Office of Research & Development

Feature Article

Studies boost Alzheimer's home safety

The Camerons live in a tidy two-bedroom rancher just across from the Merrimack River, outside of Boston. A former gunner's mate in the Navy and library custodian, Donald, 74, was always good with his hands. These days, though, his wife, Ann, has to keep power tools away from him. She also has to make sure he doesn't wander off onto the busy two-way street outside their home. Donald has Alzheimer's disease, and his memory is declining with time.

"It's become more difficult, especially in the past year," says Ann.

She and other family caregivers have been taking part in studies at the Bedford (Mass.) VA Medical Center aimed at boosting home safety for those with Alzheimer's.

The first goal of the research was learning what types of changes are practical and effective for families. The National Institute on Aging, Alzheimer's Association and other organizations have put out home-safety tips for years. But not all the tips are equally doable for caregivers.

"Many of the recommendations that were available were not research-based," says lead investigator Kathy Horvath, PhD, RN. "They were often overwhelming to people, and they didn't know where to begin. Some recommendations were just lacking in the detail that people need."

As an example, she cites the suggestion to highlight the edges of steps with white or colored duct tape, to provide contrast. People with Alzheimer's have trouble with perception and are more likely to trip and fall. "As one family member asked us," says Horvath, "does the tape have to go on all the stairs? Does it have to go across the entire stair? Just in the middle? These are the kinds of details people have questions about."

Horvath and colleague Scott Trudeau, PhD, OTR/L, an occupational therapist, set out in their first study to test which interventions worked best. One factor they explored was cost: Caregivers were unlikely to make changes that were too pricey. The average cost of home-safety products installed in families' homes in the study was $79. This included items such as grab bars for the shower, nightlights, stove-knob covers, and child-safety locks for cabinets.

Wandering woes

Many of the home-safety changes that benefit people with Alzheimer's and their family caregivers are good things to do for any older person—for example, removing throw rugs from bedrooms or hallways, or installing grab bars in the shower. Other changes are specific for those with memory loss: placing car keys or cleaning supplies out of sight, for instance, or replacing stove knobs with special safety covers.

"Wandering" is one behavior specific to Alzheimer's and other forms of dementia that concerns many family caregivers. The following are among the wandering-prevention tips in Keeping the Person with Memory Loss Safe at Home, a booklet being tested as part of a study at the Bedford VA Medical Center and Boston University:

  • Send for an ID bracelet from the Alzheimer's Association "Safe Return" program (1-888-572-8566).
  • Give the name and a recent picture of your family member to the police in case he or she wanders away and gets lost.
  • Use a motion sensor to warn you when the person wanders to an exit door or to a "risky" room, such as the kitchen, and install slide-bolt locks at the top or bottom of exit doors.

Families also were unlikely to make changes that took too much time, required technical help, caused an inconvenience, or altered the look of the home.

Says Horvath, "Something might sound like a great idea from the professional's viewpoint, but if people aren't going to do it, what have you accomplished?"

Their study resulted in a 25-page, illustrated, simple-language guide. The booklet was tested for "health literacy" to make sure people could easily understand the instructions.

It's now being tested with 160 families. Among the questions the researchers are looking at: Will caregivers who receive the toolkit (the booklet plus a shopping bag full of low-cost safety items) be more likely to make changes than those who receive only a standard checklist of recommendations? Will they experience less strain? Will their loved ones with Alzheimer's engage in fewer unsafe behaviors?

The researchers point out that no approach is foolproof. "There's no such thing as a completely safe home," says Trudeau, who has worked with people with dementia for 15 years. "What we can do is make the home environment safer, for both the caregiver and the person with Alzheimer's.

Nothing, he says, can replace the need for close supervision of someone with memory and judgment problems, "but the modifications we recommend can lessen the intensity of the vigilance required on the part of caregivers."

Horvath and Trudeau's research is conducted through VA's New England Geriatric Research, Education and Clinical Center; and the Alzheimer's Disease Center at Boston University. Funding is provided by VA and the National Institute on Aging.


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