What does it mean to modify the home environment?
Research studies and anecdotal experience suggest that factors in the physical environment, such as lighting, color or noise, can greatly impact the behavior of a person with Alzheimer's. Making changes and adjustments to the home environment can help make day-to-day activities easier and safer for the person with Alzheimer's and can reduce specific symptoms, such as wandering.
At first, changes may need only be simple adjustments, such as keeping often-used items in a certain place, labeling doors or drawers so the person can find things easily, or using notes and timers to remind the person to do certain things. As the disease progresses, more extensive measures may be necessary to ensure the person's safety and help reduce problematic behaviors.
How can modifying the home help the person with Alzheimer's?
People who have Alzheimer's may eventually lose access to what has been called the "map room" of the brain, the systems that orient us in time and space. Wandering and losing one's way to or from destinations - even within one's own home - may result. One of the goals of so-called "environmental modification" is to help people with the disease overcome the loss of these internal mapping abilities.
A great deal of clinical experience and research has demonstrated that when the physical environments of people with Alzheimer's are specially designed to support their abilities, they are able to remain more independent and socially engaged, have fewer paranoid delusions and aggressive outbreaks, and be less anxious. Home modifications can also jog short-term memories and help the person with Alzheimer's access long-term memories. Perhaps most importantly, by making the environment more "Alzheimer's-friendly," the person can live more safely and dependence on others for daily activities may be delayed for as long as possible.
What types of modifications are beneficial?
There is little question that environmental modifications improve day-to-day functioning in people who have Alzheimer's disease. Researchers are still investigating which modifications are most beneficial and how things like lighting, music and furniture placement might interact to affect behavior. A number of specific home modifications have been shown to be beneficial in reducing certain problematic behaviors in people with Alzheimer's:
- low levels of light during meals (this may improve eating habits);
- simply furnished spaces with minimal distractive clutter;
- consistent background noise, especially music of the person's choosing or simulated nature sounds;
- placing objects that cue memories in clear view, such as photographs, mementoes and familiar furniture;
- ensuring privacy and personalizing space - especially if the afflicted person spends time or resides in a healthcare facility outside of the home.
What can be done to make the home safer for the person with Alzheimer's?
The types of safety precautions that may be necessary depend upon the stage of illness and the types of symptoms the person is encountering. In early stages, precautions might include using appliances that shut off automatically, setting timers or alarms to remind one that something is cooking or that it's time to take medicine, and using notes and lists to organize activities and minimize missed appointments.
Meal preparation may pose a risk to the person with Alzheimer's as the disease progresses. The person may not recognize when a stove is on, or if food is too hot to eat. Gas appliances should be checked to be sure pilot lights are working properly, as a gas leak might go unnoticed. The home should be equipped with smoke detectors and fire extinguishers marked with clear instructions in each room of the house.
In later stages, it may also be prudent to remove guns, knives and other potentially dangerous implements from access by the afflicted person. Toxic or poisonous items, such as cleaning solutions, bleach, drain opener and prescription medicines, should be kept in a safe place to prevent accidental ingestion.
At what point should a person with Alzheimer's not be allowed to drive?
It may come as no surprise that there is substantial scientific evidence that people with Alzheimer's disease pose a significant traffic-safety problem, both from accidents and from impaired driving performance. The American Academy of Neurology, a professional organization for physicians who specialize in brain disorders, has issued guidelines for physicians regarding the risk of driving by people with Alzheimer's. Your doctor should be able to guide and counsel you on this matter.
Making the decision that it is no longer safe for a person with Alzheimer's to drive is difficult, and the decision needs to be communicated carefully and sensitively. The person may understandably be upset by the loss of independence and the need to rely on others for going places, especially in areas where public transportation is limited or nonexistent. Nevertheless, safety must be the first priority. Here are some suggestions from the National Institute on Aging:
- Look for clues that safe driving is no longer possible, including getting lost in familiar places, driving too fast or too slow, disregarding traffic signs, or getting angry or confused.
- Be sensitive to the person's feelings about losing the ability to drive, but be firm in your request that he or she no longer do so. Be consistent - don't allow the person to drive on "good days" but forbid it on "bad days."
- Ask the doctor to help. The person may view the doctor as an "authority" and be willing to stop driving if the doctor recommends it. The doctor can also contact the Department of Motor Vehicles and request that the person be re-evaluated for driving ability.
- If necessary, take the car keys. If just having keys is important to the person, substitute a different set of keys.
- If all else fails, disable the car or move it to a location where the person cannot see it or gain access to it.
How can wandering be managed?
Wandering can be a major safety risk for people with Alzheimer's disease. If wandering is a problem, it may be necessary to install alarms or locks on doors. There are various programs available that provide identity bracelets for people with Alzheimer's, so that if they do wander from home or work, they may be returned safely. Another option is to accompany the person on a walk in the neighborhood or a park. Some researchers are experimenting with "supervised wandering" that enables patients with Alzheimer's to wander and pace in safe enclosed spaces, and the results are encouraging. In some cases, it may be necessary to have someone stay with the person 24 hours a day to prevent him or her from wandering off and becoming endangered.
Where can I learn more about home modifications?
Patient groups for people with Alzheimer's and caregiver support groups can be excellent sources of information about modifying the home and other ways to help manage the behavioral symptoms of a person with Alzheimer's. Your doctor, counselor, social worker or geriatric care manager should be able to help you find more information.
What can be done to help manage incontinence?
As the disease progresses, many people with Alzheimer's begin to experience incontinence, which is the inability to control one's bladder and/or bowel movements. Incontinence can be upsetting to the person and difficult for the caregiver. In later stages of the disease, the person may not even be aware that he or she is incontinent. Sometimes it may be due to a physical illness or to medications the person may be taking, so be sure to discuss it with the person's doctor. Here are some tips from the National Institute on Aging that may help manage this issue:
- Have a routine for taking the person to the bathroom, and stick to it as closely as possible. For example, take the person to the bathroom every three hours or so during the day. Don't wait for the person to ask.
- Watch for signs that the person may have to go to the bathroom, such as restlessness or pulling at clothes. Respond quickly.
- Be understanding when accidents occur. Stay calm and reassure the person if he or she is upset. Try to keep track of when accidents happen to help plan ways to avoid them.
- To help prevent nighttime accidents, limit certain types of fluids, such as those with caffeine, in the evening.
- If you are going out with the person, plan ahead. Know where restrooms are located and have the person wear simple, easy-to-remove clothing. Take an extra set of clothing along in case of an accident.
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