ACC Creating a Safe Environment 2 — Questions and Answers
Question 1: A person with Alzheimer's repeatedly tries to leave through the back door at dusk. Which environmental modification best addresses this 'sundowning' exit-seeking behavior?
- Install a deadbolt requiring a key on the inside
- Place a full-length mirror on or beside the back door (Correct answer)
- Lock the person in their bedroom after 4 PM
- Remove all furniture near the door
Correct answer: Place a full-length mirror on or beside the back door
A mirror on or beside an exit door can discourage wandering because many people with Alzheimer's do not recognize their own reflection and turn away.
Question 2: Which flooring characteristic poses the greatest fall risk for a person with Alzheimer's disease?
- Low-pile carpet in a neutral color
- High-gloss hardwood that creates light reflections (Correct answer)
- Matte vinyl with slight texture
- Cork flooring with minimal pattern
Correct answer: High-gloss hardwood that creates light reflections
High-gloss surfaces create light reflections that persons with Alzheimer's may perceive as water or obstacles, increasing fall and misstep risk.
Question 3: Why should caregivers remove or cover mirrors in some stages of Alzheimer's disease?
- Mirrors cause motion sickness in persons with dementia
- The person may not recognize their reflection and become frightened or agitated (Correct answer)
- Reflections can trigger seizures in Alzheimer's patients
- Mirrors increase hoarding behaviors
Correct answer: The person may not recognize their reflection and become frightened or agitated
In mid-to-late Alzheimer's, individuals often fail to recognize their own reflection, which can cause fear, confusion, or verbal/physical aggression.
Question 4: A caregiver notices the person with Alzheimer's keeps rummaging through a cabinet full of cleaning chemicals. What is the BEST intervention?
- Label all chemicals clearly so the person knows what they are
- Move chemicals to a locked cabinet or out of the home entirely (Correct answer)
- Allow rummaging since it provides sensory stimulation
- Install a motion alarm on the cabinet
Correct answer: Move chemicals to a locked cabinet or out of the home entirely
Toxic substances must be secured in locked storage or removed from the home because labeling alone is not reliable for someone with cognitive impairment.
Question 5: What is the primary purpose of using contrasting colors (e.g., a brightly colored toilet seat) in a bathroom used by a person with Alzheimer's?
- To make cleaning easier for the caregiver
- To compensate for depth-perception and visual contrast deficits (Correct answer)
- To stimulate mood and reduce depression
- To comply with ADA bathroom requirements
Correct answer: To compensate for depth-perception and visual contrast deficits
Alzheimer's disease impairs contrast sensitivity and depth perception, so contrasting colors help the individual locate fixtures and surfaces accurately.
Question 6: Which action BEST reduces the risk of scalding for a person with Alzheimer's who can no longer reliably judge water temperature?
- Post a sign reminding them to test the water first
- Set the water heater thermostat to 120°F (49°C) or lower (Correct answer)
- Purchase a digital thermometer for the bathroom
- Supervise every bath or shower without changing the water heater setting
Correct answer: Set the water heater thermostat to 120°F (49°C) or lower
Lowering the water heater to 120°F or below is a systemic fix that prevents scalding even when the person cannot safely test temperature themselves.
Question 7: A person with Alzheimer's living alone keeps turning on the stove and forgetting it. After other strategies fail, what environmental solution is MOST appropriate?
- Replace the stove with one that has larger knobs
- Install an automatic stove shut-off device or remove the stove knobs when unsupervised (Correct answer)
- Move the stove to a less visible location
- Apply brightly colored stickers to remind them to turn it off
Correct answer: Install an automatic stove shut-off device or remove the stove knobs when unsupervised
Automatic shut-off devices or removing knobs eliminates the ignition hazard when the person cannot reliably remember to turn off the appliance.
ACC Creating a Safe Environment 2
A person with Alzheimer's repeatedly tries to leave through the back door at dusk.
Which environmental modification best addresses this 'sundowning' exit-seeking behavior?