At some point in the disease, the person will have difficulty climbing stairs. This may be due to age-related mobility problems, such as arthritis, or age-related low vision problems, such as glaucoma or macular degeneration. The person may also have poor depth perception, a dementia-related condition. Instead of seeing the individual steps, the person may see the steps blended together, making it difficult to know where to put one’s feet or how high to lift one’s legs.
Then, too, the stairway may be unsafe. There often is no or only one handrail, which makes it unsafe or even impossible for the person to use the stairs if he or she has a weak side due to a stroke.
Descents may be especially dangerous because of low light levels, clutter – especially on landings – that can cause trips and slips, or torn carpeting or treads in which toes may easily become caught. And finally, unsecured carpets can easily slide underneath the stair when walked on, especially if the person is rushing.
Adding or repairing handrails is one of the most important home improvements you can make if the person is still using stairs, and has adequate strength and balance skills. The right handrails can make all the difference in his/her ability to use the stairs.
Handrails should be installed on both sides of all staircases, whether for 1 step or 15. This allows the person to hold on with the stronger arm if he or she has a one-sided weakness due to a stroke. Or the person can hold on to both sides and use their upper body strength while climbing up or down. This is especially helpful if he or she has weak leg muscles or arthritic knees or hip joints.
Make sure the handrail is color-contrasted to the wall so it is easily seen. If possible, extend the wooden handrail past the bottom step and/or add a curved metal bar if needed, so that the person has a support to hold onto when stepping up or down.
Try climbing your care receiver’s stairs using the handrail. If it’s wobbly, that’s a telltale sign it isn’t installed properly and could easily pull out. Hire a handyman to securely anchor the handrails into the wall studs.
You can find the studs using a stud finder, available at most home improvement stores for around $15.00. Most studs are 16 inches apart, so once one is found, you can measure horizontally to locate the next one.
The two most common flooring materials are carpeting and wood. Whether choosing new flooring or fixing what you already have, consider the person’s lifestyle. For example, if he or she is routinely up at night but forgets to put on their slippers, climbing up and down wooden stairs in stocking feet is dangerous. In that instance, carpeting the stairs may be in the person’s best interest. For wood, a non-slippery finish is safest.
Regardless of flooring material, consider using color to contrast the risers from the steps to help the person better distinguish the step. Many individuals with dementia have poor depth perception, and climbing stairs when the steps blend together is both terrifying and unsafe.
Safety experts even recommend painting a 2-inch stripe along the edge of carpeting! And some specialists recommend using tape instead of paint as paint does not adhere to all types of synthetic carpeting. Others, however, fear tape may cause the person to slip or trip, especially if the tape is torn, slippery, or even anti-skid if the person’s toe gets “stuck” on the anti-skid tape.
If you use tape, check regularly to make sure that the tape is adhering and that the person is using the stairs safely. As always, do what’s best for your situation. If the person’s foot is becoming stuck or slipping on the tape, remove the tape.
Quite often, the safety of a specific intervention is dependent upon a user’s individual characteristics, including whether the person shuffles when he or she walks or even the type of shoes the person wears.
Although glow-in-the-dark tape is commonly recommended for highlighting a step’s edge, our tests did not find this product effective. The tape glowed for only 20 minutes and ONLY glowed in the dark if the stair lights remained on during the day – for up to 8 hours! Moreover, the tape does not have an anti-slip finish.
Carpeting with a tight loop, or a dense flat carpet, without any patterns, is the best choice. The color on the landings should be different from that on the stairs so that the person can see where the steps start and stop.
Install the carpet with either a thin pad (not foam) underneath or use no padding at all. Thick padding causes the toe to sink into the carpet, which can cause a fall. Talk to your installer about the safest installation method for your care receiver’s staircase design.
Regardless of the installation method (e.g., staples for wood, glue* for cement), make sure the carpet fits tightly, especially over the step’s edge (called “nosing”). If the carpet isn’t fastened securely, it can move under the person’s foot.
*If glue is used to fasten the carpet to the stairs, make sure there’s plenty of ventilation, as the fumes can be quite strong. If the person has asthma or a breathing condition, check first with his/her doctor before using the glue.
Things to avoid:
- Plush carpeting is dangerous on stairways, as the foot sinks into the carpeting and possibly becomes “caught,” causing the person to trip.
- Do not use the same color carpeting for the stairs and the top and bottom landing. This makes it hard to tell where the steps end and the landings begin; many people may think there’s another step and a fall can occur. Avoid very dark colors on the steps and landings, as the person may think this area is a hole into which they may fall.
- Plastic treads easily rip or pull off and can cause a fall if the person’s foot becomes caught in the tread.
- Oriental runners can be beautiful but patterned carpets of any kind can make stair climbing treacherous and confusing for someone with dementia.
Lighting & Vision
Lighting is not only essential to vision, but dim or low lighting conditions can contribute to abnormal gait and balance, increasing fall risk in older adults.
Climbing stairs can be difficult for many reasons, including poor lighting; but good lighting can help the person better see the step edges and any clutter on the stairs. Make sure the light is glare-free, or it can be blinding, especially for aging eyes.
Also, be sure there’s good lighting that’s at the same brightness level on the stairs and in adjacent spaces, such as hallways and landings. This will not only help the person to see well and to walk more safely, but it also reduces visual hallucinations and “spooky” shadows he or she may see in dim light. Finally, provide for night lighting that allows the person to adequately see the steps and surrounding areas, but be careful that it’s not too bright. Bright light at night can be disorienting – the person may think it’s daytime and not want to go back to bed.
Light in adjacent spaces can help illuminate the stair landings and make walking around safer, especially at night. Some individuals may resist using lighting, possibly due to habits developed earlier in life, especially during the Depression or war-time eras, when conserving electricity was the rule, not the exception. Then, too, the existing lighting may be too bright or harsh for nighttime use.
A great light that is easy to install and does not require any extra wiring is this one. It is fairly cheap and quite effective.
Here are three simple suggestions to increase lighting – see which one works best for your situation. Sometimes you may have to try a few before you find the one that works.
- Keep a lamp on low during the night. Try various low wattages (25 – 40 watts) to see which is the most comfortable for your care receiver, especially if the person has low vision.
- Install a screw-in light sensor that automatically turns the light on at dusk and off at daylight.
- Install a motion sensor device into a lamp (use a low wattage bulb) so the person’s movement turns the lamp on.
Sometimes it’s just too dangerous for someone to use the stairs without supervision and you need to limit access.
When possible, consider trying a monitoring device. For example, a motion sensor with a remote alarm can alert you, even when you’re in another room when he arise(s) from an afternoon nap. Or a baby monitor may pick up the sounds as he walks across the bedroom. This can give you the time you need to be at his side to offer assistance.
Gates & Doors
Denying access to the stairs using gates or locked doors may be necessary at times, but do so with caution and frequent monitoring, especially when the person is accustomed to using the stairs freely. As the photo shows, child safety gates are specifically designed for children, not for the strength or height of an adult! How a person responds to a child safety gate is very individual. Some may simply turn around and walk away, but others may attempt to open the gate or, worse, climb over it.
Keep in mind that a person may also react unfavorably to a locked exit door. Having an enjoyable activity nearby to redirect their attention can really help.
For adults with mobility impairments, living on one single floor is the best solution. You may be able to convert a first-floor den or living room into a bedroom or even build an addition, depending on your finances. And an accessible bathroom will make daily care much easier.
The second floor can be closed off, if necessary, or used by a caregiver.
When moving the person to the first floor, use the same furniture, if possible, and arrange the room similarly to the person’s previous bedroom. Some care receivers may be upset by the change, especially if he or she is sleeping alone. Consider sleeping nearby for the first few nights (on a cot or other sleeping option) to help orient the person when waking up in the middle of the night. Make sure to leave a bathroom light on low to help the person navigate the new nighttime space.
Stair Chair Lift & How Do They Work?
When using the stairs becomes unsafe, access within the home may be increased by installing a stair chair lift, but not all persons with dementia will be able to use them.
First, if the person has never used a chair lift, he or she could be afraid of falling, even though the chair moves slowly. So it’s important to give step-by-step instructions and inform the person that the chair will move before you operate it. And offer support. For example, you could say, “You’re safe, you won’t fall.” You may need to walk behind the person, offering support.
Secondly, depending on the person’s ability to transfer, it may be difficult to get on and off the seat, especially at the top of the stairs if the person fears falling. When ordering the chair lift, specify that you want the track to be installed on the top landing, too, not just alongside the stairs. This increases the cost, but it’s really worth it as it also increases transfer safety.
Finally, you’ll need to make sure that he or she has a cane, walker or wheelchair on each floor.
Battery-operated, this chair lift runs along a track that’s installed on the stairs.
Main features to look for include:
- Adjustable swivel seat with lock
- Safety belt to keep the person from falling
- Remote control so you can operate the chair lift
- Track installed on the landing increases safety
Check the stairs to make sure you can (or anyone else) can safely walk up or down with a chair lift installed; the chair lift can take up 13 inches or so of the walkway (at the top or bottom of the stairs – wherever the seat is) when the seat is folded up against the wall.
Consider a DC battery equipped stair lift so the chair will work during a power outage (AC electric chairs will not). Although the DC chair lift is battery operated, the track needs to be within 6 to 8 feet of an outlet so that the chair lift can continually recharge its battery. The battery will need to be replaced every 18 months or so.
Common charging points are at each end of the track – and if the chair isn’t parked correctly, the batteries will go flat (a common cause of service calls). Some lift chairs, however, are designed to recharge the batteries at any point on the track.
A home elevator would be the preferred alternative to stairs, but we are not including information on this option, as it’s beyond the financial means of most families.