Basic Risk Assessment: Promoting Safety in the Home After a Dementia Diagnosis

Some articles that I’ve come across seem to suggest that, as soon as a person is diagnosed with dementia, they need to be wrapped in cotton wool and protected from all types of harm immediately.   Yet this is not the case.  What is hazardous for one person may present little risk for someone else at a given point on their respective dementia journeys.    There are factors intrinsic to the person,  what they do in their daily lives and their particular home environment.   Of course these will change with time.  Here are some of the things to consider when thinking about risk.     Hopefully these will help you pinpoint where difficulties lie on an ongoing basis.  This can be your starting point for finding solutions, with the help of professionals if appropriate, that achieve a balance between safety and a person’s desire to maintain their normal lifestyle.
The Person
Person related factors may be lifelong, result from other conditions or be directly related to their dementia.
  • Consider their physical health:  both short term illness and longer chronic conditions may have an impact on mobility, dexterity, range of movement and activity tolerance?
  • Is a person more able at certain times of the day?
  • Does pain impact on what they can do?
  • Think about the  existence or absence of sensory impairment
  • Is the person likely to forget things that might impact on safety?
  • Are they able to pay attention and concentrate?
  • Can they react and adapt to changes in their environment in a timely manner?
  • Would they be able to respond appropriately in an emergency?
  • Can they adequately assess risks?
  • Do they have insight into their limitations?
  • Do they smoke?
  • Do they drink excessively or take mind altering drugs?
  • Does their medication affect their safety?
  • Will they accept necessary changes to minimise risk?  Does their reluctance to compromise create unacceptable risks?
Activities in the Home
  • What does a person do, regularly on a day to day basis and more occasionally?
  • Who supports them to engage in activities in the home and in what way?  Is the help that they receive adequate to keep them safe?
  • What is their particular skill set and levels of accomplishment in what they do?
  • Are some of the activities that they engage in more hazardous than others in their own right?
  • Does a person’s life history predispose them to doing things that are viewed as generally more dangerous occupations?
  • Are there particular things that they do that they might value more than others where they might take more risks to continue engagement?
  • Who are the other people in the home and what are their usual occupations?
  • Has the person taken on roles that are less familiar to them, for example, in caring for a partner who is physically or cognitively impaired themselves?
The Environment
  • Does the flooring present a trip hazard?  Are their areas that are uneven or slippery underfoot?  Do carpets or rugs have pattern which may be confusing from a visuo-spatial perspective and thus increase the risk of falls?
  • Are they able to adequately secure their home to keep themselves and their possessions safe?  Remember the level of security may depend on geographical location. In some rural areas it is still usual to keep doors unlocked or open.    Is the person particularly vulnerable because they are unable to judge who it is safe to let into their home?
  • Are smoke and carbon monoxide detectors fitted?  Who maintains these?  Is the person aware of what to do in a real emergency or when there is a false alarm?
  • Are there rails and aids to facilitate mobility?  Where this are fixed are they attached safely?
  • Are disability aids fit for purpose and being used in a safe manner?
  • Can they maintain their hygiene safely?
  • Do general levels of cleanliness pose any risks to health?
  • Can they call for assistance if needed?
  • Is general and task lighting adequate?
  • Are there any weapons in the home?
  • Is their a risk of flooding from taps that are not turned off and plugs left in sinks.
  • What are the sources of heat?  Is the person able to control these?  Are there items such a hot water bottles, non thermostatically controlled showers or open heat sources that could cause burns or scalds?
  • Are gas and electrical appliances safe?  Is there old or damaged equipment that could pose a greater hazard?  Do devices have safety cut out?  Are there overloaded sockets or trailing leads?
  • Is food stored hygienically?
  • Do potentially harmful substance such as medication, toiletries, cleaning and laundry products, alcoholic drinks and fertilisers need safe storage?
  • Are chairs and beds at a height where a person can transfer safely?
  • Is there damaged or broken items that might pose an increased risk?
  • Do they have to negotiate or climb over clutter to do everyday tasks?
  • Can a person open, shut and lock windows and doors as required?

Leave a Comment