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Living At Home Alone With Dementia (Part 1)

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Good morning, welcome to Dementia Q&A where we try to answer your questions about dementia in about five minutes with as little medical jargon as possible. I’m Dr. Marc, an internist and geriatrician here in Louisville, Kentucky.

This is week number four in our ongoing video series about care settings, places where people with dementia might live, and care services, things they might qualify for or benefit from.

This week we’re focused on living at home. I’m asked all the time, “Dr. Marc, is it safe for people with dementia to live at home alone?” The short answer is, yes it can be safe. For a period of time, it might become unsafe at some point and lots of people are doing it today. Of the nearly six-million people with dementia, it’s thought that over 20% are living at home on their own in the community right now. When I think about somebody who’s living at home alone with a diagnosis of dementia, I generally have five major buckets of concern, the Dr. Marc top-five. They are:

  1. Basic home safety, which affects people without dementia too, by the way.
  2. Nutrition
  3. Finances
  4. Medications
  5. Loneliness, isolation and boredom, which seems to be affecting larger and larger groups of people today than ever before.

When it comes to home safety, we always think about fall prevention first. If you’ve been given a diagnosis of dementia and you’re looking at your home and thinking, “How can I reduce the risk of falls?” here are a bunch of things you can do right now:

  1. You can declutter. It would certainly be a shame to trip and fall and hurt ourselves over our own stuff.
  2. We know that throw rugs are a hazard and cause falls. I would recommend removing them and also making sure that your other rugs are taped down.
  3. Grab bars and handrails, of course, make sense.
  4. Think about better lighting in pathways that we use, especially at night. So, between the bed and the bathroom or between the bed and the kitchen, perhaps.
  5. Good footwear is always important in the home.
  6. Lastly, I would take a look and ask yourself, “Do I need to be on all of the floors of my house if I have more than one floor? Or could I really live my life on one floor?” That way, we would sort of take the stairs out of the equation completely, which might be a good thing.

Three other areas, when safety is concerned that I really think are important for people with dementia:

  1. The kitchen. Everyone is always worried about the stove and we know that we might have to turn the power to the stove off at some point. We should try to migrate our habits for reheating things and boiling water to other appliances that have automatic shut-off mechanisms and some of them have alarms that tell us when it’s done – the microwave, a good toaster oven, and an electric kettle are all devices that make sense.

    I’d also think a little bit about hot, scalding water. Unfortunately, there are more injuries from that than you’d like to imagine. There are ways to turn hot water heaters down, so the maximum hot water temperature is lower and also, you might be able to lower the valve strength under your sinks so that less hot water flows and it mixes faster with cold water to make it staff.

    The last thing I would think about a little bit is internal locks. I have small children and family has been visiting – I’ve had people get locked in my own house and I don’t have anybody who has dementia who’s in the house with me today. It would certainly be a shame for someone with dementia who lives alone to get locked in a bathroom. Usually those locks can be removed and I’d recommend doing so.

  2. The second big category of concern I have for older adults with dementia living at home alone is nutrition. All older adults are at risk for lower appetite and malnutrition, but folks with dementia who have trouble with short-term memory and difficulty with executive function, are at increased risk because even preparing leftovers and heating them up in the toaster oven or the microwave, is a task that has a lot of steps and if you can’t plan them in order, you might have difficulty and be very frustrated. Here are some things to think about:
    • There might be mechanical reasons why someone with dementia is not eating. Perhaps they have dentures that aren’t fitting right. Perhaps they have problems with their teeth and they have pain in their mouth. Perhaps they have difficulty swallowing. Some of those need to be worked out with dentists and physicians.
    • Also, I would think about medications. A lot of medications can make people feel bloated or they can actually taste awful and so, after taking those medicines, one might not want to eat.
  3. Third, I would think about the social component of eating. A lot of people try to schedule activities either out of the house or when people come over separate from meal times. I would actually look to try to mingle those together. If there are activities at the senior center or at your community center or at the church that come with a meal, I would schedule myself to be there, so at least I knew I was getting a meal there as part of the social milieu. Likewise, if family is going to schedule visits or if I have food in the fridge already, and I know they’re just coming over, it would be great to have them come over at meal times. If they’re hungry, they could bring food or we could eat what’s in the fridge. Either way, we’re sitting down together and we’re eating. That way, I’m being prompted to eat just by virtue of being across from you while we’re both doing the same activity.

    Obviously, if people are homebound and qualify, there are programs that can deliver food to the house, like Meals-on-Wheels. I’ve been delivering Meals-on-Wheels all year and it’s really an honor to provide a hot meal and nutritious snacks to people every day, once a day. Sometimes, that might be the only visitor who comes all day or all week, so it’s very meaningful.

I hope that understanding some of my concerns around home safety and around nutrition are helpful for you as you think about living with dementia at home alone for yourself or for a loved one. Next week, we’ll cover things like finances, medications, and we’ll think a little bit more about that loneliness, isolation, and boredom problem that’s so prevalent these days.

Thanks again for watching our videos. Please hit the subscribe button, if you wouldn’t mind, and I’ll see you all next week.

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