When caring for a person with dementia, safety can become a concern, especially as the dementia progresses. Because challenging behaviors can be unpredictable, a safety plan is recommended. Caregivers must (1) think prevention, (2) adapt the environment, and (3) minimize dangers (ADEAR 2015).
Elements of a Safe Environment
Safety is the ability to keep a person safe from harm. A safe environment is one in which a person is protected from anything that is likely to cause injury. Facilities that serve people with dementia must have safety policies and procedures in place that include a systematic, explicit, and comprehensive process for managing safety risks that provides for goal setting, planning, and measurement of performance (National Safety Council, 2015).
Safety in an Adult Day Care Center
Safety is a joint responsibility, shared by center operators, managers, healthcare workers, and volunteers. Safety policies and procedures must cover environmental safety, infection prevention, emergency procedures, handling of hazardous materials and chemicals, and creation of a disaster plan. The building’s design must include safety features such as grab bars, ramps, wandering paths with ample seating, standing stations for exercise and stretching, and features that encourage independence while also ensuring safety.
Because specialized adult day care centers have clients with cognitive decline, safety policies and procedures must take into account needs and behaviors unique to a clientele with dementia. This means the center must have safety policies that address wandering, falls, aggressive behaviors, swallowing disorders, food preferences, and transportation safety, as well as staff training in these areas.
Day care centers can provide a feeling of safety for family members. In a Norwegian study involving 17 family caregivers of people with dementia who attended an adult day care program, caregivers described the center as a service that represented something safe and routine for the person with dementia (Tretteteig et al., 2017). Adult day care centers also provide training about safety in the home.
Technologies Related to Safety
For people with dementia, technologies related to safety can be something as simple as a grab-bar or a safety razor. In a healthcare center as well as in the home, safety technologies might include rails, barriers, alarms, gait belts, non-skid surfaces, comfortable seating systems, walkers, canes, and wheelchairs.
Computer-based technologies are increasingly being used to address safety concerns. Cameras, global positioning devices, text messaging, and wearable electronic devices that alert caregivers when a person is trying to leave a designated safe area can be useful.
Usability and Acceptance of Safety Technologies
For safety technologies to be useful they must be used—and for older adults with dementia, usability and acceptability are key issues. Usability is the level at which a device can assist users without interfering with their normal activities of daily living (Abbate et al., 2014). In the context of dementia care, acceptability is the degree to which a technology is pleasing and agreeable to the user. Usability and acceptability are related to:
- Willingness to use
- Ease of learning
- Time to accept
- Willingness to keep
- Number of errors due to incorrect interactions
- Level of satisfaction
- Interference with activities of daily living (Abbate et al., 2014)
Despite the sophistication of healthcare technologies, little effort has been made to assess their usability and acceptability before deployment. To be useful, the design of safety devices must follow the users’ needs, fears, mental models, self-learning ability, social behavior, lifestyle, and fashion tastes (Abbate et al., 2014).
Monitoring Wandering with a GPS Device
Wandering outside the home can put a person at risk of exploitation and injury and cause caregiver stress and anxiety. Often, however, the person does not wander far from home, may be in familiar territory, can find their way home, and may be at relatively low risk. Locking people inside a home or facility must be balanced against the potential benefits of physical exercise, social contact, informal supervision by neighbors and local shopkeepers, and the perception of autonomy afforded by “safe walking” (Milne et al., 2014).
One possible intervention to support safe walking is the use of electronic location devices such as Global Positioning System (GPS) navigation. In theory these devices can provide the exact coordinates of a person carrying a GPS device. Safe areas and times can be set up that allow the person to move around through familiar areas but will set off an alert if a geo-temporal limit (or “geo-fence”) is breached. Additional services such as an operator to phone the person and using GPS to guide them home have also been described (Milne et al., 2014).
GPS Program in Edinburgh, Scotland
In a small observational study in and around Edinburgh, Scotland, 12 caregiver/client pairs were given GPS devices, half of which set up “geo-fences” to alert the caregiver when the person with dementia left an area considered to be safe. In follow-up interviews, perceptions from caregivers and the people with dementia were generally positive:
- Participants said that walking was important and should be continued if possible.
- Caregivers said they felt reassured by having the GPS locator.
- Three participants expressed concern about being reminded of their condition and feeling watched but when interviewed at follow-up one person said she had come to feel reassured by the GPS.
- Some caregivers and care workers stated that without the GPS they would have had to limit the person’s freedom (Milne et al., 2014).
A view of Edinburgh, Scotland from Blackford Hill. Source: Kim Traynor by permission.