People with Alzheimer’s disease (AD) are at serious risk for falls—and injury. At least half of all falls occur at home. The best way to deal with any threats to safety in the home is through prevention.—checking for hazards that frequently cause slips, trips or falls and eliminating as many potential trouble spots as possible.
  
The fundamental question to ask when assessing a home setting is, "How does the person's living environment help or hinder mobility?" The answer is best determined by observing both the individual’s everyday mobility and whether a particular area or furnishing is safe or hazardous.
 
Watch, for example, how the person with AD walks around the bedroom, bathroom and other locations during day and night; transfers on and off the bed, chairs and the toilet; and steps in and out of a bathtub and shower stall.

This assessment will help target potential hazards and necessary modifications. In addition, observing the individual’s mobility can also help determine his or her comprehension, judgment and other cognitive skills, providing even more insight into changes that may be essential.

These home safety tips will help:

Pathways
• When walking from one location to another, individuals with poor gait and balance often place their hands on walls, and chairs, tables, and other furnishings for support. Ensure that furnishings are stable enough to uphold the person.

• During walking, some individuals with AD 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
• 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 AD 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.

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.

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 promote balance loss during transfers. Bed height is safe when the individual is able to sit on the edge of the mattress with both feet planted firmly on the floor.

• 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.

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.

• 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.

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.

In adapting the environment, remember that changes can be disruptive for individuals with AD 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.

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. Fall-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.    
 

To get more information on Fall Prevention and Alzheimer's, read Dr. Rein Tidekisaar's articles,  "Is Falling an Early Indication of Alzheimer's" and  "Alzheimer's & Falling: What's the Connection?".
                              
Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Dr’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592 If you have any questions about preventing falls, please feel free to e-mail Dr. Tideiksaar at drrein@verizon.net

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