Two important adaptations to the home include the removal of environmental hazards to protect the person from a possible injury and simplifying the environment as much as possible. Environmental modifications that relate to safety issues in the home are important for all older adults but are particularly relevant to the older person suffering from dementia.

While many of the above suggestions are safety-related, the following are specific environmental modifications that can be made to compensate for vision, hearing or mobility problems that the person with dementia may have which make him/her more susceptible to an accidental fall, burn or bruise.

1. VISION CHANGES:

Possible Underlying Causes:

Persons with Alzheimer's Disease may experience problems with depth perception. Other visual changes that often accompany aging include a yellowing and thickening of the lens, weakened eye muscles and constriction of the pupil. These changes may result in the older person's need for more light, the elimination of glare, even lighting condition, larger print, more color contrast to identify objects, judge distances or changes in levels and lighting that can be controlled.

Possible Modifications:

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• The light level should be as consistent as possible throughout the room and between rooms, particularly in the hallway or in entry-ways.
• Increase lighting levels for tasks as the person may need far more light to see clearly when younger.
• Keep strategic locations brightly lit at all times (e.g., bathrooms, bedrooms). Night lights in the hallways and bathroom can provide a lighted path if person gets up during the night.
• Use shades or blinds to control glare from sunlight coming through windows.
• To help prevent glare, do not highly wax or polish floors. Use a non-glare polish. Pay attention to magazines that have very shiny pages as it can be very disturbing to the person with Alzheimer's Disease.
• If the person is spending time outdoors in backyard, make sure there is some overhead protection (e.g., umbrella) for them to sit under. The use of a hat, sunglasses or other protective clothing should be considered.
• Reflector tape on handrails, stairs, doorways, corners or mantel pieces may help prevent accidents, particularly if the person is having difficulty in finding his/her way.
• Use decals on patio doors since glass is difficult to see and the reflection can be distorting to the person.
• Paint the porch or deck steps bright contrasting colors. Attach outdoor non-skid tape to the edges to prevent tripping and to outline one level from another.
• Use a color contrast between dishes or utensils and placemats or tablecloths as it makes it easier to identify the individual items.
• Items used to orient the person (e.g., clocks, calendars and signs) should have printing large enough for them to see and read. Black print on a white or yellow background is the easiest to read because of the contrast between the two colors.

Possible Underlying Causes:

Hearing change that occurs with aging is called presbycusis and affects the ability to hear high-pitched sounds and distinguish between sounds and voices when there is too much background noise.

Possible Modificadons:

• If person is hearing impaired, it is important to remember that too many background noises can be very disturbing and make it difficult to understand directions or conversation. Therefore, try to reduce noise levels within the home by turning off the television or radio when not in use.
• If possible, provide a room away from noisy machines (e.g., dishwasher, heater, television) in which person can do an activity or hold a conversation.
• Peaceful background music may help calm the person. The use of headphones may be considered if it is not disturbing.
• Drapes, floor coverings or fabric wall hangings can help muffle or absorb equipment noise.
• Arrange furniture to provide seating arrangements that are conducive to hearing well (e.g., at right angles without too much distance between furniture). Remember that lighting plays an important part in hearing well as the person may be reading lips and must be able to see clearly.
• There are many safety devices for the hearing impaired that provide a light signal when the door bell rings, the telephone rings or a smoke detector goes off. See information in The Home Evaluation Resource Booklet for the Elderly (Appendix).
• Consider the use of an amplification device known as a space aid if person is hearing impaired rather dean traditional hearing aid.

Possible Underlying Causes:

With aging there is a decrease in strength, muscle fiber and grip. There is also reduced mobility balance and reaction time as we age. The person with Alzheimer's Disease may be particularly unsteady as the disease progresses and a shuffling gait may occur.

Possible Modifications:

• Try to keep the environment clean, clutter free and easy to move around in.
• Rugs and carpets should be securely fastened to prevent slipping or tripping, especially on stairs.
• Use stable chairs that the person can get in and out of easily. Chairs with high backs, that are not too deep or low and that have arms that extend beyond the edge of the seat are recommended for ease of getting in and out of.
• Remove or secure any wire or cords that might be in circulation path.
• If there are small pets in the home, make sure their feeding dishes are not located in an area that could be easily tripped over. The same is true for small space heaters.
• Remove any furniture that is unstable (e.g., rocking chairs that can tip over easily or very low coffee tables). If furniture has sharp edges that person is bumping into, consider the use of furniture guards to protect accidents.
• Install handrails and grab bars in the bathroom. Make sure handrails are anchored into studs rather than drywall where they can easily be pulled out.
• Use skid resistant mats in the tub and shower to prevent falls.
• Use well-fitting shoes with elasticized laces which will provide more support than slip on shoes. Velcro closures on shoes (e.g., tennis shoes) can be very convenient to get in and out of.
• Make sure person's clothing is not too long and trailing on the floor.
• Check for uneven ground, craked pavement, holes in the lawn, fallen branches, thorny bushes, low clotheslines, etc. These can be easily tripped over.

Possible Underlying Causes:

While there are decreases in the older person's olfactory and tactile sensitivity with aging, it occurs later than vision and hearing changes and is very individual. Some research indicates that familiar and pleasant smells generate associations with past experiences triggering long-term memory and that touch and a variety of tactile experiences enhances the feeling of well-being.

Possible Modifications:

• Provide person with things to touch or fold (e.g., combine pieces of varied textured fabrics. See Appendix for Activity Resources).
• Provide person with opportunities to experience cooking smells, scents in packages (e.g., See Activity Resources), potpourri or outdoor areas (e.g., garden).
• Foot and hand massages in warm water can be very therapeutic and relaxing to the person with dementia.

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