Alzheimer's Proofing Your Home: Deterrents and Diversions
By Mark L. Warner, AIA •
November 11, 2002
(Editor's Note: This article is used with the permission of the author)
There are several unconventional means of preventing a wandering-prone loved one from leaving home. Not all of these ploys will work for everyone; success depends very much on the remaining resourcefulness of your loved one and the stage of the disease he is in. Trial and error will show you which tactic is best for your situation, but always remember: There is no substitute for supervision and good caregiving.
Alzheimer's, being a disease of the brain rather than the body, offers some unexpected, easy-to-overlook opportunities for keeping a loved one safe at home. Since logic and reasoning gradually fade, we can actually use this development to our advantage and ultimately make home safer for the person with AD. For example, in the first article in this series, I suggested placing locks outside of the normal field of vision and traditional lock locations. Though you and I might conceivably see a lock in these unusual places, it is less likely that this would hold true for someone with AD.
Illusions for those with dementia mean misinterpretations of common, everyday events and items. For example, a pattern or design in the carpeting might be perceived as an object. Your family member may reach down and try to pick up a dark square or a recognizable figure in the carpet's design. Another example might be the air conditioning vent blowing on the curtain, now thought to be hiding someone behind it. Or perhaps your loved one mistakes an open window for the entry a "thief" uses to sneak into your home and hide the remote control for the television. Though these are merely cases of mistaken perception, they are also windows of opportunity for the creative caregiver.
Visual cliffing refers to the misinterpretation of a change in color or texture as a change in elevation, and thus can make a good deterrent. A dark mat in front of the door, for example, may appear to your loved one as a deep hole, a deterrent sufficient to prevent him from trying to proceed any further. This ploy has worked for many caregivers, though it should be used with caution. Some people with AD see the "hole" as a trench and attempt to step or jump over it. This can lead to injury, so be aware, observe, and take the necessary precautions.
For our purposes, deterrents shall be defined as intentional obstacles to stop your loved one from an undesired activity. The most common is the stop sign. But what do people without Alzheimer's do when they come to a stop sign? They stop, look both ways, and then, if all is clear, proceed. Your family member may do exactly the same thing. The sign may slow them down for a moment, allowing the alert caregiver to take appropriate action, but in the caregiver's absence it may do nothing more than stall them for a few seconds.
Pay close attention to why some of these ploys fail. They might work perfectly well for a child, but we are not dealing with a child --we're dealing with a full-grown adult. More importantly, we're dealing with someone with the life experience pool of an adult. This is why your mother or father may stop, look both ways at the stop sign, and then proceed. And it may also be why jumping over a perceived "trench" is an educated attempt at success. It is based on past experience.
Your job is to constantly review what works and what doesn't. Your resources should be ideas that take advantage of the disease. What cues might actually stop your loved one from trying to open a certain door or go in a particular direction? I can suggest a few ideas, but it's up to you, based on your familiarity with your loved one, to choose the best or come up with effective alternatives.
What exactly is the message you want to send? Using the stop sign example again, you don't want your loved one to stop and then keep going -- you want him to stop and turn around. So perhaps a sign reading, "This door is broken. Use the other door" might work much better. Take advantage of the disease and declining short-term memory. Perhaps the time it takes to turn around and proceed to the "other" door will be sufficient for your family member to forget his original plan and be distracted by something else.
Other effective signs include: detour, do not open, men only (for a female family member), women only (for a male family member), John - do not open this door, danger.
Perhaps a sign reading "DETOUR" is not enough. Some caregivers have had good success taping paper cut-outs of recognizable authority figures to doors. For optimum effectiveness, choose an authority figure your loved one will respect and make sure he is doing something that sends the correct message, such as holding up his hand as if to say "Stop!"
For a man who served in the military, a picture of a soldier or sentry might work. With particularly religious people, success may be found with a picture of a clergyman. And for others it might be a policeman, a school crossing guard, or a nurse in uniform. Magazines and newspapers are good places to find suitable photographs or illustrations.
Sometimes it's in our loved one's best interest to make something disappear or resemble something else. In this case we are truly taking advantage of the disease.
There are several ways to accomplish this. One way is to use a product called a door mural. A door mural is simply a piece of special wallpaper that looks like anything but a door -- perhaps a set of shelves, for example. Some door murals are so realistic that they can fool anyone, not just those whose minds are muddled due to AD. Some Alzheimer's care facilities paint their exit doors to match the walls next to them, complete with wood molding and wallpaper. As a result, the residents don't recognize the doors, but the staff easily does.
New Pane Creations makes a product called "fake mullions." Mullions are the horizontal and vertical pieces of wood or metal that hold the glass in windows; fake mullions are strips of plastic that simulate them. They are particularly effective when attached to sliding glass doors, which are both exits from the home and a potential danger to anyone who accidentally walks into them when closed. Fake mullions make sliding glass doors appear more like big windows, discouraging escape and reducing the potential for accidents.
Diversions are items strategically placed to catch and redirect your loved one's attention. For example, one family had to deal with a grandfather who frequently got up at night, dressed for work, and headed for the car in the garage - even though he had retired years ago. The family placed locks and alarms on the door, but wanted to do something that avoided the problem entirely. So they took advantage of one of their grandfather's biggest weakness, his love of the family cat, Fluffy. They placed Fluffy's bed next to the door leading to the garage so Grandpa would be sure to see it. And sure enough, Grandpa got up that night, dressed himself, headed for the door and then saw Fluffy asleep in his bed. As planned, Grandpa stopped to pet Fluffy, who immediately started purring. And the more he purred, the more Grandpa pet him. Eventually Grandpa got tired and went back to bed. Problem solved!
Other diversions include light, sound and movement. Consider what works for young children - colored lights, toys that make sound, etc. If a diversion can catch your family member's attention, perhaps it can keep him occupied long enough to forget a more dangerous thought, such as opening the door leading to the garage.
Location, Location, Location
A cue or sign is of little value if no one sees it. People with AD often have a form of tunnel vision. They see only what is directly in front of their eyes - and almost nothing else. So where might the best place be to put your cues?
A sign five feet above the floor, easily seen by the average six-foot man, is of little value to a woman who's only four- feet-two. What is eye level for her? In some cases, eye level is actually floor level. In other words, while they are walking, they are watching the floor, not the wall or where they are going. So where better to place your cues than on the floor – where your family member is naturally looking?
One company we have discovered makes a floor mat in the shape of a stop sign. We don't normally recommend floor mats or throw rugs because they're too easy to trip over. But if a floor mat or throw rug stops your family member BEFORE he walks over it (and out the door), well, perhaps it has served its purpose.
Make sure that your signs are easy to read. A sign that blends in with the color of the wall behind it or is written in letters that lack contrast is of little value. Signs should be printed with simple, easy to read letters that contrast well with their background. There is no point in using cute script handwriting if it can't be read by a mind that needs things to be very clear and understandable.
Alzheimer's disease has some very unique and unusual traits, one of which is called "retrogenesis." This term basically means that the person is mentally traveling backward in time. It is typical of the disease. When I volunteer at an Alzheimer's day care center and ladies in their 80s flirt with me and ask me out on dates, I know it's the result of retrogenesis.
As someone with AD regresses, everything that was true in their younger years is true now. Some people who quit smoking for years suddenly pick up the habit again. Others try to go back to jobs they retired from years ago, look for homes of their youth, or search for long-departed loved ones. Without question, retrogenesis is one of AD's greatest enigmas.
Retrogenesis can be especially problematic in people for whom English is a second language. Many older people came to the United States in their youth and learned to speak English as they settled in. Afflicted with AD, they often revert back to their native language. When this occurs, cues and signs should be written in the language they now speak and read! Otherwise, they are meaningless.
Never rely on a single device or strategy when more than one is warranted. If a door leads outside the home, say to a balcony, stairs or an area storing dangerous items, take multiple precautions to prevent your loved one from opening it. Those who are old enough to have AD are also old enough to have accumulated a lifetime of experience and abilities. Despite the disease, many remain quite capable of unlocking a single lock or even figuring out a cleverly camouflaged door. Use as many deterrents, diversions, devices, locks and alarms as necessary to ensure the safety of your family member.
This series was written in response to the many questions we have received on wandering and the various steps families can take to protect their loved ones. It was also encouraged by the frightening number of newspaper articles and broadcasts appealing for help in finding lost family members who wandered away from home or Alzheimer's care facilities. Many are found drowned in canals and lakes, fall victim to thieves and unkind people, and even freeze to death in the cold winter months. It's a sad phenomenon that occurs far too often in this country.
Finally, a disclaimer: There is no substitute for proper supervision. Please take the advice with a grain of salt -- everyone is different and no single solution will work for all. Closely observe your family member, and do only what you feel will work best for him. There are few guarantees when dealing with a disease of the brain, so please be careful.
New Pane Creations (800) 382-7263
Tamarac Development Group (877) 255-0907
Nasco Activity Therapy (800) 558-9595
Floor Mat Stop Sign
The Company Store (Item # UA 4501 M MUL) (800) 285-3696
Mark Warner, AIA is a registered architect and gerontologist, author and international speaker. He is the author of The Complete Guide to Alzheimer's-Proofing Your Home, the first book in the Homes That Care series on age-related conditions and how to create safer, friendlier homes for those suffering from them. His firm, Ageless Design, Inc. offers consultation and assistance in the design of environments for seniors. For more information call (561) 745-0210 or e-mail: firstname.lastname@example.org.
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