As we've said elsewhere, people of all ages fall, but elderly individuals with Alzheimer's disease or a related dementia are at serious risk for falls—and injury.
In fact, losing balance and falling down is probably the most common accident that happens to those with this brain disorder.
In adapting the environment, remember that changes can be disruptive for individuals with Alzheimer's disease and may produce anxiety that can intensify cognitive deficits. Therefore, as a rule of thumb, try to keep modifications to a minimum; the key is simplicity. Adjust only those features that clearly benefit the person's mobility and decrease the risk of falls. If several changes are needed, gradually introduce them one at a time.
If you live with a person who has Alzheimer's disease, the tips below will help you make the house safer and prevent falls.
Fall-Proofing Pathways
- When walking from one location to another, individuals with poor gait and balance often place their hands on walls, and chairs, tables, dressers and other furnishings for support. Ensure that furnishings are stable enough to uphold the person. Ask your doctor about a cane or walker to help the person maintain balance, but keep in mind that someone with Alzheimer's disease may have difficultly learning a new activity or using a walking aid safely.
- During ambulation, some individuals with Alzheimer's disease keep their heads and eyes focused straight ahead, often causing them to collide with low objects in their path. Visual field restrictions contribute to this problem. For this reason, allow plenty of walking room by keeping "traffic lanes" free of furnishings, clutter and other obstacles.
Lighting to Help with Fall-Proofing
- In general, keep lights on in rooms that are walked through and make sure they are bright to avoid tripping over objects that are not easy to see. Consider a night light for dark passageways. During the day, open curtains and shades to let more sunlight in. Install extra lighting along the pathway from bedroom to bathroom, and by steps and stairways.
- Since someone may get up during the night to urinate, the route from the bed to the bathroom should be well-lit, as well as clear of objects. Use night lights to provide sufficient lighting. Be aware, however, that night lights can cast shadows and images that may lead to hallucinations and paranoia in some individuals.
- A person with Alzheimer's disease may have difficulty adjusting to stark changes in lighting. Moving from bright to dark areas and vice versa, and sensitivity to bright lights can lead to a temporary loss of vision and promote confusion. Therefore, it is important to maintain uniform lighting levels. This can be achieved by three-way bulbs and wall dimmer switches that allow caregivers to vary light levels.
- Glare from sunlight shining through windows or unshielded light bulbs that reflect on polished floors may impair vision. Disperse direct window glare with sheer shades or tinted glass. Reduce light bulb glare with frosted bulbs or translucent lighting shades. And control floor glare with carpets or low-luster polishes that diffuse light.
Fall-Profing Floor Surfaces
- Avoid carpets, rugs and tiled floors that are patterned, such as checkered or floral designs, since they can interfere with depth perception and balance. Floor coverings should be solid in color.
- Remove loose throw rugs or place non-slip backing underneath them to prevent sliding. Use carpet tape to keep carpet edges from curling up.
- An individual should wear shoes and slippers with non-slip soles that grip the floor.
Fall-Proofing Beds
- Since cognitive impairment may affect someone's ability to safely transfer from one spot to another, it is critical to adjust a bed accordingly. Move a bed against the wall to prevent it from sliding away when the person gets up. A bed with wheels can be particularly hazardous; if there are wheels, make sure they are in a locked position. Elevated bed heights and soft mattress surfaces promote balance loss during transfers. Achieve an appropriate bed height by replacing thick mattresses with those thinner in width. Mattresses should be firm enough to support balance when getting out of bed.
- The floor surface along the bed should be slip-resistant to support safe transfers. If floor surfaces are slippery, have the individual wear traction-soled socks or slippers.
Fall-Proofing Chairs
- All chairs used by individuals with Alzheimer's disease should be sturdy and have armrests, which provide leverage and balance support when getting up and sitting down. Also, armrests can offset low seat heights. For those individuals who continue to experience problems, add a cushion to increase the height of low-seated chairs.
- The stability of chairs is crucial for safety. A good test of chair stability is to grasp and lean into a chair, and slide and tilt it forward, backwards and sideways during sitting and rising.
Fall-Proofing Bathrooms
- Grab bars either attached to a toilet or wall, or elevated toilet seats can help someone sit down and get up. Bedside commodes are beneficial if toilets are inaccessible or difficult for an individual to use.
- During tub transfers, grab bars securely mounted on the tub wall or rim can supply support. All grab bars should be slip-resistant, color contrasted from the wall for visibility, and securely fixed to the studs of the wall for adequate support; regular towel bars are not designed for this purpose. Place non-skid adhesive strips on the top of sink edges to guard against hand slippage if these surfaces are used for balance support.
- A rubber mat or non-slip adhesive strips applied to the bathtub floor surface provide stable footing and visual cuing. Sometimes individuals with decreased depth perception view bathtub surfaces as "bottomless pits" and become fearful when entering.
- Bathtub benches and extended shower hoses can serve as useful devices to assure safe bathing.
Fall-Proofing Kitchen Cabinets
- Store everyday dishes and kitchen supplies within easy reach. Consider keeping items no lower than waist level or no higher than shoulder height to avoid excessive bending, stooping or reaching.
Due to intellectual impairment, individuals also may be unable to learn new tasks-such as using grab bars in the bathtub-or become frightened of new "gadgets." So, after making modifications, always test to ensure that the alteration is indeed safe and beneficial.
Safe-proofing a home is an ongoing process. As a person's mobility changes over time, it is important to periodically reassess his or her abilities and the need for additional safety features to prevent falls.
Posted May 2010
