The Understanding Home: Dementia Safe Spaces

The Problem: Trouble interpreting what they see

People who have dementia may not have trouble with their actual eyesight, or they might have glasses that correct for the trouble they have. But seeing isn’t only about the way the eye functions. Interpreting spatial relationships and assessing distance between objects is a mental activity. Similarly, a healthy eye takes in contrasting colors, but it’s the brain that helps us sort them out into shapes and then identify and name them.

Safety tips for visual problems:

Remove clutter that might make your loved one trip. But also understand that visual clutter makes the environment confusing. Busy patterns on the wallpaper or too many mirrors, for example, can make the house harder to navigate. If you have large glass doors, consider stickers to make it clearer that the pane of glass is there. Use night lights to help your loved one find the bathroom at night.

The Problem: Rummaging through drawers, messing with appliances, and hiding objects

It can be frustrating when your loved one rummages through drawers and closets, destroying their order, or moves objects around, putting them in the wrong places. There are many reasons for this behavior. The first is easy to understand: if your memory is failing, you will spend time searching for an object you have misplaced. As dementia progresses, rummaging may also be a way for someone who is losing their ability to interact with their environment to preserve old skills. A person who has done a lot of laundry over the years, for example, might acquire the habit of turning on the washer when there’s no laundry in it.

Safety tips for rummaging:

Working to change the habits and behavior of someone with cognitive decline is difficult and frustrating for both of you. Changing the environment instead, when this is possible, can be a simpler and more empathetic choice. It’s better to lock a drawer than to repeatedly discourage someone from looking in it to find a mysterious lost possession. And it’s better to remove the knobs of the washer than try to convince someone with dementia that it’s not time to do the wash. And it’s much better to simply lock up anything toxic or sharp.

Engage your loved one in the duties you’ve taken over if they seem to find satisfaction in them.

At the same time, if you have an insight into what causes the behavior, you can find ways to satisfy the need that drives it in ways that don’t cause so much trouble. If you lock drawers that contain delicate or dangerous objects, have a few prominent drawers that are not locked—and fill them with safe and familiar objects that your loved one can handle. Engage your loved one in the duties you’ve taken over if they seem to find satisfaction in them.

The Problem: Wandering

Why do people with dementia wander? There are many possible reasons. They may be looking for something or following an old habit like going to work or to the grocery store. They may find their environment unfamiliar because of memory loss and be trying to get back home. Or they may be bored or restless because of their inability to sustain their attention.

Safety tips for wandering:

Again, it’s best to focus on the environment, not the behavior. Lock or alarm doors. Have your loved one wear an identification bracelet or even a GPS tag. Install perimeter alarms. But also consider solutions that address the cause of the wandering. Try journaling to look for triggers. Is there a certain time of day that seems to be most problematic? Can you identify the need and fill it another way—for example by adding a drive to your daily, or weekly, routine? There are some amazing technologies and alarms that help caregivers monitor late-night or unexpected wandering. Look at Kenneth Shinozuka's  amazing invention to help his grandfather.

The Problem: Dangers in the bathroom

The bathroom is filled with dangers, from hard and slippery floors to hot water to cleaning chemicals. It’s also a place that can cause great frustration, both to the person with dementia and the caregiver. The bathroom is where the most basic activities of daily living happen, and it’s also the place where the dignity of a person impaired by dementia is most at risk.

Safety tips for the bathroom:

There are many devices you can buy to prevent accidents: shower chairs, faucet covers, temperature controls. Make good use of them. But also consider the loss of a sense of dignity to be a special danger in the bathroom. Any device (such as grab bars to make it easier to maneuver the toilet) that helps your loved one preserve independence in the bathroom is a treasure. Help them avoid embarrassment by periodic reminders to use the bathroom. Don’t rush them, and handle accidents with a “no big deal” matter-of-fact attitude. Incontinence pads can go a long way to calm anxiety about accidents.

The Problem: Agitation

So many factors can cause people with Alzheimer’s to become agitated or aggressive and it can be very upsetting to caregivers.  There are many reasons that could trigger agitation and the first step is to identify the cause. It could be something as simple as frustration searching for a misplaced object, feeling rushed, or being in a noisy, confusing or unfamiliar place. Emotions can also cause aggression including feelings of loss of independence, feeling lonely or lacking physical contact. Or there may be  physical discomfort caused by lack of sleep or effectiveness of medication--a doctor can help identify and solve these challenges.

Coping with Aggression

If you can identify what’s causing your loved one to be upset and simply stop doing what you were doing, they’ll calm down. Try to speak calmly and listen to her concerns. Show her you understand what is making her angry and frustrated. Slow down and relax--try to remove your own stress and create calm environments for soothing and relaxing experiences for her. Can you make a special “sensory room” or area with soft light and music and interesting textures? Look up “Snoezelen therapy” for empathetic ideas from the Netherlands.

A safe house for someone with dementia requires cleverness, foresight, and vigilance — but don’t forget that approaching safety issues from the point of view of empathy is not only a kindness to the person you love, but also a way of enhancing the safety of their environment.