to have our own spaces, our own personal things either locked or secret. I have a drawer that we keep our wallet or things in, or everyone has a place where they keep their special things, regardless of whether they have dementia or they're normal aging.

Sally Smith: In a way, it's interesting. It's almost like, so much of medicine says prevention is the best cure. Sometimes, just thinking through your house, step by step, and saying, "These could be the danger points." And "These are the places that I'm going to go ahead and lock up." "They don't need to get through the linen closet." Or, "Nobody needs to get into my personal closet." Or whatever the things are. And I bet it would take some of the stress in an already relatively stressful situation.

Rhonda Weichsel: I think the best thing to lock up first is the medicines. Make sure that you go through your medicines quite frequently and throw out anything that's old or unused. But definitely have those particular items locked up. If they have sharp items in the house - knives, things that might endanger the caregiver, or the individual themselves, that's something else that you definitely need to have locked up. Guns definitely need to be taken out of the house, or placed in a locked cabinet behind a locked door. Otherwise, chemicals, things like that, also need to be locked up.

Sally Smith: Gosh, if you don't think about that, but I see that makes absolute sense. Rhonda, thank you so much for talking with us about home safety in this situation. I'm sure you've had a lot of experience dealing with different caregivers and seeing the large spectrum of the way this can unfold for each person in their house. Thank you so much for talking with us today.

I'd like to thank you, and I want to thank my producer Betsy Reeves, web administrator Sujit Kara. Thank you to all of our listeners too for joining us today. We welcome your suggestions and invite your comments on our website. This is Sally Smith, Age to Age, saying goodbye and wishing you courage and joy on your journey. We are all connected.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you'd like to schedule an appointment with one of our physicians, please call MUSC Health Connection at 1-843-792-1414.

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