Alzheimer's Caregiving: Challenges and Safety in the Home
Learn about challenges and safety concerns as well as tips and interventions when caring for someone with Alzheimer’s disease or a related dementia. Find out how to implement home safety tips, navigate challenges with home care including medication management, fall risks, wandering, and sundowning as well as home safety protocol tips. Download your own dementia care home safety checklist as well. Make sure to check out all the long list resources available at the end of this article.
This content is not intended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician, therapist, or other medical professional regarding a medical condition or treatment. This content is for informational purposes only. See full disclosure.
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Hi There!
A couple weeks ago, a winter storm blew in, dropped 4-5 inches of snow over the course of the day and we played, what felt like, the entire day. School was cancelled, hot chocolates and teas were served, we went sledding down a huge hill with friends, and the kids built a snowman with literally, a corn cob pipe. I wish I had a picture.
For me, there is something special about listening to the snow fall and watching the birds get their fill at our nearby feeder. When it snows the world seems so quiet and calm. Looking for nature’s signs and just being is something I love doing anytime of year. Its makes me feel more relaxed and connected.
Did you know that being outside regularly can help with sundowning (heightened agitation and confusion in the late afternoons and evenings) for our loved ones living with dementia? According to the Fisher Center for Alzheimer’s Research, being outside during the daylight hours, especially in the morning when the sun is bright and shining beautifully, can help improve functioning and alertness helping to lower the risk of falls.
Dementia and Alzheimer’s Overview
Dementia is not a specific disease, but instead is a general term used to describe the decline in memory and cognitive abilities associated with aging that interfere with daily life. Alzheimer’s disease is the most common form of dementia. Other common types of dementia associated with aging include frontotemporal dementia, vascular dementia, Lewy body dementia, and mixed dementia. Symptoms associated with dementia include:
- Cognitive decline
- Memory challenges
- Difficulty remembering appointments
- Behavioral changes
- Difficulty with short term memory
- Trouble completing daily tasks such as paying bills and preparing meals
- Difficulties with daily self care tasks such as grooming
- Gets lost in familiar places
- Changes in sensory perception associated with sight, smell, hearing, and taste
Learn more about Alzheimer’s and other related dementia signs and symptoms from the Centers for Disease Control (CDC). If you have questions or concerns about an specific case, contact your medical doctor to discuss any concerns you may have.
Challenges With Dementia Care In The Home
According to the research study by Improving Safety Protocols In Aged Adults with Dementia in Care Homes, 2024, there are four main challenges that caregivers often come across when caring for someone with dementia. It is important to consider and discuss with your care team these safety challenges and how these can impact your loved one, and solutions to help ensure safety.
Falls and Mobility Challenges
Bones often get weaker as aging occurs, and falls are more likely to cause fractures in older adults. As dementia progresses, both spatial awareness and motor coordination challenges arise causing a greater risk for people with dementia. Here are some simple tips in helping to reduce the risk of falls:
- Stay active
- Complete daily exercises as prescribed by your physical therapist
- Reduce potential trip hazards in your home
- Prioritize sleep
- Avoid or limit alcohol
- Use an assistive mobility device when needed
The National Institute on Aging has a great resource on falls and fall prevention. If you have concerns regarding falls and mobility challenges, contact your personal physical therapist to discuss any concerns you may have.
Spatial Awareness and Dementia
Spatial awareness is the ability to understand how your body moves in relation to the objects around you. This also includes the awareness of distance between your body and objects as well as our body’s position in space. With dementia, spatial disorientation can occur causing confusion about surroundings whether inside or outside the house, making it difficult to remember directions, difficulties driving, and recognizing familiar places.
Challenges with depth perception can also cause confusion with changes in flooring and patterned rugs. Individuals with dementia may also experience peripheral field loss which makes it difficult to process visual information from the top, bottom, and sides of the visual field. This loss of the visual field can make it difficult to not only drive, but also move about a room without bumping into things or tripping.
Motor Coordination and Dementia
Motor coordination is the ability to use multiple body parts to perform a task with accuracy, speed, and control. As dementia progresses, walking speed and gait can change along with reduced balance, agility, muscle mass, and strength changes.
If you have concerns regarding falls, contact your physical therapist.
Sundowning and Wandering
Wandering
Wandering is when someone with dementia or Alzheimer’s is unable to recognize familiar places as well as familiar faces. It is common for a person with Alzheimer’s to get confused about where they are or become lost. According to the Alzheimer’s Association, wandering often occurs at least once in 6 out of 10 people, often repeatedly. This can occur at any stage of Alzheimer’s, and often occurs at least once. Wandering can be dangerous and even life threatening, and its important to plan ahead to ensure safety. Consider some of the following in helping to reduce the occurrence of wandering:
- Provide opportunities for meaningful activities
- Ensure basic needs are being met
- Involve the individual in daily activities such as folding laundry or putting away the dishes
- Identify the time of day when your loved one is most likely to wander, and plan a purposeful activity or exercise
- Avoid overstimulating environments such as busy super markets, parties, and festivals.
- Monitor noise level
Sundowning
Create a daily plan and figure out what time of day your loved one is most likely to wander. Is sundowning happening or confusion and disorientation occurring in the early evening through the night? Sundowning can be caused from a variety of reasons including mental and physical exhaustion from a full day of activities. Consider the following to help reduce sundowning:
- Get a full night’s rest
- Plan appointments and outings in the morning
- Keep regular daily schedule of bed time routines, meal times, and morning routines include waking times
- Reduce stimulation in the evenings
- Encourage as much outdoor time as possible
Medication Errors
Cognitive challenges can make managing medications difficult and often dangerous for those living with Alzheimer’s or a related dementia. It is vitally important that caregivers oversee medication management. Keep in mind the following when considering medication management:
- Make sure to coordinate medications with all care providers
- Have your pharmacist check for possible drug interactions
- Take as directed
- Keep a medication record
- Develop a daily medication routine
- Look into pill organizers such as a daily pill box organizer or at home medication dispensers which can be helpful for home use with caregiver oversight
- Of course, make sure all medications, over the counter or prescribed, are secure and in a locked space to prevent consuming medications without the caregiver’s knowledge
If your daily pill box organizer is no longer working for your situation, and you have concerns regarding double dosing or your loved one taking meds at the wrong time or without you knowing, look into other options such as an automatic medication dispenser. The MedReady automatic pill dispenser with lock from the Alzheimer’s Store might be a helpful tool for your situation for managing medications with more independence and ease. This handy device can be programmed to dispense medication up to four times per day, has an alarm to alert the user when it’s time to take medications along with 28 compartments that holds 9+ caplets as well as a lockable dispenser to prevent double dosing. Several models are available as well as monitoring plans.
Communication Challenges
Changes in communication including expressive language and language comprehension can be seen as the disease progresses. It is important to monitor changes in communication with your speech-language pathologist and discuss helpful strategies to enhance communication. Your speech-language pathologist can help with the following:
- Cognitive strategies
- Communication strategies and intervention
- Compensatory strategies
- Cognitive stimulation
- Teaching strategies such as visual cues and repetition
- Caregiver education regarding communication can be helpful.
Speech therapists can also help with swallowing (dysphagia) and recommend swallowing exercises and dietary changes.
Dementia Home Safety Protocols
According to the research study, Improving Safety Protocols for Aged Adults with Dementia in Care Home, 2024, states that a comprehensive approach to adapting safety protocols are needed when working with or caring for individuals with dementia. The research article states that when caring for someone with Alzheimer’s or a related dementia, it’s important to consider the following 6 areas:
Environmental Modifications
Environmental modification refers to the physical changes to a home or building to make it safer, more usable, and accessible for a person or people with a disability. Creating a safe environment for a loved one with dementia helps to ensure safety and help prevent falls. Evaluate your home’s safety room by room to ensure your home is safe and accessible.
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Individualized care plans
Keep a record of individualized care plans from your care team including by not limited to your physician, neurologist, physical therapist, occupational therapist and speech-language pathologist. Review and discuss with your care team home modifications, medication management, home exercise programs including cognitive interventions, validation therapy, behavior management, and modifications to daily living activities.
Assess and discuss individual needs
Assess and discuss individual needs based on cognitive abilities and changes over time, physical limitations, behavioral patterns, and personal preferences with your care team. Furthermore, discuss concerns that arise at home or within the community your doctor and therapists.
Engagement in purposeful and meaningful activities
Engage in purposeful and meaningful activities by creating a stimulating environment with the goal to reduce boredom and agitation. Participating in meaningful activities based on an individual’s past or present hobbies can help keep loved ones engaged and active, helping to reduce the occurrence of wandering and sundowning. Find out how to create your own dementia care activity kit.
Socialization with friends and family
Socialization with friends and family can help reduce boredom, agitation, and help reduce the occurrence of unwanted and risky behaviors. Discuss any triggers with friends and family as well as any precautions such as alcohol use, fall prevention, time of day for visit (while keeping sundowning in mind), length of visiting time, and how to respond to certain behaviors if one occurs.
Incorporate behavior management strategies
Incorporate behavior management strategies as needed. Your occupational and speech therapist can help guide you through behavior management strategies based on your specific loved ones’ needs such as validation therapy and redirection.
- Keep a log of potential triggers so as a pattern is seen you can modify as needed
- Maintain a consistent routine
- Create a peaceful, calm environment
- Avoid overstimulating environments
- Stay active
- Learn communication strategies
- Stay calm and relaxed, and try not to show frustration, and avoid arguing
- Engage in meaningful activities
- Reminiscence together
- Use clear simple language as the disease progresses
- Modify the environment
- Look into redirection and validation therapy
*Contact your doctor if behavioral changes are sudden or severe.
Takeaways
As a caregiver, your role is so important and valued more than you know. Learning tips and intervention strategies can help plan for the future and can make navigating challenges easier. Consult with your care team as concerns or changes occur.
Resources
Dementia Care Resources and Research
- Fisher Center for Alzheimer’s Research Foundation Home Modification Resource Guide
- Alzheimer’s Research Foundation
- Alzheimer’s home safety resource from the Alzheimer’s Association
- Research study Improving Safety Protocols for Aged Adults In Care Homes by Taiwo, Ejuone, and Paul, 2024
- The National Institutes of Health article, Alzheimer’s Caregiving: Home Safety Tips
- The National Institutes of Health article on Falls and Fall Prevention
- Validation Therapy for Dementia Care by Senior Living
- Wandering resource from the Alzheimer’s Association
- Sundowning resource from the Alzheimer’s Association
- Improving Sleep and Sundowning a resource from the Fisher Center for Alzheimer’s Research Foundation
- Medication management resource from the Alzheimer’s Association
- Validation therapy resource from the Alzheimer Society of Canada