Alzheimer's Society

When considering the needs of someone with dementia, it is important to find the right balance between independence and the need for protection. There is no such thing as a completely risk-free environment for any of us, and when someone is living with dementia it may be that some minor accidents are inevitable. But there are some sensible precautions that those around them can take to help minimise risk.

Dementia leads to changes in a person's capabilities and behaviour, and those around them need to be alert to these changes and adapt as necessary. Of course, each person with dementia is different, and every home situation varies. However, accidents involving people with dementia are more likely to happen, for the following reasons:

• Sense of balance and speed of reaction tend to decline as people get older.
• Physical difficulties and mobility problems make it harder to carry out some activities.
• Dementia affects memory and judgement. It also affects insight, so a person with dementia may not be aware that doing something might be dangerous to themselves or to other people.
• Those caring for someone with dementia are often tired, and feel under pressure.
• Accidents can be more likely to happen when people are stressed or confused.

Tip: reducing stress

It is inevitable that family members and carers will feel tired and irritable from time to time. The person with dementia may pick up on a person's mood from their body language, even if they do not say anything. If you find this happening to you, breathe deeply and slow down. Better still, take a few minutes' break.

Avoiding accidents

There are a number of ways to make a home safer. Some of these are simple, practical steps. However, an occupational therapist (OT) can advise you on the full range of ways to make your home safer, and on equipment to support the person with dementia. You can contact an OT through your GP or through social services.

Lighting

• Make sure that the lighting in your home is bright enough so that everyone can see clearly what they are doing, but avoid lighting which shines directly into people's eyes.
• If the person with dementia is likely to get up at night, leave a light on in the hall when you go to bed and a safe night light in the bedroom.
• Make sure there is a light on in the bathroom or toilet so the person can find their way at night.

Equipment and adaptations

Handrails in the hall and on the stairs, grab rails in the bathroom and toilet, and a toilet seat riser will help if a person is unsteady on their feet. Similarly, equipment such as bath lifts, bath seats and other special adaptations can be arranged and fitted to make bathing safer. An OT can advise on the most suitable options. (See Factsheet 428, Adaptations, improvements and repairs to the home.)

Falls

Some older people are unsteady on their feet and are more likely to fall. This can be dangerous. Check your home for anything that might cause a fall, such as rugs, loose carpets (especially on the stairs) and slippery floors. Remove trailing flexes, unsteady furniture and clutter or objects lying on the floor.

If the person has a fall that seems serious, don't try to move them or give them anything to eat or drink. If they have broken a bone they may need an anaesthetic later. Keep them warm and call for an ambulance.

Dangerous substances

Always store medicines somewhere safe. If the person is unable to administer their own medication safely, arrangements must be made for someone else to do this. Containers that allow you to measure out medicines for the whole week are available from a pharmacist. Ask your GP for advice if difficulties continue.

Lock away any poisonous substances, such as paint stripper, bleach or disinfectant, as a person with dementia may not recognise what they are. If you think that the person may have swallowed something poisonous, phone for an ambulance or take them immediately to the nearest accident and emergency department. Take the container and any remains of the substance with you so that the doctor will know what treatment to give.

The kitchen

If the person no longer seems to recognise danger, remove any potentially dangerous implements, such as sharp knives, but place items in everyday use within easy reach.

If necessary, fit an isolation valve to a gas cooker so that the cooker cannot be turned on and left on while the person's carer is out − your gas supplier can advise you about this. Provide an electric kettle that switches itself off automatically. Flood detectors are also useful in case taps are left on. (See Factsheet 437, Assistive technology.)

Accidents do happen. If the person scalds or burns themselves, pour cold water over the affected area for least ten minutes to reduce the heat and lessen the pain. Burnt skin can swell so remove anything tight, such as a watch or a ring. Do not apply ointment or butter. Cover the area with a clean, non-fluffy cloth or wrap in cling film if available. Contact the GP and describe the injury, or take the person to the nearest accident and emergency department. Do not forget to tell the doctor or hospital staff about the person's dementia, but do it as discreetly as you can.

Heating

Fires or heaters can be a danger for someone whose memory and judgement of danger are impaired.

• Always fit a fixed fire guard.
• Never dry clothes over a fire or a heater.
• Never take a portable heater into a bathroom.
• Make sure that all gas and electric appliances are serviced regularly.
• An isolation valve can be fitted to a gas fire in the same way as a gas cooker.
• Central heating and many electric fires can be regulated with a time switch.

Risk of fire

Make sure that gas detectors and smoke alarms are fitted. Even if the person with dementia is living alone, and is unable to respond to the alarm, it is likely that someone will pass the house and be able to take appropriate action. These alarms can also be set up to activate external warning devices that alert others to the situation.

Smoking can be risky. A person with dementia who smokes runs the risk of starting a fire because they may forget that they have lit a cigarette and will leave it burning. Conversely, there have been recorded instances where a person with dementia no longer remembers that they smoke if their access to cigarettes is gradually reduced over a time. This is one of the difficult areas where the person's carer or family have to balance the risks against the person's autonomy and quality of life. If you live with a smoker who has dementia, it may be safest for you both if you keep the cigarettes, or at least the matches.

Electric blankets can be dangerous for people with impaired memory, as overheating can cause a fire. If you use one, check that it has safety features, such as automatically switching off at a certain temperature. People who are incontinent people should not use electric blankets.

Practical steps

Asking the neighbours

If the person lives on their own, or the person who lives with them is out of the house for long periods, a friendly neighbour may be prepared to keep an eye out for signs that something is wrong. You may be  able to leave a spare set of keys with them and a phone number where you can be contacted if needed.

Gaining admission

If the person lives alone, it is important to sort out a way in which others can gain entry to the house. For this reason, bolts on the front door may not be a good idea.

It is important to think through such a situation beforehand, so that if there is a crisis you can deal with it without the additional worry of wondering how you are going to get in. Electronic alarm systems that rely on the person calling for help can be of no use if the person has dementia, because they may not understand how to use the system. Keysafes are a more secure way of providing access. Only agreed friends, family members or carers would have the combination, and this can be regularly changed.

Useful details

It is a good idea to keep a list of useful phone numbers in an easily accessible place. These might include the numbers for:

• gas, water and electricity (especially in an emergency)
• GP and hospital
• social worker and home care agency, if involved
• local police
• electrician, plumber, builder or locksmith
• taxi firm
• where carers, friends or family members can be reached
• the local Alzheimer's Society branch.

It will also help if you list information such as where to find:

• the gas and electricity metres
• the stop cock for the water
• the point to turn off the mains gas and water supply
• the fuse box.

Tell anyone who might need this information where to find the list.

Your local Alzheimer's Society branch will always be willing to talk to you and offer advice and information to support your needs.

For more information, Dementia Catalogue, our specialist dementia information resource, is available on the website at alzheimers.org.uk/dementiacatalogue

Factsheet 503

Last updated: October 2008
Last reviewed: October 2008

Reviewed by: College of Occupational Therapists, Specialist Section − Housing