Geriatric Medicine Book

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Home Adaptations for the Elderly

Aka: Home Adaptations for the Elderly, Home Modifications for Older Patients, Home Modifications for Hearing Impaired Patients, Home Modifications for Vision Impaired Patients, Home Adaptations for Dementia, Home Modifications for Patients with Dementia, Fall Prevention with Home Adaptation
  1. See Also
    1. Fall Prevention
    2. Assistive Devices
    3. Dementia No-fail Environment
  2. Management: General Measures
    1. Improve lighting in home
    2. Maintain clear walkways in the home (remove clutter and obstructions)
    3. Install grab bars
    4. Eliminate throw rugs
  3. Management: Bathroom
    1. Fall Prevention
      1. Install grab rails in bath, shower and near toilet
      2. Install handheld shower and tub chair or bench
      3. Remove rugs and install non-skid surfaces (safety mat) in bath and shower
    2. Injury Prevention and accessibility modifications
      1. Raise toilet seat or commode to higher level
      2. Replace glass shower doors with plastic or curtains
    3. Low Vision
      1. Grooming mirror that can be maneuvered for close patient access
      2. Install night lights and specific task lighting
    4. Low hearing
      1. Spring-loaded faucets (or motion detectors)
    5. Additional measures if cognitive Impairment or Dementia
      1. Place sign clearly denoting bathroom and leave door open
      2. Remove electrical appliances
      3. Remove or reverse the door locks (keep keys readily accessible)
  4. Management: Bedroom
    1. Fall Prevention
      1. Offer bedside commode
      2. Offer hospital bed
      3. Consider hospital bed and lower bed to floor level (if patient falls out of bed)
    2. Low Vision
      1. Add night lights
    3. Cognitive Impairment or Dementia
      1. Use baby monitor to monitor patient activities
      2. Remove carpeting if uncontrolled Incontinence
  5. Management: Car
    1. Cognitive Impairment or Dementia
      1. Disable vehicle (e.g. disconnect battery) or remove vehicle from premises
      2. Hide garage door opener and car keys
      3. Alert local police to patient's Dementia and no driving restriction
  6. Management: Fire, Burn and Electrocution Prevention
    1. Injury Prevention and accessibility modifications
      1. Apply firefighter sticker to bedroom window
      2. Practice fire drills
      3. Install smoke alarms
      4. Restrict smoking
      5. Replace bedding with fire retardant materials
      6. Do not use space heaters
    2. Cognitive Impairment or Dementia
      1. Remove lighters, matches and other items that can serve as fire source
      2. Alert fire department to patient's Dementia status
      3. Childproof electrical outlets
      4. Cover radiators
      5. Reduce hot water heater Temperature to 120 degrees (or install scald-proof faucets)
    3. Hearing Loss
      1. Fire alarms and other security alarms which trigger bright strobe lights, extra-loud alarms, pagers and bed or pillow shakers
  7. Management: Kitchen
    1. Injury Prevention and accessibility modifications
      1. Use electric stoves (or gas stoves should have auto pilot lights)
    2. Low Vision
      1. Install strip lighting under cabinets
    3. Cognitive Impairment or Dementia
      1. Install hidden stove shut-off valve, lock oven door, remove stove knobs and cover stove Burners
      2. Consider locks on cabinets, refrigerator and freezer (including small non-food items with risk of ingestion)
      3. Disable garbage disposal and secure garbage out of patient's access
      4. Lock away glass, knives and other hazards
      5. Unplug and lock away electrical appliances
  8. Management: House access, outdoors and yard
    1. Cognitive Impairment or Dementia
      1. Fence off high risk areas (water bodies, busy streets, embankments)
      2. Remove poisonous plants
      3. Lock away yard equipment (shears, spades, tools, mowers, weed wackers, Pesticides)
      4. Install door alarms
      5. Install double key locks
      6. Install spring-loaded door closers
    2. Low Vision
      1. Yellow or amber tinted lenses reduce glare (also consider hat visor or brim)
      2. Install bright lights at exterior doors (with motion and sound detection)
      3. Install lighted keyholes and doorbells
    3. Hearing Loss
      1. Doorbells and intercoms with visual indicators (flashing lights), volume controls, and multiple receivers
      2. Vibration sensors at front door can alert patients of door knocking
  9. Management: Stairs
    1. Fall Prevention
      1. Install hand railings on both sides of the stairs
      2. Install tread on stairs to prevent sliding
    2. Injury Prevention and accessibility modifications
      1. Consider low grade ramp in place of stairs
    3. Low Vision
      1. Apply contrasting color at the edge of stair treads
      2. Keep halls and stairways well lit
    4. Cognitive Impairment or Dementia
      1. Consider barrier gates at the top and bottom or stairs
  10. Management: Miscellaneous
    1. Fall Prevention
      1. Consider occupational therapy home evaluation
      2. Remove hazardous furniture (free-standing fans, high back chairs, pedestal tables, furniture on wheels)
      3. Remove rugs that lack non-skid backing (or anchor rugs)
      4. Install flush door threshold
      5. Remove clutter, exposed wire, or cord
    2. Low Vision
      1. Remove protruding cabinet hardware
      2. Opt for incandescent lighting over fluorescent lighting
      3. Light switches should have distinctive on and off settings (avoid dimmer switches)
      4. Use blinds to control light and secondary glare
      5. Thermostats, telephones and appliances should have large lettering on a contrasting background
    3. Hearing Loss
      1. Activate close captioning on television as well as amplifiers on television and radio
      2. Improve room acoustics (e.g. acoustic tiles)
      3. Adaptive equipment for telephones
      4. Watches with vibrating alarms
    4. Cognitive Impairment or Dementia
      1. Lock away potenital poisons (cleaning supplies, poisons, extra medications)
      2. Cover shiny or reflective surfaces (including mirrors if induce Hallucinations)
  11. Prevention: Emergency Preparation
    1. First-aid kit
    2. Legal documents (e.g. POLST)
    3. Emergency phone numbers programmed into phone on speed dial and listed by phone (Police, Fire, Doctor)
    4. Up-to-date list of medications and past medical history
    5. Medic-alert bracelet as well as identification
    6. Give house key to neighbors
  12. Resources
    1. NIH Publication 02-5179
      1. http://www.nia.nih.gov/alzheimers/publication/home-safety-people-alzheimers-disease/home-safety-room-room
  13. References
    1. (2017) Presc lett 24(4): 21

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