Home Safety Inventory for Older Adults with Dementia

By: Helen W. Lach, PhD, RN, GCNS-BC, Saint Louis University School of Nursing

WHY: People with Alzheimer’s disease (AD) and other dementias often develop impairment in executive function, resulting in poor judgment and decision making. These problems put the older adult with dementia at risk for accidents and injuries in the home environment (Levy-Storms, Cherry, Lee & Wolf, 2017). Older adults with dementia have twice the risk of hospitalization for injuries than those without dementia (Meuleners & Hobday, 2017). Caregivers may not be aware of safety risks or when to intervene (Lach & Chang, 2014). Comprehensive assessment of home safety and common hazards allows nurses to identify potential risks and educate caregivers on preventative measures (Horvath et al., 2013). 

BEST TOOL: The Home Safety Inventory (HSI) is a clinical assessment tool to evaluate potential safety issues with individuals and caregivers of people with dementia. Indications of potential safety issues, or history of accidents or incidents can be noted and suggestions to address concerns can be listed on the HSI form. Completing the HSI makes caregivers aware of the variety of safety problems that can occur and helps begin the conversation about modifying the environment, supervision, and/or other strategies that might be indicated.

TARGET POPULATION: The tool is for assessment of older adults with dementia, either those living alone or those living with caregivers. Those who are not aware of the diagnosis of dementia are at risk of engaging in unsafe activities (Amjad et al., 2016).

VALIDITY AND RELIABILITY: The HSI has been used clinically and in research with caregivers of older adults with dementia to assess home safety problems (Lach, Reed, Smith, & Carr, 1995; Lach & Chang 2014). Psychometric testing has not been done.

STRENGTHS AND LIMITATIONS: The HSI is a clinical tool and items were selected based on studies of safety problems in people with dementia, and allows for individualization. The assessment tool may not include all of the possible safety problems. Health professionals should individualize the items based on clinical assessment of the individual and home environment.

FOLLOW-UP: Caregivers need education about possible safety issues and potential problems, since older adults with dementia can get lost or have an accident or injury without any warning.  These occurrences can happen early in the progression of the disease when the caregiver is not aware of the individual’s deficits. Completing the HSI with caregivers can help them identify early signs of difficulty with activities that may indicate a risk for safety problems and injury. The HSI should be reviewed and updated if there are changes in cognition or functional abilities.

MORE ON THE TOPIC:

Best practice information on care of older adults: https://consultgeri.org.

Alzheimer’s Association. See web site: https://www.alz.org/care/alzheimers-dementia-activities.asp for safety information on wandering, driving and other safety topics. 
 
Amjad, H., Roth, D. L., Samus, Q. M., Yasar, S., & Wolff, J. L. (2016). Potentially unsafe activities and living conditions of older adults with dementia. Journal of the American Geriatrics Society, 64(6), 1223-1232. 
 
Horvath, K. L., Trudeau, S. A., Rudolph, J. L., Trudeau, P. A., Duffy, M. E. & Berlwitz, D. (2013). Clinical trial of a home safety tool kit for Alzheimer’s disease. International Journal of Alzheimer’s disease, 1-11.
 
Lach, H. W., & Chang, Y. P. (2014). Caregiver perspectives on safety in home dementia care. Western Journal of Nursing Research, 29(8), 993-1014.
 
Levy-Storms, Cherry, D. L., Lee, L. J., & Wolf, S. M. (2017). Reducing safety risk among underserved caregivers with an Alzheimer’s home safety program. Aging and Mental Health, 21(9), 902-909.
 
Meuleners, L. B., & Hobday, M. B. (2017). A population-based study examining injury in older adults with and without dementia. Journal of the American Geriatrics Society, 65(3), 520-525.