VII. STRATEGIES FOR ENVIRONMENTAL MANAGEMENT

The following is a brief description of the types of environmental strategies that can be used to make the home safer and more functional in order to manage specific behaviors more effectively:

A. Removing or Modifying Objects:

In order to make the home safer for both the person with Alzheimer's Disease and the household, it may be necessary to remove hazards and objects that are potentially dangerous. Examples include sharp objects, poisonous materials, trailing wires or cords, loose mats, unsteady furniture, medications or guns. Appliances that can no longer be used safely may have to be removed or modified. If a person is continually losing objects (e.g., keys) the caregiver may consider making up several sets, hiding a spare or providing the person with a substitute model.

B. Enriching Home Like Environment and Increasing Familiarity:

While objects may need to be removed if a room is too crowded, it is important to maintain the familiarity of the setting for the demented person. If, for example, unsteady furniture is removed it is important that it be replaced by an appropriate substitute, particularly if it supports the person's walking through a room.

Through the use of sensory stimulation and cues, the home environment can be enriched and used as a support in increasing the person's need for familiarity (e.g., cooking smells, photo albums of family, pictures of familiar scenes on the wall, flowers, the texture of a favorite fabric). When there is a need to reinforce awareness of a particular room, increasing familiarity and location might be done through the use of color, a sign and/or a picture of the room.

C. Restricting or Changing an Area:

An area or room may have to be closed off or locked to protect the person with Alzheimer's Disease from harming him/herself. For example, a swimming pool may need to be fenced off or a safety gate might need to be installed at the top of a stair in order to prevent the person from going down the stairs during the middle of the night. Also, it may be necessary to change an area that may no longer be working. For example, a caregiver may move out of the bedroom he or she shared with the person if it interferes with sleep patterns.

D. Introducing Environmental Modifications:

Some aides can be introduced to make the environment safer and more supportive (e.g., grab bars, railings on the stairs, a raised toilet seat, eating utensils). Other modifications can be made so that the home fits the person's behavioral needs (e.g., providing shades that can control afternoon glare that otherwise may result in restlessness).

E. Simplifying Tasks and the Environment:

As it becomes more difficult for the person with Alzheimer's Disease to do everyday tasks, it becomes more important for the caregiver to simplify tasks or activities based on the functioning level of the person as well as reinforcing the persons current abilities. For example, if the person is having difficulty dressing or choosing an appropriate outfit, arranging items in sequence can be helpful in reducing confusion and anxiety. While a person with a dementing illness cannot learn new skills, some individuals can remember simple tasks or facts with enough repetition.

Keeping the environment simple and uncluttered is an important aid in making the home safer for the person as well as making it less perplexing and frustrating. This is particularly appropriate in the kitchen and bathroom areas where only necessary items should be left out.

F. Providing Appropriate Environmental and Sensory Stimulation:

If the person is feeling agitated, bored or restless it may be helpful to remove the person to another setting that provides appropriate sensory stimulation. A room can provide too much stimulation or too little For example, if a room is particularly noisy and the person is becoming agitated, moving him/her to a quieter room and playing soothing music may be effective. Giving the person a foot or hand massage in warm water can also produce a calming effect as well as provide important tactile stimulation. If the person appears to be bored, moving him/her to a room with views onto street activity or providing a fish tank or a bird in a cage may add interest.

G. Diverting Attention:

Diverting the person's attention through the introduction of a familiar or enjoyable activity rather than exhibiting anger or annoyance at a specific act may decrease some problem behaviors. When boredom or inactivity exists, presenting an activity that is appropriately complex for the person's ability and that arises out of a person's past history and interests can be helpful. For example, if the person was a cashier, providing him/her with coins to sort might be an appropriate type of activity.

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