The Disability Information and Resource Centre

Safety in the Home

Dementia is the name given to the broad range of symptoms resulting from illnesses that cause degenerative intellectual functioning.

The onset and symptoms present differently in each situation with side effects ranging from confusion, memory loss and disorientation, to the reduced ability to finish thoughts or follow directions. For some individuals their dementia may also be combined with decreased mobility, loss of balance and decreased co-ordination.

As the disease progresses these symptoms can impact on everyday life as individuals struggle to perform familiar tasks, remember recent events, or understand and recognise potential problems and solutions.

For those living with someone with dementia it can be a confusing and scary time, however these are some simple ideas which can be quite effective in making the home a safer and more user-friendly environment.

ARRANGING THE HOME ENVIRONMENT

Providing an uncluttered home environment not only eliminates falls/tripping hazards, but it also removes potential distractions which may add to confusion and disorientation. Some people with dementia are particularly sensitive to the sensory environment and can find too much clutter confusing. For example, a dark mat before a door may look like a hole in the floor creating concern, or patterned flooring may be mistaken for steps causing the person to alter their walking gait and fall.

Suggestions for arranging the home environment include:

* Remove loose rugs and mats, seal up carpet edges and provide non-slip flooring.
* Provide a well lit environment during both day and night as people with dementia may not have the insight to look for light switches, i.e. install a path of night lights from the bedroom to the toilet.
* Remove potentially disorientating visible barriers, such as closed doors.
* Provide pictures/labels around the home to identify rooms and cupboards, i.e. a picture of a toilet seat on the toilet door, a photo of each family member on their bedrooms, labelled clothing draws.
* Do not hide important items, i.e. ensure toilet paper is clearly visible without the need to search it out.
* Remove or lock up potential hazards, i.e. medication or any materials that could be mistaken for food, drink or current medication.
* Remove items that have the potential to cause disaster/injury if mismanaged, i.e. hot water bottles, electric blankets, hair straighteners, bar radiator heaters, sharp knives etc.
* Remove locks from bathroom/toilet doors so individuals cannot lock themselves in and become panicky.
* It is important to monitor the temperature of the home as individuals with dementia can loose their insight into how hot or cold it is. In winter install a timed heater which switches on in the morning and off at night, in summer do the same with an air conditioner.
* If wandering is a concern consider putting extra locks on either the upper or lower parts of the door as these are harder to see since they are not in the direct line of sight.
* Make the bathroom environment safer with grab rails, slip resistant mats and floor treatments or equipment such as shower chairs and toilet seat raisers.
* Install electrical safety switches, gas leak detectors and smoke alarms.
* If possible look at setting the hot water system to a ‘safe’ temperature. Alternatives, although slightly more expensive, include tempering valves and thermostatic mixing valves.
* Place bells or chimes on doors and gates to sound if someone is coming…or going
* Create a safer garden environment by removing overhanging branches, cluttered pathways and hazardous substances in garages.
* Consider getting a home safety assessment from an occupational therapist who can look at potential needs such as; grab rails around the home, modifying/eliminating steps; creating shower alcoves; installing hand held shower hoses and setting the correct heights of furniture.

SAFETY EQUIPMENT, TIPS AND GADGETS

It is impossible to have a completely risk free environment and you need to accept that minor incidents can and probably will occur. The following are some examples of gadgets and ideas which can help promote a safer home environment.

* Consider installing isolation valves on gas stoves and heaters which turn the equipment off after a designated period of time.
* ‘Access proof’ your home buy installing magnetic cabinet locks, stove guards, oven locks, tap covers and cupboard latches.
* If keeping track of time and appointments is a problem, consider a talking watch which verbalises the time and alarms a message as programmed. Other handy ideas include easy-to-read electronic clocks and calendars with automatic day, date and time.
* In order to keep track of medication consider using pill boxes or Webster packs with separate compartments for each day of the week (can be split into morning and afternoon). Some pill boxes also have a system which locks the pill box against opening until a pre-programmed time then alarms a reminder.
* If falling is a concern hip protectors may provide some prevention against injury.

When introducing new ideas or items of equipment it is often important to implement these during the early stages of dementia as during the later stages it becomes harder to introduce new skills or adjust to new ideas and ways of doing things

WANDERING

Wandering can be a common concern for people living at home with dementia. Some simple ideas to easy the worry includes:

* Visiting neighbours and shops in the local area to explain the situation and provide a contact phone number if needed.
* Avoid having items which may trigger the idea of wandering lying about, i.e. hand bag, coat and keys.
* Ensure the wanderer is wearing a personal identification bracelet and has a list of emergency contact numbers and identification in their wallet or purse.
* If there is a concern regarding someone getting locked inside a house during a potential emergency, rather than altering the house locks against wandering, consider making the garden secure so they can leave the home and have a safe environment to wander in.
* Consider installing movement detection devices such as bed and chair sensor mats which alarm when pressure is taken off the mat. Other options include portable infra red motion detectors which can be placed near doorways to alert a pager if the person leaves the room or body worn transmitters which alarm when the person moves beyond a certain range from the alarm panel.

For further information on these and other ideas on how to make the home a safer environment please contact the Independent Living Centre: www.ilc.asn.au/

*Source: Disability SA Independent Living Centre

(An Overview Of The Dementias)

What is Dementia?

This sheet explains what dementia is, who gets it and some of its most common forms. It describes some early signs of dementia, and points out the importance of an early medical diagnosis Dementia is the term used to describe the symptoms of a large group of illnesses which cause a progressive decline in a person’s mental functioning.

It is a broad term which describes a loss of memory, intellect, rationality,social skills and normal emotional reactions.

Who gets dementia?

Most people with dementia are older, but it is important to remember that most older people do not get dementia. It is not a normal part of aging. Dementia can happen to anybody, but it is more common after the age of 65 years. People in their 40’s and 50’s can also have dementia.

What causes dementia?

There are different forms of dementia and each has its own causes. Some of the most common forms of dementia are:

Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia and accounts for between 50% and 70% of all cases. It is a progressive, degenerative disease that attacks the brain. In its early phases, the symptoms can be subtle such as memory loss and vagueness, taking longer to do routine tasks, or losing the point of a conversation. As the disease progresses, the changes will become more dramatic until, in the last stages, the person cannot care for themselves.

Vascular Dementia

Vascular dementia (previously known as multi-infarct dementia) is the second most common cause of dementia. This is a term associated with problems in the circulation of blood to the brain causing a deterioration of mental abilities as a result of multiple strokes, or infarcts, in the brain. A stroke refers to the death of a piece of brain tissue supplied by a blood vessel or blood vessels where it’s blood supply is blocked or interrupted. These strokes may cause damage to specific areas of the brain responsible for speech or language as well as producing generalised symptoms of dementia. As a result, Vascular dementia may appear similar to Alzheimer’s disease.

A mixture of Alzheimer’s disease and Vascular dementia is a common cause of dementia, and it can sometimes be difficult to separate the two.

Parkinson’s Disease

Parkinson’s disease is a progressive disorder of the central nervous system, characterised by tremors, stiffness in limbs and joints, speech impediments and difficulty in initiating physical movements. Late in the course of the disease, some people may develop dementia. Drugs may improve the physical symptoms, but can have side effects which may include hallucinations, delusions and temporary worsening of confusion and abnormal movements.

Dementia With Lewy Bodies

A significant number of people diagnosed with dementia are found to have tiny spherical structures called Lewy bodies in the nerve cells of the brains. It is thought these may contribute to the death of brain cells. Dementia is often mild at the outset and can be extremely variable from day to day. The symptoms are the fluctuation in the condition, visual hallucinations and extreme sensitivity to classical and psychotic medications leading to marked symptoms of stiffness, tremor and restriction of movement. Dementia with Lewy bodies sometimes co-occurs with Alzheimer’s disease and Vascular dementia.

Pick’s Disease

Pick’s disease, like Alzheimer’s disease, causes progressive and irreversible decline in a person’s abilities over a number of years. It is a rare disorder of the frontal part of the brain which can be very difficult to diagnose. The disorder usually begins between 40 and 65 years of age. Disturbances of personality, behaviour and language may come before, and initially be more severe than, memory defects.

Huntington’s Disease

Huntington’s disease is an inherited, degenerative brain disease which affects the mind and body. It affects 7 in every 100,000 people in Australia. It usually appears between the ages of 30 and 50 and is characterised by intellectual decline and irregular, involuntary movement of the limbs or facial muscles. Other symptoms include personality changes, memory disturbance, slurred speech, impaired judgement and psychiatric problems. There is no treatment available to stop the progression of the disease, but medication can control movement disorders and psychiatric symptoms. Dementia occurs in the majority of cases.

Alcohol Related Dementia: Korsakoff’s Syndrome

Too much alcohol, particularly if associated with a diet deficient in thiamine (Vitamin B1) can lead to irreversible brain damage. This dementia is preventable. If people don’t drink, or they drink at a safe level, they don’t get it.

The most vulnerable parts of the brain are those used for memory, and for planning, organising and judgement, social skills and balance. If drinking stops here may be some improvement. Taking thiamine appears to help prevent and improve the condition.

Creutzfeldt-Jacob Disease

Creutzfeldt-Jacob disease (also known as Mad Cow Disease) is an extremely rare, fatal brain disorder caused by a prion, which is a protein particle. It occurs in one in every million people per year. Early symptoms include failing memory, changes of behaviour and lack of coordination. As the disease progresses, usually very rapidly, mental deterioration becomes pronounced, involuntary movements appear, and the person may become blind, develop weakness in the arms or legs and finally lapse into a coma.

Is it dementia?

There are a number of conditions which give symptoms similar to those of dementia. By treating these conditions the symptoms will often disappear.

These include:

* Some vitamin and hormone deficiencies

* Depression

* Medication clashes or overmedication

* Infections

* Brain tumour

It is essential that a medical diagnosis is obtained at an early stage when symptoms first appear to ensure that a person who has a treatable condition is diagnosed and treated correctly.

Can dementia be inherited?

This will depend on the cause of the dementia, so it is important to have a firm medical diagnosis. If there are concerns about the risk of inheriting dementia, discuss it with a doctor, or contact the Alzheimer’s Association and speak to a counsellor.

What are the early signs of dementia?

The early signs of dementia are very subtle and vague and may not be immediately obvious. However, common symptoms include:

* Progressive and frequent memory loss

* Confusion

* Personality change

* Apathy and withdrawal

* Loss of ability to do everyday tasks

What can be done to help?

At present there is no prevention or cure for most forms of dementia. However, some medications and alternative treatments have been found to reduce some symptoms.

Community support is available for the person with dementia, their families and carers and can make a positive difference to managing dementia.

Further Help

A range of books, videos and Help Sheets are available through your State or Territory Alzheimer’s Association by contacting the Dementia Helpline.

These Help Sheets can also be obtained on the internet at http://www.alzvic.asn.au

This publication provides a general summary only of the subject matter covered. Any person with dementia or a carer for a person with dementia should seek professional advice about the specific case. The Alzheimer’s Associations in Australia are not liable for any error or omission in this publication, even if negligent.

* Source : Alzheimer’s Association (SA) Inc