Safety is important for everyone at any stage of life. Having a safety plan, and anticipating changes, becomes all the more important when managing changes that come with dementia. These changes can affect a person’s sense of time, orientation, judgment, how to complete tasks, and moving their bodies. Brain changes can also impact how people interpret what they see, hear, feel, taste, or smell.  Caring for someone with dementia is an on-going balance of supporting a person’s sense of autonomy while mitigating safety issues. We recognize that it can be hard to take proactive steps for several good reasons including respect for the person’s autonomy and our own acknowledgement of the progression of the disease. 

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‘The best environment for a person with memory loss or dementia is one that helps them feel as independent and supported as possible…with creativity and flexibility, it’s possible to make adaptations that make the home [and navigating the community] safer and less stressful for all’

Below are categories of safety for your consideration as you continue to evaluate, monitor, and put into place safety measures in advance of need. If you are in need of support navigating any of these areas, do not hesitate to reach out to your person’s medical team for further guidance.

Home Environment:

• Fall Risks
  • Completed a home safety checklist, like *** from the Alzheimer’s Association. Adjustments to the home may include:
    • Installing grab bars in the bathroom, egresses, and stairs
    • Remove loose rugs
    • Decluttering
    • Using colored tape to differentiate stairs if there are vision issue
  • Schedule a Home Safety Evaluation…
• Fall Risks
  • Complete a home safety checklist, like this one from the Alzheimer’s Association. Adjustments to the home may include:
    • Installing grab bars in the bathroom, egresses, and stairs
    •  Removing loose rugs
    • Decluttering
    • Using colored tape to differentiate stairs if there are vision issues
  • Schedule a Home Safety Evaluation through your local elder eervice agency or a visiting nurses agency
  • Obtain a personal emergency response button (e.g. Lifeline).
• Kitchen Use
  • Monitor your person’s use of kitchen appliances over time. It is not unheard of, for example, for people to forget what does and does not go in the disposal or that metal does not go in the microwave.
  • Range/Stove/Oven Safety:
    • Some new appliances have automatic shut offs. You can also consider purchasing an automatic turn-off.
    • Consider implementing  safety knob covers, removing the knobs, to the stove/range Some people may decide to disconnect the appliance altogether.
  • Cabinet & Drawer Locks for cabinets or drawers containing cleaning products, knives, etc.
• Medication Management
  • Standard Pill Minder Box, along with tracking sheet as needed.
  • Order Blister Medication Packs from a local pharmacy.
  • Consider using an Automatic Pill Dispenser, such as: Hero, MedMinder.Pharmacy, Philips Lifeline, LiveFine, GMS Auto, e-Pill MedSmart PLUS, MedaCube
• Firearms/Weapons/Power Tools
  • Engage with safety planning with your person early on in the disease progression if possible so they can participate in the discussion. Create an agreement about what happens to the device, similar to a Living Will. 
  • Schedule a safety assessment/training from a trained firearm specialist.
  • Locking or disabling weapons may be viable for only a period of time.
  • Consider removing firearms and/or weapons from the home to fully protect the person with dementia and others. 
  • You may consider pursuing an Extreme Risk Protection Order (aka Red Flag Laws) through the MA court system to have the person surrender their license. Learn more here. 
• Technology
  • Phone 
    •  Ask your person who they would call in case of emergency to ensure they still recall  911 as a resource.
    • Monitor your person’s ability to field telemarketer outreach. 
    • Consider simplifying the phone. Like a landline with pictures, seen here, or a cell phone for specifically for seniors seen here. 
  • TV
    • Remotes can be complex, especially if there is more than one. Consider simplifying the options. LIke this one or this one.
    • Consider activating parental controls.
  • Computer Use 
    • Collaborate in advance of disease progression to share usernames & passwords. Use a secure place to record. 
    • Keep software up-to-date and consider implementing parental  controls as needed. 
    • Continue to monitor the use of social media and email. 

Community:

• Traveling – Important to take into account current needs, abilities, and preferences whether alone or together. Environmental changes can trigger anxiety and/or confusion.
• Identify the best mode of travel and assess if traveling alone, with a partner, or two, is best. 
• If flying, identify both airports’ supportive services and coordinate their involvement in advance. 
• If staying in a hotel, consider notifying staff in advance of any particular needs or preferences. 
• Consider traveling during the time of day that is best for the person with dementia (ie if they get agitated & confused in the afternoon, travel in the morning). 
• Have a back-up plan in case plans need to change. 
• Driving – The majority of accidents occur within a 3 mile radius of our homes. There is increased risk for driving safety issues with people who have dementia given the impacts to reaction time, decision making, and navigation. 
• Start the conversation of retiring from driving early. The Alzheimer’s Association has some tips for this conversation, seen here.
• Periodically, drive with your person as the passenger to see how they are doing.
• Trade off driving with your person, or regularly offer to drive. 
• You may consider, or the person’s doctor may recommend, a driving evaluation through a hospital based program (e.q. Spaulding, Newton-Wellesley Hospital). This service will need a doctor’s order and there is a cost associated.
• You can request a medical evaluation through the MA RMV. To learn more, click here.  
• Wandering – 6 out of 10 people with dementia will wander at some point during the disease process. Here are some suggestions as you work towards monitoring and minimizing the risk of this behavior.
• Increasing the person’s opportunity for engagement in meaningful activities. This can decrease boredom, irritability, and/or anxiety which can be contributors to wandering behaviors. 
• Do not leave someone with dementia alone in new or unfamiliar areas. 
• Ensure all basic needs are met – hunger, thirst, toileting.
• For those living with the person with dementia, consider Installing doors locks and alarms on the interior of the upper or lower part of the door to deter someone from leaving the home.
• Consider installing video cameras in and outside of the home environment.
• Obtain a medical ID bracelet, for example this one.
• Sign your person up for the Safe Return Program through the Alzheimer’s Association & your local police station. Learn more here.
• GPS Tracking Devices can be a helpful tool. You will want to explore if the device requires daily charging and if wifi is needed. Examples include: Philips Lifeline, Track!, and certain smartphone apps (eg Life 360, Find My Friend, Find My iPhone).
• In the later stage of the disease, some find chair and bed alarms helpful for moments when caregivers are out of the room and/or overnight.

Behavioral Changes:

• Speak with the person’s medical provider (primary care, neurologist) if you notice changes in your person’s personality or behaviors that puts their or your safety at risk (angry outbursts, aggression, delusions, paranoia, etc).
• Call Alzheirmer’s Association 24/7 Helpline 1-800-272-3900.
• Speak with a social worker to increase understanding about the disease and skills for how to respond.
• Call 911 if there is immediate concern for their or your safety. 

Health & Financial Decision Making:

• Establish Health Care Proxy & Durable Power of Attorney as soon as possible.
• Financial Exploitation: People with dementia are especially vulnerable to fraudulent efforts. Read more here:
• Consider placing a “No Solicitors” sign on the front door to deter uninvited or unwelcomed parties making contact with those in the home. 
• If there is  concern about abuse, neglect or exploitation of an older adult, call Elder Protective Services at: (800) 922-2275 or visit their website here.  

For Additional Learning:

• AA’s ‘Stay Safe’ Pamphlet: https://www.alz.org/media/documents/alzheimers-dementia-staying-safe-with-alzheimers-b.pdf
• NPR discussion on gun safety: Guns And Dementia: A Growing Worry For Families As Americans Age : Shots – Health News : NPR
• PBS News Hour discussion on gun safety: How families of gun owners with dementia grapple with safety – Bing video
• At the Crossroads – Dementia & Driving Handbook, from MIT Age Lab 105052 (hfdstatic.com)