It is more effective to change the environment than it is to attempt to change the patients behaviors. While some AD behaviors may be managed with special medications, many cannot. It is possible to make changes in an environment so you decrease the hazards and stressors that accompany these behavioral and functional changes.

By minimizing danger you can maximize independence. A safe environment can be less restrictive where the AD patients can experience increased security and more mobility.

The following is safety recommendations for specific problems:

Wandering:

* Keep rooms as uncluttered as possible...an active wanderer needs lots of room to roam. They will be less agitated if they feel they have their freedom.

* Divert the AD patient's attention away from using the doors through: A. placing small scenic posters on the doors B. Placing removable curtains or brightly colored streams across the door. C. Wallpapering the doors to match any adjoining walls.

* Place "STOP', "CLOSED" or 'DEAD END" signs in strategic areas on doors.

* Obtain Alzheimer's identification bracelet or pendent for the AD person with the words "memory impaired" inscribed along with an emergency phone number. Place the bracelet on the AD person's dominant hand to limit the possibility or removal or solder the bracelet closed. [This can be especially useful for the families if the person is still ambulatory and therefore spends time outside of the nursing home.

Hallucinations, illusions and delusions:

Due to the complex changes occurring in their brain, patients with AD see or hear things that have no basis in reality. Hallucinations come from within the brain and involve hearing, seeing and feeling things that are not there.

Illusions:

Illusions differ from hallucinations because the AD patients are misinterpreting something that actually exists. Shadows on the wall may look like people.

Delusions:

Delusions are persistent thoughts that AD patients believe are true but in reality, are not. They may be certain that someone is stealing from them, but this can not be verified.

With all the above symptoms, environmental adaptations may be helpful. However, if an AD patient has ongoing disturbing hallucinations, illusions, or delusions, medical evaluation is important.

The following are suggestions to help combat these particular problems:

* Wall colors can be bright-colored in order to reflect more light. Solid colors are less apt to confuse an impaired patient than a patterned wall. Large, bold prints [such as floral wallpaper or drapes] may cause confusing illusions.

* Dimly lit areas may produce confusing shadows or difficulty with interpreting everyday objects. Make sure there is adequate lighting especially in bathroom areas.

* Glare can also create visual problems. Reduce glare by keeping blinds or curtains partially covered.

* If the AD patient becomes frightened or confused ask them if they can point to a specific area that is producing it. Perhaps one particular aspect of the environment is being misinterpreted.

* Avoid watching violent or disturbing television programs. The AD patient may believe the story is real.

Impairment of senses:

It is common to have impairment of the senses in Alzheimer's disease. The ability for patients to interpret what they see, hear, taste. smell, or feel declines or changes.

The following are recommendations to help minimize the dangers these loses can cause:

Vision:

Ad patients may experience a number of changes in visual abilities. For example, "visual agnosia" is a condition in which patients lose their ability to comprehend visual images. Although there is nothing physically wrong with the eyes, AD patients may no longer be able to accurately interpret what they see due to changes in their brain. Also, their sense of perception and depth may be altered. These changes will cause safety concerns.

* Try to create color contrast between floors and walls to help AD patients see depth. Floor coverings are less visually confusing if they see a solid color.

* Consider using dishes that contrast with the table, for easier identification.

* Place brightly colored signs or simple pictures on important rooms such as the bathroom for easier identification.

Hearing:

People with AD have normal hearing, but they may lose the ability to accurately interpret what they hear. This may result in confusion or over-simulation.

* Avoid excessive noise in the environment. Soothing music will help maintain a sense of calm.

* Be sensitive to the amount of noise that is outside and close the windows if necessary.

* Be aware that large gatherings of people may cause the AD patient to become agitated or distressed. Be prepared to remove the AD patient.

The following are ideas that were created and found useful for Alzheimer's patients:

* Make sure all fences are high enough so that it is impossible for AD patients to climb over.

* Maintain a staff-to-patient ratio that allows staff to monitor the movements of the patient almost continually, to minimize injuries and serious accidents.

* Place visual clues [colors, identification signs] to help patients remember their way and give them reminders of what boundaries, doors etc. are meant for.

* Round the edges of walls, etc. to lessen the impact of hitting when falling.

* Address the memory and communication needs of the patients by using sensory stimuli [memory boards where they clip photographs and other reminders.]

* Plan additional meals and beverage breaks to keep the patients weight at normal levels and to prevent dehydration.

* Provide a steady stream of structural, assisted activities and groups functions that keep the patients busy and stimulated.

(c) copyright 1994

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