Safety at home & driving

Wandering is common in dementia and it is genuinely dangerous — people are found injured, or not found in time. It can happen the very first time, without warning, to someone who has never done it before. Prepare before you think it applies to you.

Prepare now, today

• Keep a current photo on your phone and printed. Update it every few months.
• Get identification onto the person — an engraved bracelet or necklace worn all the time, and a card in every coat pocket and wallet with their name, "memory impairment" and your number. Labels sewn into coats work too.
• Ask local police about a vulnerable-person or safe-return registry. Many departments run one; registering in advance speeds everything up.
• Write a one-page sheet now: photo, description, medical conditions, medicines, former addresses and workplaces, favourite places, your contact numbers. Keep copies by the door.
• Tell the neighbours. A quiet word with two or three people nearby is one of the most effective safety measures there is.

Reduce the chance of it happening

• Work out the reason. Looking for the toilet, trying to get to work, bored, in pain, escaping noise. Fixing the reason beats blocking the door.
• Build a long daily walk into the routine.
• Note the time of day it tends to happen and put something in that slot.
• Put clear picture signs on the bathroom, bedroom and kitchen doors.
• Place locks high or low, out of the normal line of sight, and add a bell or chime to outside doors.
• Keep car keys, coats and shoes out of view if leaving is triggered by seeing them.
• Camouflage the front door with a curtain, or a dark mat that can read as a hole.
• Consider a pressure mat or door sensor that alerts you at night.

Never lock a person with dementia alone in a house. A door they cannot open is a fire trap, and it is unlawful in many places. Supervision and alerts, not imprisonment.

Falls are the biggest cause of injury. Start there.

Falls

• Remove or tape down every loose rug. Clear the walking routes.
• Grab bars beside the toilet and in the shower. Towel rails are not grab bars.
• Non-slip mats in the bath and shower; a shower chair.
• Handrails on both sides of the stairs, and a contrasting strip on the edge of each step.
• Bright, even light everywhere. Older eyes need far more light, and shadows get misread.
• Night lights along the route from bed to bathroom.
• Get their eyes and ears tested. Get the shoes right — proper shoes, not slippers.
• Ask the doctor to review medicines for ones that cause dizziness.

Kitchen

• Fit an automatic shut-off on the cooker, or remove the knobs, or turn off the supply when not in use.
• Lock away cleaning products, and anything in a bottle that could be drunk.
• Remove or lock up sharp knives when supervision is not possible.
• Check the fridge weekly for food that has gone off.
• Use a kettle and appliances that switch themselves off.

Bathroom and water

• Turn down the maximum water temperature at the heater — scalds happen because hot water feels different when sensation and judgement are impaired.
• Remove door locks, or fit ones you can open from outside.
• Never leave someone alone in a bath.

General

• Working smoke alarms on every floor, tested monthly. A carbon monoxide alarm too.
• Lock up tools, chemicals, and anything in the garage or shed.
• Remove or secure firearms — see below.
• Keep a list of emergency numbers in large print by the phone.
• Give a spare key to a trusted neighbour.
• Do not rearrange the furniture. Familiarity is itself a safety feature.

An occupational therapist can do a home safety assessment and will spot things you have stopped seeing. Ask the doctor for a referral — it is often covered.

Driving is rarely about driving. It is about independence, adulthood and not being managed. Expect it to be hard, and separate the two issues: can they still drive safely, and how will they get around afterwards.

Signs it is time to stop

• Getting lost on familiar routes.
• New dents and scrapes on the car, or on the garage.
• Drifting between lanes, or driving far too slowly.
• Confusing the brake and the accelerator.
• Missing signs, signals or stop lines.
• Other drivers reacting to them.
• Getting angry or badly flustered behind the wheel.
• You would not put a child in the car with them. That one is usually decisive.

How to handle it

• Have the conversation early, before it is urgent, and agree how you will both know it is time. A written agreement made at diagnosis is much easier to invoke later.
• Get an independent driving assessment. Occupational therapists with driver rehabilitation training do these. A verdict from a stranger with a clipboard lands far better than one from a family member.
• Let the doctor be the one to say it. Ask them to raise it directly. Many are willing, and some states require reporting.
• Check your state's rules on reporting a medically unsafe driver — the licensing authority's website will say.
• Solve the transport problem first. Who drives them to the shop, the church, the appointment? Losing the car is losing a life, unless something replaces it.

If they will not stop

• Keep the keys somewhere else.
• Ask a mechanic to disable the car, or remove the battery.
• Sell the car, or park it somewhere else entirely — out of sight works better than argument.
• Report to the licensing authority if it comes to that. It is a horrible thing to do and it is the right thing to do.

This is one of the hardest conversations in dementia caregiving, and it frequently takes several attempts. The helpline at 800.272.3900 can talk you through how to approach it.

• Take over the medicines earlier than feels necessary. Double doses and missed doses both cause real harm, and this is one of the first things to go.
• Use a weekly pill organiser filled by you, or ask the pharmacy for blister packs made up by date.
• Keep the bottles locked away between doses.
• Use one pharmacy for everything, so someone is checking for interactions.
• Take every medicine — including over-the-counter ones, supplements and eye drops — to each appointment, in a bag.
• Ask the doctor or pharmacist at least once a year: "is anything on this list making the confusion worse, and is anything here no longer needed?" Several common medicines can worsen thinking in older adults.
• Keep the poison control number to hand, and call 911 if you suspect an overdose.

Never start, stop or change a dose on your own, and never act on dosing information from a website — including this one. We deliberately do not list doses anywhere on this site. That belongs with the prescriber.

If there is a gun in the house, deal with it early and calmly, the same way you would deal with driving. Impaired judgement, confusion about who a family member is, and the raised rate of depression after a dementia diagnosis together make this a serious risk to everybody in the household.

• Best option: move firearms out of the home entirely, to a relative or a storage facility.
• If they stay, lock them unloaded in a safe, with ammunition locked separately, and the caregiver holding the only keys or combination.
• Handle it as part of a general safety review rather than a confrontation about one object.
• Ask the doctor to raise it — clinicians are increasingly expected to.

Location trackers, door sensors, fall detectors and wearables can genuinely help — particularly for wandering. Two honest caveats before you buy one.

• A device is not supervision. It tells you afterwards. It does not stop anything.
• Think about dignity and consent. Where the person can still understand the question, ask them. Most people accept a tracker when the alternative is explained. Covert monitoring of someone who can still consent is a decision worth being uncomfortable about.

We list monitoring devices, with each one's FDA status and the evidence behind it, on our digital health tools page. We recommend none of them, because most have little evidence that they change an outcome. Some consumer wearables are sold for "brain health", but the studies we hold show only that people can wear them and that some readings line up with memory scores at a single point in time.

Call 911 now if:

• Someone is missing and a short search has not found them.
• There has been a fall with a head injury, or they cannot get up.
• Anyone is in immediate danger.
• There are signs of a stroke — sudden weakness or drooping on one side, sudden trouble speaking, sudden severe headache.
• You suspect an overdose or poisoning.

Call the doctor today if:

• Confusion has got much worse over hours or a couple of days.
• There is a fever, pain, or a change after starting a new medicine.
• They have stopped eating or drinking.
• A new behaviour has appeared suddenly.

Call the helpline, 800.272.3900, when:

• You do not know what to do next.
• You are frightened — of them, or of yourself.
• It is 3am and you need a human being.