Making the Environment Safe for Alzheimer’s Patients
We would not think of placing sight-impaired individuals in an environment without making adjustments for their disability. Similarly, we are expected to make adjustments for Alzheimer’s and other memory-impaired patients; they may see but their perception of what they see could be faulty. They may also forget the features of their environment, giving caregivers cause to boost their sense of safety again and again.
Family Learning Center ® teaches that “it is less about physical structures and more about the feeling inspired by the quality of the place.”
This article aims to guide the caregiver into creating an environment which inspires a sense of safety in Alzheimer's patients.
Clean living room with ample lighting and clutter-free space
The importance of a good physical environment is to "encourage and support independence while promoting safety." - Alzheimer's Association
General Safety Guidelines
- Keep the environment as consistent as possible to inspire feelings of stability and security. Avoid redecorating and rearranging too often. Use the same daily schedule as much as possible.
- Too much open space, too much clutter, too much noise or too many people can cause agitation in people with dementia. Monitor carefully.
- Keep furniture and furnishings simple and attractive. Patients may feel anxious surrounded by too many plants, ornaments and pieces of art.
- Maintain a low level of sounds: no shouting; no loud rock or rap music.
- Keep living areas bright during the day; at night, use night-lights.
- Help create a safe, friendly atmosphere by displaying a cheerful disposition. Patients can be affected (positively or negatively) by facial expressions and body language.
Any space which is open and accessible to the patients is considered their physical environment. With memory loss it is easy for them to lose their sense of direction. Signs and labels can be used as cues to help them navigate their way.
- Names/Photos on Bedroom Doors
They may gain a sense of independence looking for, and finding their names or photos on their bedroom doors--even if they wander around before they find it.
Example of a Rest Room Sign
- Picture Signs
Customary signs help them recognize the bath room, the dining room, and other designated areas.
- Color and Art
Color and art are also more helpful than verbal directions. Finding the green door or the picture of a tree on the door, is easier than finding “the door on the right” or “the second door down the hall.”
Because older people with memory impairment usually suffer from vision impairment, it helps if door frames are painted in a color which contrasts with the wall.
Can This Floor Pattern Be Scary?
- Solid Floor Colors
Some forms of dementia include psychosis which makes the individuals see holes where there are dark colors in a pattern.
Rugs with busy patterns and dark sections like the one to the right are not recommended.
Erase fear, and boost their sense of safety with solid colors for floors and rugs.
A runner in a contrasting solid color can also be a good guide from the bedroom to the bathroom.
Sensory input into the physical environment affects the security of the Alzheimer’s patient. The sights and sounds of chaos or an overpowering scent may confuse them. When the input is pleasant, it can reduce their anxiety and depression, and increase their social interaction.
Some dementia with psychosis also make individuals see people and things that are not there. Rather than disagree with them about what they see, just assure them that they are safe. Boost their sense of safety with well-lit rooms, familiar photos and flowers.
Background Music Poll
Did you ever think that background music has an adverse effect on anyone?
Memory impaired individuals also have difficulty interpreting sounds. Background music is annoying. It can be confusing when they try to listen to someone speak, while at the same time they are hearing additional sounds. Television and music tapes should be turned on specifically for the patients to listen, not to keep playing continually. When there is a listening activity, play their kind of music and encourage sing-a-longs.
Touch is important when the patients have difficulty interpreting what they see and hear. In addition to offering them a cool drink, let them touch the glass. Let them put a hand in the warm water to convince them that the temperature is comfortable for bathing.
- Taste and Smell
“Weight loss happens to almost everyone with memory loss unless special attention is paid to the senses [taste and smell] involved with eating. . . Popcorn poppers or bread makers are two examples of things that have had great results for increasing the smells that stimulate hunger.” - Family Learning Center ®
The Optimal Environment
(according to the Alzheimer’s Association in "Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes")
- Sufficient lighting
- Pleasant music
- Multiple opportunities to eat and drink
- Private bedroom and bathroom
- Personal furnishings, pictures and other items in the living area
- Easy, safe access to the outdoors
- Control over unauthorized exits
- Opportunity to walk around for those who have the tendency to wander off
The most important human being in the patients’ space is the caregiver. For safety purposes, friendliness is more important than professionalism. They feel safer cooperating with a friend than with a professional helper.
Different people contribute differently to the environment. It depends on who they are—family members, clergy, health care professionals. All should be encouraged to give priority to the interest and safety of the patients. Respect and privacy should be given at all times.
Large crowds of visitors are not welcome. The scene may appear too busy; plus conversation and laughter can easily become too loud. One and two visitors at a time are more acceptable. As the patients’ ability to communicate diminish, it becomes more important to surround them with people who really care and respect their need to feel safe.
Keep medicine cabinets locked.
Additional Safety Tips
Here are a few other safety tips which cater to both the safety and independence of the patients.
- The height of the beds should allow the patients' feet to touch the floor, enabling them to get out of bed with minimum effort.
- Use bed rails, not to keep bedridden individuals in bed, but for safety purposes: moving from side to side, or from bed to chair.
- Use non-slip mats in the bathrooms to prevent slips and falls; keep the floor clean and dry.
- Hand-held showers help the patients maintain their independence and dignity; they should be lightweight.
- Medical prescriptions should not be accessible to the patients until administered by the caregiver.
Alzheimer's Association: Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes, Copyright 2009 by Alzheimer's Association.
Generations Home Care: Family Learning Center ®, Environment is Important; Creating a Calming, Restful Environment; Environmental Hazards & Safety, Copyright 2015 by Institute for Professional Care Education®.
© 2016 Dora Isaac Weithers