Alzheimer's Society

It is important to find the right balance between independence and the need for protection when you are caring for a person with dementia. There is no such thing as a completely risk-free
environment for any of us. You will probably have to accept that some minor accidents are inevitable. But there are some sensible precautions you can take. Here are some suggestions.

Dementia leads to changes in a person's capabilities and behaviour. This is caused by the disease process. You will 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 are more likely to happen for the following reasons:

• Our sense of balance and our speed of reaction tend to decline as we get older.
• Physical disabilities make it harder to carry out some activities.
• Dementia affects memory and judgment. It also affects insight, so a person with dementia will not be aware that doing something might be dangerous to themselves or to other people.
• Carers are often tired and feel under pressure.
• Accidents tend to happen when people are stressed.

Avoiding accidents

It is inevitable that carers feel tired and irritable from time to time. Unfortunately, the person with dementia will pick up your mood from your body language, even if you do not say anything. If this is happening, breathe deeply and slow down. Better still, take a few minutes 'time out'.

An occupational therapist (OT) can advise you on ways to make your home safer and on aids 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 both of you can see clearly what you are doing.
• If the person you are caring for is likely to get up at night, leave a light on in the hall when you go to bed and a 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.

Aids and adaptations

Handrails in the hall and on the stairs and grab rails in the bathroom and toilet will help if a person is unsteady on their feet. Similarly, special adaptations can be fitted to make bathing safer. An OT can advise.

Falls

Older people may be 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 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 you will need to make arrangements for this to be done by someone else. Containers, which allow you to measure out medicines for the whole week,
can be obtained from a pharmacist. Ask your GP for advice if this is a problem.

Lock away any poisonous substances such as paint stripper, bleach or disinfectant. A person with dementia may not recognise them for 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 make sure that potentially dangerous implements such as sharp knives are removed. Items in everyday use should be placed 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 you are out and provide an electric kettle which switches itself off automatically.

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. Cover the area with a clean, non fluffy cloth. 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 as discreetly as you can.

Heating

Fires or heaters can be a danger for someone whose memory and judgment 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.

Other precautions

Gas detectors and smoke alarms should be fitted. Even if the person with dementia is living alone, and is unable to respond to the alarm, it is likely that others, such as the postal or milk delivery service, may pass the house on a regular basis and be able to take appropriate action. These alarms can also be set up to activate external warning devices which alert others to the situation.

If water from the taps is very hot, it may be possible to turn down the thermostat.

Electric blankets can be very dangerous for people with impaired memory.

A person with dementia who smokes runs the risk of starting a fire because they may forget that they have lit a cigarette and leave it burning. This is one of the difficult areas where the carer has to balance the risks against safety 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.

Ask the neighbours

If the person lives on their own or you are 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 a 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 you can gain entry to the house. For this reason, bolts on the front door may not be a good idea. Electronic alarm systems which rely on the person calling for help are no use if the person has dementia because you cannot rely on them to use the system.

It is best to have thought 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.

Useful numbers

It is a good idea to keep a list of useful numbers in an easily accessible place. For example:

• Emergency numbers for gas, water and electricity
• GP and hospital
• Social worker and home care agency if involved
• Local police
• Local electrician, plumber, builder or locksmith
• Local taxi firm
• Telephone numbers where you can be reached
• Your local Alzheimer's Society number.

Include information such as:

• Where to find the gas and electricity metres
• Where to find the stop cock for the water
• Where the mains gas and water can be turned off
• Where the fuse box is located.

People who need to know should be told where to find the list.

Carers' advice sheet 503

Last updated: January 2002
Last reviewed: January 2002