Safety: Autonomy for Dementia

In its simplest form, autonomy is a person’s ability to act on their own values and interests. A person exercises autonomy when they make decisions for themselves based on their own desires. Our ability to remain autonomous, especially as we age, can greatly influence our sense of pride, confidence, and independence. However, it’s common for older adults to feel like they are losing their ability to remain autonomous due to physical and mental deficits, especially for those struggling with dementia. Dementia can affect a person’s ability to understand the consequences of a decision, impair judgement and comprehension, all of which can affect their ability to practice autonomy. However, taking away a person’s autonomy by not involving them in their own care plans can negatively impact their sense of independence and confidence. While those with dementia may need additional support to ensure their safety, it’s important to encourage their own autonomy.

Supporting Autonomy in Those with Dementia

As dementia progresses, individuals may often feel a sudden loss of independence, even when they still have the ability to make sound decisions and judgments. Safety may be affected by dementia symptoms such as confusion, memory loss, disorientation, limited mobility, coordination and changes in the environment. Oftentimes caregivers will overlook their loved one’s abilities, opting to make decisions on behalf of their loved ones. Although they often have good intentions, it’s important for caregivers and family members to practice patience and allow their loved ones to exercise the skills they still have. The best environment for a person living with dementia is one that allows them to stay independent and feel supported in a safe environment. Caregivers can support their loved one by creating a nurturing environment that balances independence and safety, while continuously using creativity and flexibility to anticipate changes as their loved one’s cognition declines. As your loved one progresses through dementia, you may consider implementing tips from the Alzheimer’s Association to ensure their safety while also supporting their autonomy:

Evaluate the Environment

 A person with dementia is more at risk of safety hazards within certain areas of the home as the disease progresses. Places in the home, such as the garage, where there are tools, toxic chemicals, cleaning supplies, and sharp surfaces should be monitored or locked completely. In addition, you may consider implementing the following tips:

• Install safety measures such as childproof locks on cabinets, locks with codes
• Remove clutter, loose rugs and carpet edges to prevent falls
  • Install night-lights in the hallways and in bathrooms so the person with dementia can see where they are going during the evening.
  • Those with dementia may not be able to differentiate between temperatures, so installing thermostats to control the temperature of water that comes from water taps can help prevent burns.

Kitchen Safety

The kitchen is another place within the home that presents many safety concerns. As the disease progresses, individuals with dementia may forget how to operate common household appliances such as the stove or garbage disposals. Here are some ideas to help make your loved one’s kitchen safer:

• Use appliances that have an automatic shut-off feature
• Prevent accidents by applying stove knob covers, removing knobs, or turning off the gas (for gas appliances) when the stove is not in use.
• Remove toxic plants, decorative fruits, plastic bags and garbage bags
• Vitamins, prescription medications, sugar substitutes and seasonings should also be stored out of sight in a place where they can be regularly monitored.
• Knives and other cutlery should also be stored in place that is out of reach, especially if your loved one has violent tendencies or aggression.
• Replace long electrical cords on appliances with coiled or retractable cords can help prevent falls in the kitchen.

Bathroom Safety

Those with late-stage (severe) dementia should not be left alone in the bathroom at any time. Instead, a caregiver or family member should provide support in the bathroom when necessary. If privacy is needed or requested, caregivers should be nearby and offer support. To ensure the safety of a person with dementia, caregivers or support people should:

• Remove the lock from the bathroom door to prevent the loved one from getting locked inside.
• Place nonskid adhesives to the shower or bathtub floor to prevent falling or slipping. Nonskid adhesives should also be placed on the floor near the sink, toilet and shower if the floor is not carpeted.
• Install grab bars near the toilet and shower
• Use a plastic shower stool and hand-held shower head to assist with bathing
• Remove all electrical appliances from the bathroom and cover electrical outlets.
• Provide assistance with shaving and grooming.

Medication Safety

After receiving a dementia diagnosis, an individual may need assistance with medication set-up and administering. To help promote independence caregivers and family members can:

• Use a pill box organizer to keep medications organized and help a person with dementia know when to take their medications and at what time. As the disease progresses, a person may need a pill dispenser with an automated alarm clock to alert them when it’s time for their medication.
• Develop a routine so a person with dementia is more likely to remember to take their medications. Oftentimes, this is paired with a meal, in the morning or before bedtime. It’s important to consult a doctor or pharmacist to ensure the medication is taken correctly (i.e. with food).
• Use simple instructions such as, “this is your medication for high blood pressure. Put the pill in your mouth and take a sip of this water to help swallow it.”

Driving Safety

As dementia progresses, cognitive impairment and declining motor function will worsen, and ultimately require those with dementia to stop driving. However, it’s difficult to know exactly when this will happen as so little is known about how the various stages of dementia relate to driving behavior. Most often, family members become aware of driving performance errors after witnessing them or being notified of an incident.

Driving represents a sense of freedom and autonomy for many individuals; so, taking away the keys can be a difficult experience. However, the Alzheimer’s Association makes it clear that a dementia diagnosis does not mean an individual needs to stop driving. It’s important to plan for the time when driving is no longer possible. Those with dementia should also be involved in decision-making and planning regarding the cessation of driving.

The most important thing you can do is to start the conversation with your loved one. The Alzheimer’s Association compiled a list of tips to consider when preparing for the conversation:

• Stress the positives and offer alternatives
• Address resistance while reaffirming your unconditional love and support
• Appeal to the person’s sense of responsibility

If the conversation doesn’t go well, you should be prepared for the person to become angry with you:

• Be patient and firm. Demonstrate understanding.
• Acknowledge the pain of this change and appeal to the person’s desire to act responsibly.
• As a last resort, take away the car keys or consider selling the car.

Encouraging Autonomy at Maplewood Senior Living

At Maplewood Senior Living, we aim to foster a sense of independence and autonomy for all of our residents. We offer supportive services and accommodations that make living with autonomy a possibility at every level of care. To learn more about our offerings, please contact us.