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Chapter 14: Safety and Home Modifications

Introduction

Creating a safe home environment is one of the most important responsibilities in dementia care. As cognitive abilities decline, the person with dementia becomes more vulnerable to accidents, injuries, and potentially dangerous situations. What was once a familiar, comfortable home can become filled with hazards.

This chapter provides comprehensive guidance on assessing safety risks and implementing practical modifications that reduce dangers while preserving independence and dignity. You'll learn how to prevent falls, manage wandering, ensure medication safety, and prepare for emergencies—all while creating an environment that feels like home, not an institution.

The Balance: Safety modifications must balance risk reduction with quality of life. The goal isn't to eliminate all risk (impossible) but to create reasonable safety while allowing the person to live as normally as possible.

The Importance of Home Safety in Dementia Care

Why Safety Matters:

  • Injury prevention: People with dementia are at higher risk for falls, burns, poisoning, and other accidents
  • Supports independence: A safe environment allows the person to move freely without constant supervision
  • Reduces caregiver stress: Knowing the home is safe provides peace of mind
  • Prevents hospitalization: Many accidents are preventable with proper modifications
  • Maintains dignity: Safety measures allow the person to remain at home longer
  • Protects from wandering risks: Secure environment prevents dangerous exits

Risk Factors Increase Over Time:

  • Cognitive impairment: Poor judgment, forgetting safety rules, not recognizing hazards
  • Physical changes: Balance problems, slower reflexes, vision changes, gait instability
  • Behavioral changes: Wandering, agitation, impulsivity
  • Medication effects: Some medications increase fall risk

1. Fall Prevention

Falls are the leading cause of injury among older adults with dementia. People with dementia are 2-3 times more likely to fall than those without cognitive impairment.

Why Falls Occur in Dementia

Cognitive Factors: - Poor judgment about abilities - Forgetting to use assistive devices - Disorientation - Impaired spatial awareness - Not recognizing hazards

Physical Factors: - Balance and gait problems - Muscle weakness - Vision changes - Slower reflexes - Medication side effects (sedation, dizziness, orthostatic hypotension)

Environmental Factors: - Clutter and obstacles - Poor lighting - Slippery floors - Loose rugs - Uneven surfaces - Lack of handrails

Comprehensive Fall Prevention Strategies

Remove Tripping Hazards: - Remove or secure all throw rugs and mats - Eliminate clutter from walkways - Remove low furniture (ottomans, coffee tables) - Secure or remove electrical cords across walkways - Keep floors clear of objects - Remove pets' toys and bowls from walkways - Ensure carpet edges are tacked down

Footwear: - Well-fitting shoes with non-slip soles - Low or no heel - Avoid flip-flops, backless slippers, or socks alone - Consider non-slip slipper socks for indoor use - Shoes should support ankles

Bathroom Safety: - Install grab bars (see Grab Bars section) - Use non-slip mats in tub/shower - Consider shower chair or bench - Raised toilet seat - Keep floor dry at all times - Night light for nighttime bathroom visits

Bedroom Safety: - Bed at appropriate height (feet touch floor when seated) - Clear path from bed to bathroom - Night light - Keep essentials within reach to avoid getting up - Consider bed rails if appropriate (can be hazard if person tries to climb over)

Stairway Safety: - Handrails on both sides - Non-slip treads or carpet secured - Remove items stored on stairs - Adequate lighting at top and bottom - Consider gate if person shouldn't use stairs unsupervised - Mark edge of steps with contrasting tape

Furniture Arrangement: - Sturdy furniture that won't tip if leaned on - Remove furniture with wheels - Ensure clear, wide pathways - Remove glass tables (risk if fall on them) - Furniture at appropriate height for easy sitting/standing

Lighting (see Adequate Lighting section): - Eliminate shadows and dark areas - Install night lights in bedroom, bathroom, hallways - Keep flashlight by bed - Automatic lights for nighttime navigation

Vision Support: - Regular eye exams - Keep eyeglasses clean and accessible - Ensure prescription is current - Adequate lighting everywhere

Physical Exercise: - Regular walking or supervised exercise - Balance exercises (with physical therapist) - Strength training - Tai chi (shown to improve balance)

Medication Review: - Review all medications with doctor - Some medications increase fall risk (sedatives, blood pressure meds, pain medications) - Avoid unnecessary medications - Take medications with food if they cause dizziness

Assistive Devices: - Walker or cane if recommended - Ensure proper fit and training - Keep assistive device within reach - Gait belt for transfers (see Chapter 12)

Supervision and Assistance: - Supervise during high-risk activities (bathing, toileting, stairs) - Be present during transitions (sitting to standing) - Offer arm for stability during walking - Don't rush movements

What to Do If a Fall Occurs

Immediate Response: 1. Stay calm 2. Ask if they're hurt before moving them 3. Check for bleeding, pain, deformity 4. If injured, call 911 5. If not injured, help them up slowly (see below) 6. Monitor for 24-48 hours for delayed symptoms

Helping Someone Up After a Fall: 1. Bring a sturdy chair to them 2. Have them roll onto their side 3. Help them to hands and knees 4. Place chair in front of them 5. Have them use chair to pull up to kneeling 6. Put stronger leg forward 7. Help them stand using chair for support 8. Sit them in chair to rest and assess

After a Fall: - Document what happened - Try to determine cause - Make environmental changes to prevent recurrence - Inform doctor (fall may indicate infection, medication issue, or stroke) - Reassess safety throughout home

Fall Risk Assessment

Regularly assess fall risk by considering: - History of falls - Gait and balance problems - Medications that increase fall risk - Vision problems - Orthostatic hypotension (dizziness when standing) - Environmental hazards - Cognitive impairment level

2. Home Safety Assessment

A systematic home safety assessment identifies hazards before accidents occur. Conduct an assessment every 6 months or whenever the person's abilities change.

Room-by-Room Safety Assessment

Entry and Exits: - ☐ Pathways clear and well-lit - ☐ Handrail at entrance steps - ☐ Non-slip mat at door - ☐ Locks secure but manageable for emergencies - ☐ Door locks modified if wandering is a concern - ☐ Doorbell works - ☐ Address clearly visible for emergency responders

Living Room: - ☐ Furniture stable and arranged for easy navigation - ☐ No throw rugs or secured with non-slip backing - ☐ Electrical cords secured and out of pathways - ☐ Adequate lighting - ☐ Remote controls simplified and accessible - ☐ Fireplace blocked or supervised - ☐ Sharp-edged furniture removed or padded - ☐ Stairs gated if appropriate

Kitchen: - ☐ Stove safety measures in place (see Stove Safety section) - ☐ Sharp knives stored safely or removed - ☐ Cleaning products locked away - ☐ Non-slip mats at sink - ☐ Step stool removed (climbing hazard) - ☐ Automatic shut-off kettle - ☐ Microwave at safe height - ☐ Fire extinguisher accessible - ☐ Smoke detector working - ☐ Expired food removed regularly

Bathroom: - ☐ Grab bars installed - ☐ Non-slip mats in tub/shower and on floor - ☐ Shower chair or bench if needed - ☐ Raised toilet seat if appropriate - ☐ Medications secured (see Medication Management) - ☐ Electrical appliances unplugged and stored - ☐ Water temperature controlled (120°F/49°C maximum) - ☐ Lock removed from door or ability to open from outside - ☐ Adequate lighting - ☐ Night light

Bedroom: - ☐ Bed at appropriate height - ☐ Clear path to bathroom - ☐ Night light - ☐ Phone accessible - ☐ Clutter-free - ☐ Smoke detector working - ☐ Window locks secure

Stairways and Hallways: - ☐ Handrails on both sides - ☐ Non-slip treads - ☐ Adequate lighting with switches at top and bottom - ☐ Clutter-free - ☐ Step edges marked with contrasting tape - ☐ Gates installed if appropriate

Garage/Basement/Attic: - ☐ Access restricted if unsafe - ☐ Chemicals, tools, and hazardous materials locked away - ☐ Adequate lighting - ☐ Car keys removed/secured - ☐ Garage door opener secured

Outdoor Areas: - ☐ Pathways clear and even - ☐ Adequate lighting - ☐ Handrails where needed - ☐ Steps marked clearly - ☐ Hose and tools stored safely - ☐ Pool secured with fence and locked gate - ☐ Garden tools and chemicals locked away - ☐ Gates and fences secure to prevent wandering

General Safety Considerations

Temperature Control: - ☐ Thermostat accessible to caregiver but potentially locked - ☐ Water heater set to safe temperature (120°F/49°C) - ☐ Space heaters removed (fire hazard) - ☐ Adequate heating and cooling

Fire Safety: - ☐ Smoke detectors on every level, in bedrooms - ☐ Carbon monoxide detectors installed - ☐ Test detectors monthly - ☐ Fire extinguisher in kitchen - ☐ Escape plan established and practiced - ☐ Matches and lighters secured - ☐ Candles removed - ☐ Cigarettes/smoking materials secured

Electrical Safety: - ☐ Outlets covered or with safety plugs - ☐ Extension cords in good condition and not overloaded - ☐ Appliances unplugged when not in use - ☐ Circuit breakers labeled

Weapons and Dangerous Items: - ☐ Guns secured or removed from home - ☐ Ammunition stored separately and locked - ☐ Sharp objects (knives, scissors, razors) secured - ☐ Power tools secured or removed

Communication: - ☐ Phone easily accessible - ☐ Emergency numbers posted prominently - ☐ Medical alert system functional (see Medical Alert Systems) - ☐ Cell phone charged and accessible

Using a Safety Assessment Checklist

How to Conduct Assessment: 1. Walk through entire home with checklist 2. Get down to the person's eye level (seated or standing with walker) 3. Look for hazards from their perspective 4. Consider their specific impairments (vision, balance, judgment) 5. Involve occupational therapist for professional assessment 6. Prioritize highest-risk areas (bathroom, stairs, kitchen) 7. Make changes incrementally to avoid overwhelming the person

When to Reassess: - Every 6 months - After any fall or accident - When abilities decline noticeably - When new behaviors emerge (wandering, agitation) - After hospitalization - When moving to new residence

3. Grab Bars

Grab bars provide crucial support and stability, especially in bathrooms where most falls occur. Properly installed grab bars can prevent falls and provide confidence.

Types of Grab Bars

Permanent Grab Bars: - Screwed into wall studs or blocking - Most secure option - Various lengths (12" to 48") - Straight, angled, or L-shaped - Weight capacity typically 250-500 lbs

Temporary/Suction Grab Bars: - Attach with suction cups - Portable (good for travel) - NOT recommended for primary support (can fail) - Only suitable for light support - Must be on smooth, non-porous surface

Floor-to-Ceiling Grab Bars: - Tension-mounted between floor and ceiling - No drilling required (good for rentals) - Less secure than wall-mounted - Can work if ceiling is sturdy

Tub and Toilet Rails: - Clamp onto edge of tub or toilet - Tool-free installation - Provides support for specific transfers - Weight capacity usually 250-300 lbs

Where to Install Grab Bars

Bathtub/Shower: - Vertical bar on wall at entry: For balance when stepping in - Horizontal bar on back wall: 33-36" from floor, for support while standing - Horizontal bar on side wall: For sitting/standing from shower chair - Angled bar: 45° angle from low to high, helps with sitting and standing

Toilet: - One bar on each side: 33-36" from floor, 1.5 feet long minimum - Fold-down bar: If space is limited - Toilet safety frame: Standalone option that clamps to toilet

Bedroom: - Near bed if person has difficulty with transfers - Consider bed rail instead

Hallways: - Along long hallways if balance is poor - Continuous handrail from bedroom to bathroom

Stairs (see Handrails section): - Both sides of stairs - Extends beyond top and bottom steps

Proper Installation

Critical Installation Guidelines: - MUST be installed into wall studs (studs are typically 16" apart) - If stud isn't in right location, install blocking between studs - Never install into drywall alone (will pull out under weight) - Use screws, not drywall anchors (anchors can fail) - Install at proper height (typically 33-36" from floor) - Ensure grab bar is level - Test installation by pulling with full body weight

Installation Steps: 1. Locate wall studs using stud finder 2. Mark installation height (33-36" from floor) 3. Hold bar in place and mark screw holes 4. Drill pilot holes into studs 5. Attach bar with screws provided (usually 2-3 inches long) 6. Tighten securely 7. Test by pulling hard

When Studs Aren't Available: - Install backing board (plywood) between studs during renovation - Use blocking between studs - Consider floor-to-ceiling pole - Hire professional installer - Use clamp-on rails for toilet/tub

Professional Installation: Recommended if: - You're not confident in DIY installation - Wall construction is unusual - Structural concerns exist - Multiple bars needed throughout home - Occupational therapist recommends specific placement

Choosing the Right Grab Bars

Considerations: - Diameter: 1.25" to 1.5" diameter is easiest to grip - Texture: Textured or ridged for better grip, especially when wet - Color: Contrasting color from wall helps visibility - Material: Stainless steel is most durable and rust-resistant - Length: Based on available space and user needs - Weight capacity: Check rating (usually 250-500 lbs)

Avoid: - Towel bars (not designed for weight-bearing, will pull out) - Soap dishes or shelves (not secure) - Suction bars as primary support (can fail)

Using Grab Bars Safely

Proper Use: - Grasp with full hand, not just fingers - Pull toward your center of gravity - Don't lean all weight on bar too far from wall - Use both hands when possible - Don't use to pull from floor (too much force, can pull out)

Teaching the Person: - Show them where grab bars are located - Practice using them when they're calm and stable - Provide verbal cues: "Hold the bar" - Ensure adequate lighting so they can see bars - Consider contrasting color for better visibility

4. Non-Slip Flooring

Slippery floors are a major fall hazard. The right flooring and treatments significantly reduce fall risk.

Best Flooring Options for Dementia Care

Good Flooring Choices:

Carpet with Low Pile: - Provides cushioning in falls - Good traction - Warmer underfoot - Should be tightly woven and secured - ❌ Avoid: High pile, shag, or loop carpets (tripping hazard, walker wheels catch)

Vinyl or Linoleum (matte finish): - Easy to clean - Water-resistant - Non-slip when dry - Good for kitchen and bathroom - ❌ Avoid: Glossy finishes (slippery)

Cork: - Naturally slip-resistant - Cushioned surface - Warm underfoot - Moisture-resistant when sealed

Rubber Flooring: - Excellent slip-resistance - Cushioned - Durable - Good for bathrooms - Can look institutional

Wood (with proper treatment): - Use matte finish, not glossy - Apply non-slip treatment - Keep clean (dust makes it slippery) - ❌ Can be slippery when wet

Flooring to Avoid: - Tile (very slippery when wet, cold, hard if they fall) - High-gloss finishes (any material) - Marble or polished stone (extremely slippery) - Loose rugs (tripping hazard) - Transitions between floor types (minimize or mark clearly)

Making Existing Floors Safer

Remove or Secure Rugs: - Remove all throw rugs if possible - If keeping rugs: Use non-slip rug pads underneath (rug pads rated for floor type) - Tape down edges with double-sided carpet tape - Use rugs with rubber backing - Still, removing is safest

Apply Non-Slip Treatments:

For Hard Floors: - Non-slip floor coatings (professionally applied) - Adhesive non-slip strips (stairs, bathroom) - Anti-slip tape (high-traffic areas) - Non-slip floor wax (matte finish)

For Tile: - Non-slip treatment products (increase surface friction) - Non-slip mats (bathroom, kitchen sink) - Consider replacing if very slippery

For Wood: - Matte finish polyurethane (not glossy) - Non-slip wax - Keep clean and dust-free

Bathroom Floor Safety

Critical Area (most falls happen here): - Install non-slip mats inside tub/shower - Non-slip mat on bathroom floor (secured, no curled edges) - Keep floor dry at all times - Wipe up water immediately - Consider textured vinyl or rubber flooring - Use bath rugs with rubber backing (or remove entirely)

Maintenance for Slip Resistance

Regular Cleaning: - Dust and debris make floors slippery - Clean up spills immediately - Use appropriate cleaners (some leave slippery residue) - Avoid wax buildup - Dry floors thoroughly after mopping

Periodic Checks: - Check rug pads for wear - Replace worn non-slip mats - Reapply non-slip treatments as needed - Check for damage to flooring - Ensure transitions are secure

Visual Considerations

Avoid Patterns That Confuse: - People with dementia may misinterpret patterns - Dark patterns may look like holes - High-contrast patterns may appear as steps - Shiny floors may look wet - Choose solid, matte colors - Use contrasting colors only at true transitions (doorways, step edges)

5. Adequate Lighting

Good lighting is essential for safety, reduces confusion, and helps with visual changes common in aging and dementia. Poor lighting increases fall risk and can increase agitation (especially in evening).

Why Lighting Matters in Dementia

Vision Changes: - Reduced ability to see in low light - Difficulty adjusting to light changes - Increased sensitivity to glare - Reduced depth perception - Cataracts common (creates cloudy vision, glare sensitivity)

Safety: - Prevents falls by making obstacles visible - Helps with depth perception (stairs, curbs) - Reduces confusion about environment - Makes grab bars and safety features visible

Behavioral Benefits: - Good lighting reduces sundowning - Eliminates frightening shadows - Reduces confusion and agitation - Helps with orientation

Principles of Good Lighting

Brightness: - Use higher wattage than typical for older adults - All areas should be well-lit, no dim corners - Light should be bright enough to read comfortably - But avoid overly bright lights that create glare

Uniformity: - Consistent light levels throughout home - Avoid sudden changes from bright to dark - Transitions (doorways, hallways) especially important - No dark corners or shadows

Eliminate Glare: - Use matte or frosted bulbs, not clear - Avoid light shining directly in eyes - Cover shiny surfaces (glass tables) - Use lampshades to diffuse light - Avoid reflective floors

Natural Light: - Open curtains during day - Natural light helps with circadian rhythm - But control to avoid glare - Use sheer curtains to diffuse bright sunlight

Lighting by Room

Hallways: - Bright overhead lighting - Motion-sensor lights for nighttime - Light switches at both ends - No shadows or dark spots - Night lights every 10-15 feet

Stairways: - Very bright lighting (highest wattage) - Light switches at top and bottom (clearly marked) - Light the entire staircase, no shadows - Consider motion-activated lights - Mark step edges with contrasting tape

Bathroom: - Bright, even lighting throughout - Light over mirror (but not creating glare) - Night light for nighttime use - Motion-activated lights good option - Avoid shadows near toilet and shower

Bedroom: - Bedside lamp within reach - Adequate overhead lighting - Night light creating path to bathroom - Light switch accessible from bed - Consider motion-activated lights for nighttime

Kitchen: - Bright overhead lighting - Under-cabinet lighting for counters - Light over stove - Good lighting at sink - Eliminate shadows in cabinets

Living Room: - Multiple light sources (no dark corners) - Task lighting for reading - Avoid glare on TV screen - Lamps accessible without reaching too far

Outdoors: - Well-lit pathways and entrances - Motion-sensor lights for security and visibility - Light steps and changes in elevation - Timer lights for evening

Types of Lighting

Overhead Lighting: - Provides general ambient light - Should be bright (higher wattage) - Use frosted bulbs or fixtures with diffusers - LED bulbs save energy and last longer

Task Lighting: - Directed light for specific activities - Reading lamps - Under-cabinet lights in kitchen - Magnifying lamps for detail work

Night Lights: - Low-level lighting for nighttime navigation - Place in bedroom, bathroom, hallway - Motion-activated versions save energy - Warm color (not blue-white which disrupts sleep)

Motion-Sensor Lights: - Automatically turn on when movement detected - Excellent for nighttime bathroom trips - Good for hallways and stairs - Can be battery-operated (no wiring needed)

Emergency Lighting: - Battery-powered lights that turn on when power fails - Keep flashlight by bed - Ensure emergency lighting in key areas

Lighting Tips and Tricks

Light Switches: - Clearly marked with labels or glow-in-the-dark tape - Place at consistent height throughout home - Rocker switches easier than toggle - Consider large, illuminated switches - Smart switches with timers or voice control

Bulbs: - LED bulbs: Energy-efficient, long-lasting, cool to touch - "Warm white" (2700-3000K) for living spaces (mimics incandescent) - "Daylight" (5000-6500K) for task lighting - Higher lumens = brighter (at least 800-1000 lumens for general lighting) - Avoid bulbs labeled "soft" or "mood" (too dim)

Automatic Timers: - Set lights to turn on before dark - Helps prevent sundowning - Provides routine - Ensures home is lit when needed

Smart Lighting: - Control with smartphone or voice - Set schedules - Motion sensors - Gradually brighten in morning (simulates sunrise) - Can be expensive but helpful

What to Avoid

  • Dimmer switches (confusing, may be set too low)
  • Bare bulbs pointing at eye level (glare)
  • Highly decorative fixtures that don't provide good light
  • Lamps with hard-to-operate switches
  • Flickering fluorescent lights (can increase agitation)

6. Door Locks

Door locks serve two important purposes: security from outside intruders and prevention of wandering. Balancing these needs requires thoughtful modifications.

Wandering: Understanding the Risk

Why People with Dementia Wander: - Searching for something (home, person, familiar place) - Following old routine (going to work) - Boredom or restlessness - Disorientation - Need for purpose or activity - Sensory seeking (wanting to be outside)

Dangers of Wandering: - Getting lost and unable to find way back - Exposure to weather (hypothermia, heat stroke) - Traffic accidents - Falls in unfamiliar areas - Dehydration - Drowning (attraction to water) - Victimization

Statistics: - 60% of people with dementia will wander - If not found within 24 hours, risk of serious injury or death increases dramatically - Wandering is a leading cause of death in dementia

Door Lock Modifications

Goals: - Prevent unsupervised exits - Maintain emergency egress (fire safety) - Reduce the appearance of "locks" that may increase agitation - Allow caregiver to enter and exit easily

Lock Options:

Slide Bolts (High or Low): - Install slide bolt at top of door (above eye level) - Or install at bottom of door (below eye level) - Person with dementia doesn't see it or forgets to look - Caregiver can easily open - ✅ Inexpensive, effective - ✅ Emergency responders can break door if needed - ❌ Not foolproof (person may discover it)

Keyed Deadbolts: - Require key to open from inside - Keep key hidden but accessible to caregiver - ✅ Very secure - ❌ Fire hazard: May trap person in emergency - ❌ Illegal in some jurisdictions - Not recommended unless you have specific key storage plan for emergencies

Childproof Doorknob Covers: - Plastic covers that spin freely on doorknob - Prevent gripping and turning knob - ✅ Inexpensive, easy to install - ✅ Caregiver can remove to open - ❌ May frustrate person - ❌ Not effective if person removes cover

Dutch Door: - Door split horizontally - Lock bottom half, open top half for air/view - ✅ Allows fresh air without exit - ❌ Expensive to install

Door Alarms: - Alarm sounds when door opens - Alerts caregiver that person is exiting - ✅ Inexpensive, easy to install - ✅ Doesn't prevent exit but gives warning - ✅ Good backup to other measures - ❌ Doesn't physically prevent wandering - Types: magnetic contact alarms, motion sensor alarms

Smart Locks: - Lock/unlock via smartphone - Can set schedules - Alert you when door opens - ✅ Convenient for caregiver - ✅ Can track door activity - ❌ Expensive - ❌ Requires tech comfort

Door Disguise: - Hang curtain over door - Paint door same color as wall - Install full-length mirror on door - Put "STOP" sign on door - ✅ Makes door less noticeable - ✅ No installation - ❌ Not effective once discovered

Handle-Style Locks (instead of knobs): - More difficult to operate than twist knobs - May slow person down - ❌ Not reliable on its own

Window Safety

Prevent Window Exits: - Window locks or stops (prevent opening more than 4-6 inches) - Keyed window locks - Window alarms - Security bars (must have quick-release for fire safety) - Keep upper-floor windows locked

Ground Floor Considerations: - Especially important for first-floor and basement windows - Person may try to exit through window if door is secured - Consider planting thorny bushes under windows (natural deterrent)

Balancing Safety and Fire Code

Critical Considerations: - Modifications MUST allow emergency egress - Caregiver must be able to quickly evacuate person in fire - Some lock types are illegal (check local fire codes) - Emergency responders must be able to access home

Recommendations: - Use locks that are quick-release for caregiver - Never use locks that trap person without caregiver intervention - Keep key immediately accessible (not hidden away) - Practice emergency evacuation - Notify fire department about situation (many have registry programs)

Beyond Locks: Reducing Wandering

Environmental Strategies: - Place "STOP" sign on door - Paint door same color as wall (camouflage) - Put scene mural on door (disguise) - Hang dark mat in front of door (may appear as hole to avoid) - Keep outdoor clothing and shoes out of sight

Activity and Engagement: - Provide meaningful activities (reduces boredom) - Regular exercise (reduces restlessness) - Establish routine - Meet needs (hunger, thirst, bathroom, comfort)

Identification and Tracking: - Medical ID bracelet with name, address, diagnosis - GPS tracking device (watch, shoe insert, pendant) - Recent photo available - Project Lifesaver or similar program - Notify neighbors (provide photo and contact info)

Safe Wandering Areas: - Fenced yard with secure gate - Walking path that loops back - Supervised outdoor time - Wandering garden

Restraint Issues: - Preventing someone from leaving can be considered restraint - Balance safety with personal freedom - Least restrictive methods preferred - Consult with doctor, lawyer, and ethics committee if concerns

When Locks Aren't Enough: - 24-hour supervision may be necessary - Consider adult day care - Respite care for breaks - Eventually, secured memory care facility may be safest

7. Stove Safety

The kitchen, particularly the stove, presents serious hazards including fire and burns. Many people with dementia forget they're cooking or don't recognize the danger.

Risks of Stove Use in Dementia

Common Dangers: - Forgetting food on stove (fire risk) - Touching hot burners (burns) - Turning on wrong burner - Putting flammable items on stove - Leaving gas on without igniting (gas leak, explosion risk) - Using inappropriate cookware (plastic, metal in microwave) - Forgetting how to use appliances - Attempting to extinguish fire improperly

Stove Safety Solutions

Disable the Stove:

Electric Stove: - Turn off circuit breaker - Remove knobs (store safely) - Unplug if possible - Install lockable cover

Gas Stove: - Turn off gas shut-off valve (behind stove or at meter) - Remove knobs - Post "DO NOT USE" sign - Have gas company turn off if needed

Stove Safety Devices:

Automatic Shut-Off Devices: - Sensors detect if stove left on too long - Automatically turns off stove - Some detect smoke or movement (if no movement near stove, shuts off) - Brands: iGuardStove, Wallflower, FireAvert - ✅ Allows continued use with safety backup - ❌ Expensive ($200-400)

Stove Knob Covers: - Cover burner knobs - Prevent unintended use - Clear covers let you see settings - ✅ Inexpensive - ❌ Person may figure out how to remove

Induction Cooktop: - Only heats when magnetic cookware present - Surface stays cool - Automatically shuts off - ✅ Safer than gas or electric - ❌ Expensive to install - ❌ Requires specific cookware

Alternative Cooking Options

When person can no longer safely use stove:

Microwave: - Simpler to use than stove - Less fire risk - Keep it simple (minimal buttons) - Use microwave-safe containers only - Caution: Food can be very hot

Toaster Oven: - Smaller, easier to manage - Automatic shut-off - Place away from flammable items - Supervise use

Electric Kettle with Auto Shut-Off: - Safer than stovetop kettle - Automatically turns off when water boils - Choose one with cool-touch exterior

Meal Delivery or Pre-Made Meals: - Remove need for cooking - Heat-and-eat options - Meals on Wheels - Family prepares meals in advance

Caregiver Cooks: - If person can't cook safely, caregiver prepares all meals - Remove temptation by keeping person out of kitchen during cooking

Kitchen Safety Beyond the Stove

Knives: - Lock up or remove sharp knives - Keep only butter knives accessible - Supervise any knife use

Small Appliances: - Unplug when not in use - Remove if not needed - Simplify what's available

Cleaning Products: - Lock in cabinet - Remove from under sink - Avoid products that look like food/drinks

Garbage Disposal: - May forget how to use - Risk of putting hand in - Consider disconnecting

Oven: - Disable if person tries to use unsafely - Remove knobs - Turn off at breaker - Post "DO NOT USE" sign

Fire Safety

Smoke Detectors: - Install on every level and in kitchen - Test monthly - Interconnected (all sound when one detects smoke) - Replace batteries twice yearly

Fire Extinguisher: - Keep in kitchen (accessible to caregiver) - Train all caregivers in use (PASS: Pull, Aim, Squeeze, Sweep) - Check pressure gauge regularly

Fire Blanket: - Quick way to smother small fires - Hang near stove - Easier to use than extinguisher for some

Emergency Plan: - Practice evacuation - Have two exit routes - Meeting place outside - Keep exits clear - Call 911 immediately for any fire

Monitoring and Supervision

Supervision Levels:

Early Stage: - May cook with supervision - Remind to use timers - Check periodically - Simplify recipes

Middle Stage: - Close supervision required - Caregiver remains in kitchen - Assist with tasks - Consider limiting to microwave only

Late Stage: - No cooking - Keep out of kitchen during cooking - All cooking by caregiver

Technology Monitoring: - Stove alarms (alert if left on) - Cameras to monitor kitchen - Smart home sensors

8. Medication Management

Medication errors are common and potentially dangerous in dementia. As cognitive function declines, the person may forget doses, take too much, or take wrong medications.

Risks of Poor Medication Management

Common Errors: - Forgetting to take medication - Taking double doses (forgetting already taken) - Taking wrong medication - Taking wrong dosage - Taking at wrong times - Mixing medications unsafely - Taking expired medications - Difficulty opening containers

Consequences: - Undertreated conditions (pain, infections, chronic diseases) - Overdose (serious side effects, hospitalization, death) - Drug interactions - Falls (many meds increase fall risk) - Confusion and delirium - Loss of independence

Medication Safety Strategies

Caregiver Controls All Medications:

Early Stage: - Caregiver fills pill organizer - Person may self-administer with reminders - Caregiver checks that doses were taken - Keep all other medications secured

Middle to Late Stage: - Caregiver administers all medications directly - Person no longer has access to medication bottles - Lock up or remove all medications from bathrooms, bedside - Caregiver supervises swallowing

Secure Storage: - Lock medications in cabinet or lockbox - Include prescription and over-the-counter medications - Don't forget vitamins, supplements, and topical medications - Store in cool, dry place (not bathroom) - Keep list of current medications in case of emergency

Medication Organization Tools

Pill Organizers: - Weekly organizers with 4 times per day (morning, noon, evening, bedtime) - Large compartments easier to use - Fill weekly (caregiver task) - Check each day to verify doses taken - Keep filled organizer separate from bottles

Automatic Pill Dispensers: - Dispenses pills at programmed times - Alarm sounds when dose ready - Locks remaining pills - Can send alerts to caregiver if dose missed - Brands: MedMinder, Hero, Pria - ✅ Good for early stage with reminder needs - ❌ Expensive ($30-60/month) - ❌ Won't help if person doesn't respond to alarm

Medication Management Apps: - Set reminders on phone - Track when doses taken - Alert caregiver if missed - Provide medication information - Examples: Medisafe, CareZone, Mango Health

Blister Packs (from pharmacy): - Pharmacy packages each dose in individual blister - Labeled with date and time - Easy to see if dose was taken - Available from some pharmacies - May have fee

Simplifying Medication Regimens

Work with Doctor to: - Reduce number of medications (deprescribe if possible) - Choose once-daily formulations - Use combination pills (fewer pills) - Eliminate non-essential medications - Use long-acting versions - Coordinate all medication times

Medication Review: - Review ALL medications with doctor at every visit - Include prescriptions, over-the-counter, vitamins, supplements - Ask: Is this still necessary? - Watch for medications that worsen cognitive function - Beers Criteria list (medications to avoid in older adults)

Administration Tips

Giving Medications: - Have person seated - Give one pill at a time if difficulty swallowing - Offer full glass of water - Watch to ensure swallowing (some may "cheek" pills) - Use pill crusher if needed (ask pharmacist if crushable) - Mix with applesauce or pudding if needed (check with pharmacist) - Give with food if required - Be patient and calm

If Person Refuses: - Try again in 15 minutes - Offer choice: "Pill with water or juice?" - Don't argue or force - Try different approach (different caregiver, different location) - Contact doctor if consistently refuses (may need liquid or injectable form) - Never hide in food without doctor approval (some medications unsafe this way)

Liquid Medications: - Use oral syringe for accurate dosing - Mark dose line on cup - Refrigerate if required

Patches: - Rotate placement sites - Mark on calendar when applied - Remove old patch when applying new - Watch for skin irritation - May try to remove (cover with clothing)

Injections (insulin, blood thinners): - Caregiver administers - Secure sharps container - Follow proper injection technique - Rotate sites

Medication Safety Practices

Label Reading: - Check name and dose every time - Use magnifying glass if needed - Adequate lighting - Consult pharmacist with questions

Storage Guidelines: - Cool, dry place (not bathroom due to humidity) - Original containers (for identification) - Out of reach of children if they visit - Check expiration dates quarterly - Dispose of expired medications properly (take-back programs, not down drain)

Multiple Caregivers: - Communication log: who gave what and when - Only one person responsible for each dose - Clear handoff procedures - All caregivers trained

Traveling: - Pack extra medication - Carry on plane (don't check) - Bring list of medications - Know pharmacy phone number for refills

Emergency Information

Keep Updated List: - Medication name (brand and generic) - Dose and frequency - Prescribing doctor - Pharmacy and phone number - What it's for - Start date

Where to Keep Lists: - In wallet or purse - On refrigerator - In car - With medical alert information - Give copy to family members

For Emergency Responders: - "Vial of Life" in refrigerator with medication list - Medical alert bracelet noting dementia - List visible near entrance

9. Emergency Preparedness

People with dementia are more vulnerable in emergencies. Advanced planning ensures safety during disasters, medical emergencies, and other crises.

Why Emergency Planning Matters

Special Vulnerabilities: - May not recognize danger - Can't follow complex instructions - May resist evacuation - Communication difficulties - Can't advocate for self - Medical needs more complex - Wandering risk increases in chaos - May become separated from caregiver

Creating an Emergency Plan

Essential Components:

Evacuation Plan: - Two exit routes from each room - Meeting place outside - Practice evacuations regularly - Account for mobility limitations - Plan for if separated (ID bracelet, recent photo)

Shelter-in-Place Plan: - Designate safe room - Stock with supplies - Know how to turn off utilities - Communication plan

Communication Plan: - Out-of-area contact person (for family to call) - List of all caregiver phone numbers - Medical alert system - Charged phone always with person - ICE (In Case of Emergency) contacts in phone

Medical Information: - List of medications (3 copies: go-bag, wallet, with neighbor) - List of doctors with contact information - Medical conditions and allergies - Copy of insurance cards - Durable power of attorney for healthcare - Advanced directives - Recent photo (for if person wanders)

Support Network: - Notify neighbors of situation - Give neighbors your contact information - Ask neighbors to check in after emergency - Coordinate with family members - Backup caregivers identified

Emergency Go-Bag

Prepare Bag in Advance (keep near exit):

Documents (in waterproof container): - Medication list - Medical information - Insurance cards (copies) - Photo ID (copy) - Legal documents (POA, advanced directives) - Contact list - Recent photo of person with dementia

Medications: - 3-7 days supply - Rotate regularly to keep fresh - Include over-the-counter medications - Pill organizer

Comfort Items: - Familiar photos - Comfort object - Favorite snack - Activities (puzzle book, music player with headphones)

Supplies: - Flashlight with extra batteries - Battery-powered or hand-crank radio - Phone charger (portable battery pack) - Cash (ATMs may not work) - Water and non-perishable snacks - Glasses (extra pair) - Hearing aids (extra batteries) - Incontinence supplies if needed - Change of clothing

Medical Equipment: - Walker, cane, wheelchair (as needed) - Extra glasses - Dentures and supplies

Types of Emergencies

Fire: - Smoke detectors on every level - Fire extinguisher in kitchen - Practice escape plan monthly - Crawl under smoke - Feel doors before opening (if hot, don't open) - Meet at designated spot outside - Never go back inside

Weather Emergencies (tornado, hurricane, earthquake): - Monitor weather alerts - Have battery-powered weather radio - Know shelter location (basement for tornado, interior room) - Evacuation plan if mandatory - Supplies for 3-7 days

Power Outage: - Flashlights (not candles—fire risk) - Battery-powered lights - Blankets for warmth - Food that doesn't require cooking - If medical equipment requires power, have backup plan - If prolonged, go to shelter or family home

Medical Emergency: - Call 911 immediately - Tell dispatcher person has dementia - Stay calm - Have medication list ready - Someone accompanies person to hospital - Bring go-bag

Wandering/Missing Person: - Search home and yard thoroughly first - Call 911 immediately (don't wait) - Tell police person has dementia (increases urgency) - Provide recent photo - Check with neighbors - Search where they used to live or work - Alert community on social media - Check bodies of water

Caregiver Emergency: - If caregiver is injured or ill - Have backup caregiver identified - Emergency contact list visible - Medical information for both caregiver and person with dementia - Neighbors aware of situation

Registries and Alert Systems

Project Lifesaver: - Person wears radio transmitter bracelet - If missing, police use tracking device to locate - Search time reduced from hours to minutes - Available in many communities - Small monthly fee

Silver Alert: - State-run alert system (like Amber Alert) - Notifies public when senior goes missing - Check if your state has program

MedicAlert + Safe Return: - 24/7 emergency support - ID jewelry with information - If person found, responders call hotline - Maintains profile with medical info, contacts

Local Registry: - Some police/fire departments maintain registry - Provides advance notice of residents with special needs - May do wellness checks

Special Considerations

If Living Alone: - Daily check-in system - Medical alert system (see next section) - Key in lockbox for emergency access - Neighbors aware and checking - Consider this may no longer be safe

If Evacuating: - Don't wait until mandatory evacuation - Bring go-bag - Bring medications - Keep person calm (your calm helps) - Go to family home, friend, or shelter - Bring familiar items for comfort - If shelter doesn't accept you, ask for special needs shelter

Returning Home After Emergency: - Check for hazards before allowing person inside - Restore routine as quickly as possible - Provide extra comfort and reassurance - May see temporary decline (reaction to stress)

10. Medical Alert Systems

Medical alert systems provide quick access to help in emergencies, especially important when person is alone or caregiver needs assistance.

What Are Medical Alert Systems?

Basic Concept: - Wearable button (pendant, bracelet, watch) - When pressed, connects to monitoring center - Operator assesses situation and dispatches help - Can call family, ambulance, or fire department

Types: - Traditional: Base unit in home, requires landline or cellular connection - Mobile: GPS-enabled, works anywhere (outside home) - Automatic fall detection: Senses fall and calls automatically

When Medical Alert Systems Help

Scenarios: - Person lives alone (even part-time) - Caregiver can't be within hearing distance - Person at high risk of falls - Person has medical conditions requiring quick response - Caregiver needs to step away - Nighttime (caregiver is asleep) - Caregiver has health issues and may need help

Limitations: - Person must remember to wear device - Person must remember to press button - Person must be able to press button - In later stages, person may not understand how to use - Better for early to middle stage

Choosing a System

Features to Consider:

Automatic Fall Detection: - Sensor detects fall and calls for help automatically - Important if person can't press button after fall - Not 100% accurate (false alarms possible) - Worth the extra cost for high fall risk

GPS/Mobile Capability: - Works outside home - Tracks location - Good for active person or wandering risk - More expensive than home-only

Two-Way Communication: - Speak directly through pendant/base unit - Essential feature (monitoring center can assess situation) - Check speaker volume (must be loud enough)

Waterproof: - Can wear in shower (where many falls occur) - Most are water-resistant - Check rating

Battery Life: - Should last several days to weeks - Low battery alerts - Rechargeable vs. replaceable - Test battery regularly

Range: - How far from base unit works (for home systems) - Should cover entire home and yard - Test in all locations

Caregiver Notification: - Alerts caregiver when button pressed - App notifications - Can family monitor?

Monthly Cost: - Typically $25-50/month - Setup fees vary - Automatic fall detection adds $10-15/month - GPS/mobile adds cost - No long-term contracts best

Major Providers

Popular Systems (not endorsements, just information):

Medical Guardian: - Multiple system options - Mobile and home systems - Fall detection available - 30-day trial

Life Alert: - "I've fallen and I can't get up!" commercials - Traditional system - Expensive - Long-term contract

Philips Lifeline: - Established company - AutoAlert (fall detection) - Mobile and home systems - GoSafe mobile system has GPS

Bay Alarm Medical: - Affordable - No contracts - Fall detection available - Good customer service

GreatCall Lively: - Mobile system (watch-style) - Simple interface - 5Star service - Good for active users

MobileHelp: - Cellular-based (no landline needed) - Mobile options - Fall detection - Affordable

Setting Up and Using the System

Installation: - Most are simple plug-in - Test immediately after setup - Test weekly to ensure working - Train person how to use - Show them button and practice pressing

Encouraging Use: - Emphasize "just in case" - Wear it as routine (put on with clothes each morning) - Make it fashionable (jewelry-style) - Remind regularly - Lead by example (wear one too if that helps)

Testing: - Test monthly by pressing button - Check battery regularly - Ensure can hear base unit throughout home - Update contact information as needed

What Happens When Button Is Pressed: 1. Monitoring center answers immediately 2. They ask what's wrong 3. They assess situation 4. They call family/caregiver or 911 based on need 5. They stay on line until help arrives

Alternatives and Supplements

Smartphone Apps: - Some apps provide similar features - Cheaper but requires remembering to open app - May not be reliable enough - Examples: Red Panic Button, bSafe

Smart Home Devices: - "Alexa, call for help" - Can call contacts - Won't call 911 directly - Not designed for emergencies - Better than nothing

Smartwatches with Fall Detection: - Apple Watch has fall detection - Can call emergency contact - Not designed specifically for seniors/dementia - May be too complex to use

Caregiver Monitoring Systems: - Sensors throughout home - Alert caregiver to unusual patterns - Don't replace medical alert but supplement - Examples: CarePredict, Lively

When Person Won't Wear Device

Common Problem: - Forgets to put it on - Doesn't like feeling monitored - Takes it off - Loses it

Solutions: - Make it part of morning routine - Choose comfortable, lightweight option - Watch-style may be more acceptable - Attach to belt loop - Have caregiver wear one too - Automatic fall detection doesn't require pressing button - In late stage, may not be practical solution

Cost Considerations

Typical Costs: - Equipment: \(0-\)200 (often free with service) - Monthly monitoring: $25-50 - Fall detection: Add $10-15/month - GPS/mobile: Add $10-20/month - Setup/activation: \(0-\)100

Insurance: - Medicare doesn't cover - Some Medicare Advantage plans cover - Medicaid may cover in some states - Veterans Affairs may cover for veterans - Private insurance typically doesn't cover - HSA/FSA may cover - Tax deductible as medical expense (consult tax advisor)

Is It Worth It? - One prevented hospitalization pays for years of service - Peace of mind for caregiver - Allows person to remain home longer - Generally yes, worth the cost

Creating a Safe Environment While Maintaining Dignity

The Balance: Safety modifications should not make the home feel institutional or stripped of personality. The goal is to maintain familiar, comfortable surroundings while reducing risks.

Principles of Dignified Safety

Preserve Autonomy: - Allow the person to do what they safely can - Don't remove all risks (some risk is part of life) - Make gradual changes as abilities decline - Include person in decisions when possible

Maintain Familiarity: - Keep familiar furniture and belongings - Don't drastically redecorate - Changes should be subtle - Maintain routines

Aesthetic Considerations: - Grab bars in colors that match bathroom - Attractive lighting (not institutional) - Keep decor pleasant - Hide adaptations when possible (door locks out of sight)

Person-Centered Approach: - Modifications based on individual needs - Consider their history, preferences, and personality - What works for one person may not work for another - Be flexible and creative

Progressive Changes

Early Stage: - Subtle modifications - Person may participate in safety planning - Maintain independence - Focus on fall prevention

Middle Stage: - More extensive modifications - Increased supervision - Balance safety with freedom - May need to remove access to kitchen, garage, etc.

Late Stage: - Maximum safety measures - Constant supervision or secure environment - Comfort is priority - May need specialized care setting

Working with Professionals

Occupational Therapist (OT): - Home safety assessment - Recommend specific modifications - Teach safe transfer techniques - Often covered by insurance with doctor order - Invaluable resource

Certified Aging-in-Place Specialist (CAPS): - Home modification expert - Knowledgeable about dementia-specific needs - Can design and oversee renovations

Local Aging Services: - Area Agency on Aging - May provide home assessment - May have grants for modifications - Connect to resources

Handyman/Contractor: - Install grab bars correctly - Make physical modifications - Ensure work is safe and code-compliant

Costs and Funding for Home Modifications

Typical Costs: - Basic modifications (grab bars, lighting): $500-2,000 - Moderate (multiple rooms, non-slip flooring): $2,000-10,000 - Extensive (bathroom renovation, ramps): $10,000-30,000+

Funding Sources: - Medicare: Generally doesn't cover home modifications (covers durable medical equipment) - Medicaid: Some states cover modifications through waiver programs - Veterans: VA grants for disabled veterans (up to \(7,500-\)20,000) - Grants: Local aging services, nonprofits, Rebuilding Together - Tax Deductions: Some modifications qualify as medical expenses - Home Equity: Reverse mortgage, home equity loan - Long-Term Care Insurance: Check policy - Out-of-Pocket: Most modifications paid privately

When Home Is No Longer Safe

Signs It May Be Time for Higher Level of Care: - Frequent falls despite modifications - Wandering that cannot be managed - Unsafe behaviors (stove, driving despite restrictions) - Caregiver cannot provide adequate supervision - Multiple emergencies or hospitalizations - Person is isolated and alone much of the day - Caregiver is exhausted and health is suffering

Options: - Increase in-home care (home health aides) - Adult day care (supervision during day) - Assisted living with memory care - Memory care unit in nursing home - Respite care while assessing long-term plan

This Doesn't Mean Failure: - You've kept them safe at home as long as possible - Professional care settings can provide 24/7 safety - Your relationship can focus on quality time, not just safety - It's a loving decision to ensure they're safe

Key Takeaways

  1. Fall prevention is critical and involves removing hazards, improving lighting, adding grab bars, and addressing physical/medical factors.

  2. Conduct regular home safety assessments room by room, modifying as the person's abilities change.

  3. Grab bars must be installed correctly into wall studs, not just drywall, to support weight.

  4. Non-slip flooring reduces fall risk, especially in bathrooms. Remove or secure all throw rugs.

  5. Adequate lighting throughout the home prevents falls, reduces confusion, and helps with sundowning.

  6. Door locks must balance wandering prevention with fire safety and emergency egress.

  7. Stove safety is essential through disabling, automatic shut-off devices, or close supervision.

  8. Caregivers should manage all medications, using organizers, secure storage, and simplified regimens.

  9. Emergency preparedness requires advance planning, including go-bags, medical information, and backup caregivers.

  10. Medical alert systems provide quick help in emergencies but are most effective in early to middle stages.

  11. Balance safety with dignity by making modifications subtle and maintaining familiar environments.

  12. Professional assessments by occupational therapists provide expert recommendations for home safety.

  13. Modifications should be progressive, starting with subtle changes and increasing as dementia progresses.

  14. Wandering is common and dangerous, requiring multiple strategies including locks, alarms, identification, and supervision.

  15. Know when home is no longer safe and be willing to consider higher levels of care when needed.

Review Questions

  1. What are three major risk factors that increase falls in people with dementia?

  2. List five essential items to remove or modify to prevent falls in the home.

  3. Why must grab bars be installed into wall studs rather than drywall alone?

  4. What are three ways to make bathroom floors safer?

  5. Describe the ideal lighting conditions to prevent falls and reduce confusion in dementia care.

  6. What are the benefits and risks of using keyed deadbolts on interior doors to prevent wandering?

  7. What are three methods to improve stove safety for someone with dementia?

  8. Why should caregivers control all medications for someone with middle to late-stage dementia?

  9. What essential items should be included in an emergency go-bag?

  10. What are the key features to look for in a medical alert system for someone with dementia?

  11. How do you balance safety modifications with maintaining a dignified, home-like environment?

  12. What signs indicate that home may no longer be a safe environment?

Additional Resources

Books

  • "The Dementia-Friendly Home: Simple Changes to Make Life Easier" by Susan C. Miller - Practical home modification guide with photos

  • "The Complete Eldercare Planner: Where to Start, Which Questions to Ask, and How to Find Help" by Joy Loverde - Includes safety planning

Online Resources

Organizations

  • Area Agency on Aging - Local resource for home assessments and modifications funding

  • Rebuilding Together (rebuildingtogether.org) - Free home repairs for low-income seniors

  • National Association of Home Builders - Find Certified Aging-in-Place Specialist (CAPS)

Products and Services

  • Medical Alert Systems: Compare at ConsumerReports.org or AARP.org

  • Automatic Stove Shut-Off Devices: iGuardStove, Wallflower, FireAvert

  • Home Safety Products: Amazon, local medical supply stores

  • Grab Bars and Bathroom Safety: Moen, Kohler, Drive Medical, Carex

Professional Services

  • Occupational Therapy: Get referral from primary care doctor

  • Certified Aging-in-Place Specialists: Find at NAHB.org/CAPS

  • Eldercare Locator (1-800-677-1116): Connect to local aging services

Next Chapter: Chapter 15: Legal, Financial, and Support Resources explores essential legal planning, financial management, and community support services.

Related Chapters: - Chapter 7: Managing Challenging Behaviors - Behavioral approaches to wandering - Chapter 12: Daily Living and Caregiving Skills - Transfer techniques and fall prevention - Chapter 9: Medical Treatments and Medications - Medication information