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.
The changes shown in this slideshow are only some of the safety modifications recommended in the booklet Keeping the Person with Memory Loss Safe at Home. The booklet and an accompanying kit stocked with low-cost home safety products are being tested among families by researchers with VA and Boston University.
Shaving with a straight edge or safety razor poses a risk for cuts. Use a cordless rechargeable electric shaver in place of a razor. A cordless shaver is safer than a corded one because it won't cause a shock if it's dropped in water.
To prevent accidents on the stairs, highlight step edges with contrasting tape to make steps more visible. Two-inch duct tape works well. Put one strip across the entire edge of each step, with an inch covering the stair tread and an inch folded down below the edge of the step.
Though hard to see in this image, the brick landing is 10 inches higher than the slate floor leading up to it. Such height differences may be difficult to discern for people with dementia. Highlighting the step edge with tape helps avoid falls.
Use a daily medication dispenser, such as a big pillbox. Don't keep medicines and vitamins out on the counter. Instead, hide or lock them in a cabinet or closet.
The stove can be risky for those with memory loss. Remove stove knobs and hide them in a nearby drawer. (See next slide for an alternative.)
Instead of removing stove knobs, you can use safety covers.
Use a child-safety lock to store away cleansers, knives, small appliances, or other potentially hazardous items in a kitchen cabinet.
Caregivers should keep a flashlight, as well as a telephone, near the bed in case of nighttime emergencies.
Install smoke alarms on each level of the home, including the basement. Test them monthly and replace the batteries as needed.
Install grab bars in the tub and shower. Make sure they're screwed into studs.
Replace glass shower doors with a curtain, install a handheld shower head, and use a non-skid bathmat in the tub.
Replace towel bars with grab bars that can hold towels but also provide support.
Install a slide-bolt lock toward the top or bottom of a door that leads outside—not near the doorknob—so the lock will be less noticeable. Also, use portable motion sensors, like the white unit sitting on the shelf near the door, to let the caregiver know when the person with dementia is trying to go out into the street. This is especially important for homes on busy streets with lots of traffic.
Make sure outside stairs have railings, and keep porches and walkways clear of clutter, such as flowerpots or statuettes.
"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.
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.