I worry a lot about my father. Last week he went off to make a cup of tea and came back without one but had turned the gas on and forgotten to light it. Fortunately, I realised straight away and turned it off. My brother is going to install an electric cooker soon, which has two large red lights at the back when switched on which are quite obvious. My father is pleased. He says that he has never liked gas cookers.
As you witness how the symptoms of dementia affect the person you are caring for, you may feel concerned about potential dangers. This is a realistic fear. Many people with dementia suffer not only from the symptoms of the disease such as loss of memory, confusion, and disorientation but also from physical problems such as poor eyesight, unsteadiness on their feet and poor hearing. Consequently, they are prone to many dangers, e.g. burning, cutting, falling, getting electrocuted or poisoned, taking tablets, causing fires or gas explosions, catching cold, etc. However, to totally rule out the risk of accident, you would have to severely limit the person’s freedom and arrange twenty-four hour surveillance. Coping therefore involves balancing independence and freedom against safety.
Apart from trying to provide a safe environment for the person with dementia, it is important to try to ensure that they feel safe. Even if you manage to allow a certain degree of freedom in a relatively safe environment, the person with dementia might not necessarily feel safe. For them everything is strange - familiar people gradually become strangers and it is no longer obvious what is going on or what will happen next. (Please see chapter on anxiety and fear for more details.) For this reason it is important to try to understand how the person with dementia might feel and to provide not only a stable and safe environment, but also plenty of reassurance so that the person realises that there is nothing to worry about.
How to provide a safe environment and a feeling of security
Try to put yourself in the person’s shoes
By putting yourself in their shoes and trying to understand what the person with dementia might be feeling or how things must seem, you may be able to prevent accidents, anticipate their fears and provide the appropriate reassurance. (Please see chapters on anxiety, fear, hallucinations and paranoid delusions.)
Lock away anything that could be dangerous
Lock away dangerous objects such as knives, electrical appliances and cleaning products in the kitchen; gardening equipment and household products in the garage or basement and medication in the medicine cabinet (over-the-counter as well as prescribed drugs). You could try to encourage the person’s independence with regard to medication by leaving just the right amount of medication in the container each time or getting a compliance pack. In some cases, it might be simpler to limit access to potentially dangerous areas or rooms.
Furniture, fittings and grip rails
Try not to have unnecessary clutter, which might hinder movement (without making your home so orderly that it looks clinical). Grip rails may help the person move around the home, reduce the risk of falling and increase their confidence. (Please see chapter on lifting and moving the person with dementia.) Make sure that furniture and fittings are stable and do not have sharp edges. Any mats on the floor should be well fixed and not turned up at the edges. It is best not to polish the floor as it might cause someone to slip.
Locks and security
Fit locks on doors which lead out of the home to avoid the person with dementia wandering off unnoticed. Make sure though that they can be easily opened in case of emergency. Locks should also be fitted on windows which are large enough to get through as the person with dementia might try one day.
Lighting and heating
It is a good idea to leave a light on at night between the person’s bedroom and the bathroom. If they have problems seeing or tend to wander at night, it might help to fix reflector tape on the edges of furniture. It is important to make sure radiators are solidly fixed, that there are safety guards on fires and that hot pipes are covered to prevent burning.
Check electrical appliances and get rid of trailing wires
Make sure that electrical appliances are safe (no bare wires, plugs correctly wired, sockets fixed firmly to the wall, etc.). It is possible to obtain plastic covers for plug sockets. Arrange wires from electrical appliances (e.g. televisions, lamps etc.) so that the person with dementia won’t trip over them. It can sometimes help to make the cable shorter. It would be a good idea to remove electric appliances such as razors, hairdryers, curling tongs and even electric heaters from the bathroom.
Make sure that the person with dementia keeps warm
People with dementia risk becoming cold without noticing. A draught proofed, insulated and well-ventilated house would obviously help, but there are also simpler ways to make sure that the person is warm. For example, you could place the bed against an inner wall, put newspaper under the floor covering (to help protect the person from draughts) and warm the bed in advance with a hot bottle (but make sure that it is not too hot or alternatively cover it). If you use an electric blanket make sure to switch it off or unplug it before the person with dementia gets into bed. When the person goes outside in cold weather make sure that their head is covered and that they have warm clothes, gloves, socks and adequate shoes.
If the person falls and it seems to be quite serious, don’t try to move them or give them anything to drink. They might need an anaesthetic later. Keep them warm and call for an ambulance.
If the person burns or scalds themselves pour cold water over the affected area for at least ten minutes to reduce the heat on the skin and lessen the pain. Remove anything tight such as rings, watches or jewellery. Don’t apply ointment, but cover the wound with a piece of non-fluffy material. Then contact your doctor or take the person to a hospital.
Last Updated: Thursday 06 August 2009