The Art of Aging Well
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Most of us think of home as a safe haven -the place we feel most comfortable and at ease. For the person with dementia, though, the home can pose several hidden hazards. You can help your loved one avoid most of them by being vigilant and assessing home safety when you visit. We know, however, that it is not always possible to monitor activity 24/7 -not even a nursing facility can offer that kind of supervision. No matter how closely you watch your loved one, an accident may occur. This post is designed to not only address potential home hazards but to also explain best practices should an injury occur.
People with dementia are often at high risk for falls. One of the most common culprits is the loss of depth perception, a problem especially seen in people with Alzheimer's disease. Poor depth perception may cause your loved one to miss the edge of a chair or a couch when sitting down or miss a step on the stairs. Similarly, difficulty in recognizing contrast can hinder the ability to see rugs with zig-zagging patterns and result in tripping and falling. You can help with this problem by providing close supervision and verbal cues such as, "Keep backing up a few more steps until you feel the chair against the backs of your legs." Depending on how advanced your loved one's dementia has become, you may need to physically help guide him or her into a safe position before giving the cue to sit down.
Another common cause of falls is dizziness or unsteadiness due to medications or weakness due to other medical conditions. If your loved one is taking atypical antipsychotics or benzodiazepines, or if he or she is experiencing weakness due to an illness like COPD, CHF or cancer, it is important that he or she stand up slowly and take a minute to steady and orient himself or herself before trying to walk. If your loved one gets too tired to remain standing while showering, you can purchase a tub bench from almost any pharmacy. This will allow your loved one to sit down during showers.
Cognitive impairments are a third reason for falls. As dementia progresses, many people forget that they need to use a cane or a walker for balance, or that they require the assistance of another person to walk. People with dementia may also get up and wander around the home at night without a flashlight -if motion-detected lights are not present in the home, your loved one can stumble in the dark, not even realizing a light switch may be nearby. If you do not sleep in the same room as your loved one, purchasing a baby monitor that will alert you to any nighttime wandering is a good investment. If you hear your loved one moving around, you can get up and either keep an eye on him or her or guide him or her safely back to bed.
Changes in balance, mobility and coordination increase chances of slipping while walking. These falls frequently occur in the kitchen or the bathroom where tile is often present and spills are common. You can reduce the likelihood of these falls by cleaning up any spills as soon as they happen and purchasing non-skid bath mats and rugs, as well as shoes or slippers with non-slip soles. Avoid letting your loved one walk around barefoot or in socks.
A pathological fracture, which occurs when your loved one's bones are fragile, can also increase fall risk. When your loved one stands up and places all weight on his or her legs, a bone in the leg can fracture under the pressure and cause a fall. Aside from making sure your loved one gets enough calcium in his or her diet, there is no way to prevent a pathological fracture from occurring.
When you are considering whether to keep your loved one at home or place him or her in a nursing or an assisted living facility, remember this: If your loved one has fallen at home, he or she is also likely to fall in a facility. A fall takes only a split second to occur, and facility staff can't monitor your loved one 24/7. If falls are your chief worry, you may be better off hiring a home caregiver who can dedicate full, 100% attention to your loved one.
If a fall does occur, there are several steps you can take to reduce the chance of serious injury, including the following:
Tell your loved one not to move. If your loved one has a broken bone, internal damage, or a head wound, moving around or struggling to get up might make things worse.
Look for noticeable bruises or breaks. Look for limbs bent at a strange angle and any areas that are bleeding. If your loved one has a significant amount of blood from a head wound, call 911 immediately. Doctors might want to perform a painless test called a CT scan to make sure that there is no internal bleeding or swelling in the brain.
Ask your loved one about pain. After a fall, it's normal for your loved one to complain of scrapes and bruises on the hands, elbows and knees. If, however, he or she reports having sharp pain in the hip or thigh, or if he or she complains of pain in the stomach or chest, it's best to call 911 and have a doctor examine your loved one. Again, the doctor might want your loved one to undergo a CT scan of the chest and abdomen to make sure there is no internal bleeding.
Check for range of motion (ROM). This involves taking each arm and leg and gently bending and extending it. Move slowly and stop at once if your loved one cries out or complains of sharp or piercing pain.
Help your loved one sit up. Once you have checked your loved one over and are reasonably sure that there are no serious injuries, help him sit or her up in a comfortable position.
Use a gait belt to help your loved one stand. A gait belt is a belt that fastens around your loved one's waist. Using a gait belt to help your loved one stand is much safer for both of you than pulling on his or her arms. Crouch down to your loved one's level and instruct him or her to bend the knees so that his or her feet are resting flat against the floor. Instruct your loved one to push against the ground with his or her feet. At the same time, pull up on the gait belt. Be sure to use your legs to lift and not your back.
Call for help if you can't get your loved one up safely. If your loved one is unable to push with his or her legs, you may need to call another household member or a neighbor to help you get your loved one off the floor. Another option is to call 911. The paramedics will help your loved one off the floor and check him or her over. While you wait for help to arrive, do what you can to make your loved one comfortable. For instance, you might want to cover your loved one with a blanket or put a pillow under his or her head. Don't scold your loved one for falling, even if the fall was his "fault."
Burns occur when your loved one's skin comes into contact with a hot object, such as a burner on the stove. Scalds occur when your loved one's skin comes into contact with a hot fluid, such as boiling liquids or bathwater that is running at too high a temperature.
Most burns and scalds occur in the kitchen or the bathroom. You can help prevent them by supervising your loved one. If your loved one wants to help you cook, ask him or her to assist with tasks that do not involve being near the oven. Safe tasks include making a salad, setting the table, polishing silverware (not the knives), shelling walnuts, and decorating cookies or cupcakes.
When your loved one is in the kitchen, turn the handles of all the pots and pans so that they are facing the wall instead of facing outward. This makes it less likely that your loved one will grab the handle of a hot pan and tip the contents over on himself or herself.
Finally, ask your plumber to lower the thermostat on your water so that the temperature doesn't become too hot. Since dementia slows reaction time, some people scald themselves by stepping into a bath that is too hot and not getting out quickly enough to prevent serious damage.
If your loved one receives a burn or a scald wound, there are several treatments you can apply:
Remove from the source of the burn. Quickly pull your loved one's body part away from the hot surface or dry off the hot liquid.
Do not remove any clothing stuck to the burn. It's a good idea to remove jewelry and clothing that are around the area of the burn, but do not remove any clothing that has adhered to the burned skin. Doing so could cause more damage.
Apply cool (not cold) or lukewarm water to the burned area. Cool or lukewarm water will ease the pain and minimize the damage caused by the burn. If possible, use water running from a tap. If not, get a large pot or bucket, fill it with cool water, and immerse the burned spot.
Do not apply greasy substances like butter. The idea that putting butter or another greasy substance like Crisco on a burn will help the burn heal faster is an old wives' tale. In fact, these substances may make the burn worse.
Keep your loved one calm. Wrap a blanket around your loved one's shoulders to keep him or her warm and to help prevent shock. It also helps if you talk to your loved one in a gentle, reassuring voice. Make conversation and encourage your loved one to answer your questions.
Apply a clean gauze dressing. Apply a loose gauze dressing, making sure to tape around the burn and not directly on it. There are some situations when it's best to take your loved one directly to the hospital for medical attention. In fact, you should always take someone over the age of 60 to the emergency room unless the burn is extremely minor. Some other cases where immediate medical attention is recommended include:
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