Safety & Living Well With Dementia

Safety is important, for everyone at every stage of life.  Having a safety plan, that anticipates changes is all the more important when managing dementia. Dementia changes can affect a person’s sense of time, orientation, judgment, and ability to complete tasks, and move their bodies.  Brain changes can also impact how people interpret what they see, hear, feel, taste, and smell.  Caring for someone with dementia is an ongoing process of supporting a person’s sense of autonomy while mitigating safety issues.  It can be hard to take proactive steps for several reasons, including respect for the person’s autonomy and our own difficulties in acknowledging the progression of the disease.  

Below are some categories to consider as you evaluate, monitor, and establish safety measures before they’re needed.  If you need support navigating any of these areas, don’t hesitate to reach out to your person’s medical team for guidance.

Home Environment

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 Services or a Visiting Nurses agency.
• Obtain a personal emergency response button (such as 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 garbage disposal or microwave.
• Range/stove/oven safety:
• Some new appliances have automatic shut-offs.  You can also purchase an automatic turn-off to install yourself.
• Consider using safety knob covers or removing the knobs on the stove/range.  Some people decide to disconnect the appliance altogether.
• Install cabinet and drawer locks where cleaning products, knives, and other potentially hazardous items are kept.

Medication Management

• Use a standard pill minder box, along with a tracking sheet as needed.
• Order blister medication packs from a local pharmacy.
• Consider using an automatic pill dispenser (Hero, MedMinder.Pharmacy, Philips Lifeline, LiveFine, GMS Auto, e-Pill MedSmart PLUS, MedaCubez).

Firearms/Weapons/Power Tools

• Engage in safety planning with your person early in the disease process if possible.  Create an agreement about what happens to these items, similar to a Living Will. 
• Schedule a safety assessment/training from a trained firearms specialist.
• Be aware that locking or disabling weapons may be effective for only a limited period of time.
• Consider removing firearms and/or weapons from the home to fully protect the person with dementia and others. 
• Consider pursuing an Extreme Risk Protection Order (also known as Red Flag Law) through the Massachusetts court system to compel the person to surrender their license.  Learn more here. 

Technology

• Phone 
• Ask your person who they would call in case of emergency to make sure they still remember 911 as a resource.
• Monitor your person’s ability to field telemarketer calls. 
• Consider simplifying the phone by getting a landline with pictures (click here to see one), or a cell phone designed for older adults (click here to see one). 
• TV
• Remotes can be complex, especially if there’s more than one.  Consider simplifying the options (like this one or this one).
• Consider activating parental controls.
• Computer Use 
• Collaborate early in the disease process to share usernames and passwords.  Record them in a secure place. 
• Keep software up to date and consider implementing parental controls as needed. 
• Continue to monitor the use of social media and email.

Community

Driving: The majority of accidents occur within a three-mile radius of home.  There is increased risk for driving safety issues in people with dementia due to the impacts to reaction time, decision making, and navigation.

• Start a conversation about “retiring from driving” early.  The Alzheimer’s Association has tips for this conversation (click here).
• Periodically, ride with your person to see how well they’re driving.
• Trade off driving with your person, or regularly offer to drive.
• Consider scheduling, or ask the person’s doctor to recommend, a driving evaluation through a hospital-based program.  To learn more, click here.
• Request a medical evaluation through the Massachusetts RMV.  To learn more, click here.

Wandering: Six out of ten people with dementia will wander at some point during the disease process.  Here are some suggestions for monitoring and minimizing the risk of this behavior.

• Increase the person’s opportunity for engagement in meaningful activities.  This can decrease boredom, irritability, and/or anxiety, which can contribute to wandering behaviors.
• Do not leave someone with dementia alone in new or unfamiliar areas.
• Ensure all basic needs are met (hunger, thirst, toileting).
• If you live with a person with dementia, consider installing door locks and alarms on the interior of the upper or lower parts of the doors to deter them from leaving home unaccompanied.
• Consider installing video cameras inside 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 and your local police station. Learn more by clicking here.
• GPS tracking devices can be helpful tools. You will want to explore if the device requires daily charging and WiFi.  (Examples include Philips Lifeline, Track!, and certain smartphone apps such as Life 360, Find My Friends, Find My iPhone).
• In later stages of the disease, chair and bed alarms may be helpful for when caregivers are out of the room and during overnight hours.

Traveling: Take into account current needs, abilities, and preferences, whether alone or together.  Environmental changes can trigger anxiety and/or confusion.

• Determine the best mode of travel and assess whether traveling alone or with a partner or two is best.
• If flying, identify all airports’ supportive services and coordinate their involvement in advance.
• If staying in a hotel, consider notifying staff of any particular needs or preferences.
• Consider traveling during the time of day that is best for the person with dementia (for example, if they get agitated and confused in the afternoon, travel in the morning).
• Have a back-up plan in case plans need to change.

Behavioral Changes

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

Health & Financial Decision Making

• Establish Health Care Proxy and Durable Power of Attorney as soon as possible.
• Be vigilant about financial exploitation.  People with dementia are especially vulnerable to fraudulent efforts. To learn more, click here.
• Consider placing a “No Solicitors” sign on the front door to deter uninvited or unwelcome people from making contact with those in the home. 

If you’re concerned about abuse, neglect, self-neglect, or exploitation of an older adult, call Elder Protective Services at 1-800-922-2275 or visit their website here.

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