Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Although a number of behavior and sensory problems may accompany Alzheimer's
disease, not every person will experience the disease in exactly the same way.
As the disease progresses, particular behavioral changes can create safety
problems. The person with Alzheimer's may or may not have these symptoms.
However, should these behaviors occur, the following safety recommendations may
help reduce risks.
Remove clutter and clear the pathways from room to room to prevent falls
and allow the person with Alzheimer's to move about more freely.
Make sure floors provide good traction for walking or pacing. Use nonskid
floor wax or leave floors unpolished. Secure all rug edges, eliminate throw
rugs, or install nonskid strips. The person with Alzheimer's should wear nonskid
shoes or sneakers.
Place locks high or low on exit doors so they are out of direct sight.
Consider installing double locks that require a key. Keep a key for yourself,
and hide one near the door for emergency exit purposes.
Use loosely fitting doorknob covers so that the cover turns instead of the
actual knob. Due to the potential hazard they could cause if an emergency exit
is needed, locked doors and doorknob covers should be used only when a caregiver
Install safety devices found in hardware stores to limit how much windows
can be opened.
If possible, secure the yard with fencing and a locked gate. Use door
alarms such as loose bells above the door or devices that ring when the doorknob
is touched or the door is opened.
Divert the attention of the person with Alzheimer's disease away from using
the door by placing small scenic posters on the door; placing removable gates,
curtains, or brightly colored streamers across the door; or wallpapering the
door to match any adjoining walls.
Place STOP, DO NOT ENTER, or CLOSED signs on doors in strategic areas.
Keep shoes, keys, suitcases, coats, hats, and other signs of departure out
Obtain a medical identification bracelet for the person with Alzheimer's
with the words "memory loss" inscribed along with an emergency telephone number.
Place the bracelet on the person's dominant hand to limit the possibility of
removal, or solder the bracelet closed. Check with the local Alzheimer's
Association about the Safe Return program.
Place labels in garments to aid in identification.
Keep an article of the person's worn, unwashed clothing in a plastic bag to
aid in finding someone with the use of dogs.
Notify neighbors of the person's potential to wander or become lost. Alert
them to contact you or the police immediately if the individual is seen alone
and on the move.
Give local police, neighbors, and relatives a recent photo of the person
with Alzheimer's, along with the person's name and pertinent information, as a
precaution should he or she become lost. Keep extra photos on hand.
Consider making an up-to-date home video of the person with Alzheimer's
Do not leave a person with Alzheimer's who has a history of wandering
Lock up all dangerous or toxic products, or place them out of the person's
Remove all old or spoiled food from the refrigerator and cupboards. A
person with Alzheimer's may rummage for snacks but may lack the judgment or
taste to rule out spoiled foods.
Simplify the environment by removing clutter or valuable items that could
be misplaced, lost, or hidden by the person with Alzheimer's disease. These
include important papers, checkbooks, charge cards, and jewelry.
If your yard has a fence with a locked gate, place the mailbox outside the
gate. People with Alzheimer's often hide, lose, or throw away mail. If this is a
serious problem, consider obtaining a post office box.
Create a special place for the person with Alzheimer's to rummage freely or
sort (for example, a chest of drawers, a bag of selected objects, or a basket of
clothing to fold or unfold). Often, safety problems occur when the person with
Alzheimer's becomes bored or does not know what to do.
Provide the person with Alzheimer's a safe box, treasure chest, or cupboard
to store special objects.
Close access to unused rooms, thereby limiting the opportunity for
rummaging and hiding things.
Search the house periodically to discover hiding places. Once found, these
hiding places can be discreetly and frequently checked.
Keep all trash cans covered or out of sight. The person with Alzheimer's
disease may not remember the purpose of the container or may rummage through it.
Check trash containers before emptying them in case something has been
hidden there or accidentally thrown away.
Hallucinations, Illusions, and Delusions
Due to complex changes occurring in the brain, people with Alzheimer's may
see or hear things that have no basis in reality. Hallucinations involve
hearing, seeing, smelling, or feeling things that are not really there. For
example, a person with Alzheimer's may see children playing in the living room
when no children exist. Illusions differ from hallucinations because the person
with Alzheimer's is misinterpreting something that actually does exist. Shadows
on the wall may look like people, for example. Delusions are false beliefs that
the person thinks are real. For example, stealing may be suspected but cannot be
It is important to seek medical evaluation if a person with Alzheimer's has
ongoing disturbing hallucinations, illusions, or delusions. Discuss with the
doctor any illnesses the person has and medicines he or she is taking. An
illness or medicine may cause hallucinations or delusions. Often, these symptoms
can be treated with medication or behavior management techniques. With all of
these symptoms, the following environmental adaptations also may be helpful.
Paint walls a light color to reflect more light. Use solid colors, which
are less confusing to an impaired person than a patterned wall. Large, bold
prints (for example, florals in wallpaper or drapes) may cause confusing
Make sure there is adequate lighting, and keep extra bulbs handy in a
secured place. Dimly lit areas may produce confusing shadows or difficulty with
interpreting everyday objects.
Reduce glare by using soft light or frosted bulbs, partially closing blinds
or curtains, and maintaining adequate globes or shades on light fixtures.
Remove or cover mirrors if they cause the person with Alzheimer's disease
to become confused or frightened.
Ask if the person can point to a specific area that is producing confusion.
Perhaps one particular aspect of the environment is being misinterpreted.
Vary the home environment as little as possible to minimize the potential
for visual confusion. Keep furniture in the same place.
Avoid violent or disturbing television programs. The person with
Alzheimer's may believe a story is real.
Do not confront the person with Alzheimer's who becomes aggressive.
Withdraw and make sure you have access to an exit as needed.
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 12/5/2013