Aging individuals, or persons with progressively worsening medical conditions, who are completely aware of their current abilities will be able to tell others when it is time to get grab bars installed in their home. The hotspots for grab bar or handrail installations may include the following: the bedroom on the bed frame and in the bathroom near the toilet and in the shower/bath stall. Grab bars provide that extra leverage when an individual is having trouble standing up on their own. The bars also provide that external, sturdy option for balance and preventing falls when a walker is not enough.
There are also individuals whose cognitive capacities are so limited that they must rely on their primary caregivers for basic decisions, including not just grab bar installation…but knowing “when” it is time to install them. Such factors are observed in situations where loved ones are constantly looking over individuals with dementia/Alzheimer’s disease who are so far gone, but still have enough physical energy and movement to get into some serious trouble. Here are some common and observable signs that the caregiver may notice about the individual that could determine whether or not it is time to introduce grab bars into the home:
- Increased number of falls or loss of balance: Is the individual falling more frequently despite using an ambulation device such as a cane or a walker? What was the individual doing when he or she fell? Keep track of what rooms they are falling in the most often and whether or not they attempted to grab a stabilizer (i.e. cane, walker, a piece of furniture) to prevent the fall. Falls can occur for any number of reasons, but some common ones include: falling out of bed, sliding on a slippery surface such a tile or wet floor, miscalculating a sit-to-stand transfer and lowering to the floor instead, reaching for an item overhead, forgetting to use a walker or a cane while walking, tripping on a rug or a threshold, etc.
If caregivers are discovering just how terrifying a trip to the bathroom is for their loved one, especially when they go it alone because of some standing balance difficulties, then it is time to consider installing grab bars in the bathroom. The same could be said about any other room in the house during any type of daily living activity. Rather than restrict the individual from participating in order to reduce falls, supplement their home with grab bars.
- Increased furniture-walking: Is the individual starting to, hand-over-hand, crawl along furniture or stationery objects in the home in order to maintain their balance? One example would be that their walker may not fit in the bathroom so the grip onto the door frame, followed by the sink counter in order to get to the toilet or the shower. Another example would be seeing the individual grasp onto the night stand in order to pull themselves out of bed at night. Once again, caregivers can keep track of where in the home the individual is coming to rely on furniture for support and contemplate whether or not a grab bar would be more appropriate for each area.
- Pulling up on unstable objects: Basic laws of physics is the least of someone’s worries when they are plagued with cognitive disorders such as dementia. When they decide to pull or push down on an object to maintain their standing balance, they often do NOT acknowledge if that object is stable or safe. Some scary examples include: chairs with wheels, door knobs, oven door handles, towel racks, top-heavy tables, lamp poles, closet rods, shower rods, etc. Many of these objects may be visually stable-looking, but since they are rarely installed in something solid like a wall stud the objects frequently fall apart when sustaining any weight capacity. Caregivers need to note if their loved ones are attempting to stabilize themselves on these type of objects and consider replacing them with grab bars.
- Increased transfer assist: This specifically refers to sit-to-stand transfers from the toilet, a wheelchair, a shower chair, the edge of the bed, a dining chair, a couch, etc. Do you as the caregiver now have to physically assist or even lift the individual off of the seat due to increased weakness? Of course, there are other pieces of adaptive equipment that may be able to provide assistance (i.e. toilet risers). However, a grab bar can be extremely helpful to pull off of, especially if it is placed at the right height next to the seat giving the individual trouble.
- Increased wandering: This problem encompasses several scenarios. As mentioned previously, caregivers do not want to completely restrict someone from walking around their own home in order to prevent falls or accidents. That doesn’t make the possibilities any less scary. If the individual is freely roaming around the home with little physical impairment, but their cognitive impairments make them forget general safety tips such as forgetting to bring a walker or a cane with them, pulling on unstable objects, walking over slick or slippery surfaces in socks, then it is time to consider placing grab bars in the home.
Please remember that introducing grab bars into the home is still introducing an entirely new piece of equipment to the user, which can be challenging for someone with cognitive impairments. Individuals with dementia, especially moderate-to-severe dementia, tend to function better within an established routine and a familiar environment. Caregivers cannot expect individuals with advanced dementia to know how to or to remember to safely use grab bars if they have never had them before. Consult with a rehabilitation specialist or a dementia specialist regarding what types of environmental cues the individual could use to remind them to use the grab bars. Consider grab bar installation immediately after your loved one has received a dementia diagnosis. Even if their standing balance is not currently an issue, it very well could be in the near future given the predictable down-turn that dementia takes. If the grab bars are already in the home, then the individual still has the memory and cognitive capacity to use the grab bars.