The physical home environment is fraught with hazards for the person with Parkinson’s disease. As a result of neuromuscular symptoms that limit movement and mobility even common structures such as stairs can present dangerous obstacles. Most people choose a place of residence based on various factors that typically have little relation to ability to maneuver through the house or apartment without full mobility. Many older people live in the home they have occupied for most of their adult years, the home where perhaps they raised their family. They are so accustomed to the “lay of the land” within the home that the floor plan, furnishings, and other elements of the home’s environment do not appear hazardous, yet they can create hazards for the person with Parkinson’s. A comprehensive home safety inventory can help to identify potential hazards and possible solutions.
Entryways and Doors
The entry to a house or an apartment can present a number of hazards for a person who has mobility problems. Take an objective look at entryways from the outside. There should be a clear and unobstructed path from the driveway, sidewalk, or street to the home’s door.
• Foliage such as hedges and shrubs is attractive but can present actual or perceived obstacles. Trim foliage so branches do not hang over sidewalks and stair railings.
• Many houses have double doors, a screen or storm door, and a security door. Do these doors open in the same direction or in opposing directions? Double doors can be difficult for someone with impaired coordination to manage; consider removing the screen or storm door.
• Are there cracks, uneven sections, or breaks in sidewalks or steps? These present tripping hazards for a person with Parkinson’s who may shuffle or drag the feet when walking.
• Where the car is parked, is there enough room to open the car door completely to get in and out? Is there a clear path around the car and to the entry?
• Are entryways, driveways, and garages brightly lit at night? Lights that are activated by motion sensors assure that lighting is available whenever someone is present. Lights should be on (or available if motion-activated) during times of marginal daylight, such as early morning and early evening, as these are times when visibility is diminished.
• If the home is an apartment, are common areas well lit and properly maintained? Elevator buttons should be easy to activate, and elevator doors should stay open long enough to allow
someone moving slowly to enter. The building manager can adjust the timing if necessary.
• If the person with Parkinson’s uses a wheelchair or a walker, are sidewalks and doorways wide enough for it? If not, how can they be modified? If there are steps, is there a way to construct a ramp? Sometimes it is necessary to use a different entry.
Interior Doorways, Hallways, and Stairs
Most interior doorways are 30 inches across, not wide enough to accommodate a wheelchair, and can be tricky with a walking aid such as a walker. Narrow spaces such as doorways may also trigger freezing of gait. Some doorways can be widened; for others, the structure of the house or placement of walls makes this impractical. Hallways are generally at least four feet wide, usually wide enough for clear passage. However, long hallways feel narrower, even if they are not; this feeling of narrowness can cause freezing. Bright lighting can help offset this perception. Make sure hallways and stairs have sturdy railings on both sides. If the main living areas are on one level and bedrooms are on another, are there ways to rearrange rooms so the person with Parkinson’s can remain most of the time on one level? At the very least, climbing up and down stairs takes energy and concentration. When gait disturbances and bradykinEsia are prominent symptoms, they can make it impossible for the person to maneuver steps.
Often electrical outlets are behind furniture. This is not a problem when lamps, televisions, stereos, and the like, are plugged into them, as these items generally stay plugged in. As well, this arrangement keeps cords safely out of tripping range. Reaching behind a couch or under a table to plug in a vacuum cleaner or other limited use device can be a risky proposition. Removing covers that plug into the outlets, such as those designed to prevent small children (including grandchildren) from experimenting with electricity, can be difficult for someone who has limited dexterity.
• Run electrical cords under furniture and along baseboards as much as possible, and fasten them down if they can stray into a common path of travel. Use extension cords, if necessary to eliminate exposed cords that present tripping hazards.
• Use extension cords to provide access if furniture arrangements block outlets.
Furniture and Décor
The deep, soft cushions of the sofa that were once so comfortable now present a challenge for the person with Parkinson’s who has balance problems. Many people with Parkinson’s have difficulty moving from standing to sitting or sitting to standing. Sofas and chairs with firm seating surfaces and chairs that have arms but do not rock or swivel offer the safest seating options.
Many people display photos, collectibles, and other items on end tables, coffee tables, and shelves. These arrangements can present obstacles for the person with Parkinson’s, whose slowed movements and difficulty in changing direction can result in bumping into such displays. The person with Parkinson’s may be injured or be distressed about breaking items. Plant stands and hanging planters can also create hazards. Consider placing shelves and plants along walls that are away from common travel paths or displaying favorite items in rooms that are less frequently used.
What is the traffic pattern through commonly used rooms? Must people wind their way around and between items of furniture? Although this process may be second nature for other family members (and may have been for the person with Parkinson’s before motor symptoms began to interfere with mobility), it can now present an obstacle course. Try to arrange furniture so there are wide paths of travel, preferably through the center of the room rather than along a wall if practical. People with Parkinson’s are especially sensitive to feeling “trapped” in areas that are too confined for them to maneuver for changes in direction, such as turning around. This trapped feeling can lead to freezing and falls. In commonly used areas, there should be adequate room to allow the person to make a U-turn.
Some rooms, such as kitchens and bathrooms, are difficult to rearrange because items such as cabinets, counters, fixtures, and appliances are in fixed locations. As much as possible, keep countertops and floors free of clutter. Remove throw rugs, even from bathrooms.
Most household appliances such as microwave ovens and coffee makers are designed for ease of use and have large or touch-sensitive controls. Controls for major appliances such as stoves, ovens, and dishwashers vary considerably. Many stoves have knobs that must be pushed in and turned simultaneously to safeguard against accidentally turning on a burner; these can be difficult for the person with Parkinson’s to manage.
• Some toasters and toaster ovens use small sliding levers for light-dark toast settings; these are designed to be difficult to manipulate so bumping them does not cause them to move. Leave the settings at the preferences of the person with Parkinson’s; other family members can change them for their own use and then change them back.
• Leave frequently used appliances accessible and plugged in, ready to use, if this arrangement is practical. In kitchens, make sure items on countertops do not block access to electrical outlets.
• Consider hand-held electric can openers that are lightweight and require minimal manipulation. Countertop or mounted can openers can require dexterity and strength to maneuver and hold cans in place.
• Do refrigerator doors open completely? Are interior drawers and trays easy to open and close?
Where are the clothes washer and dryer? Laundry facilities that are in the basement or the garage may require maneuvering up and down steps or through doors. Interior laundry rooms are generally safer, although they may be small and used for storage as well as laundry.
• The most popular washing machines are those that load at the top; the most popular dryers load at the front. If practical, consider putting a table between the washer and the dryer for clothes that go into and out of the washer. This arrangement reduces the need to bend.
• Put a chair at the table so the person with Parkinson’s can sit down to move wet clothes from the table to the dryer.
• Are there general settings on the washer and the dryer that typically are safe for most of the laundry the person with Parkinson’s might do? If so, leave the machines on these settings. Some machines have touch-sensitive controls; others have push buttons or push-and-turn dials that may be difficult for someone with limited dexterity and coordination to operate.
Throw rugs and area rugs pose significant tripping hazards for people with Parkinson’s and cause many falls. The shuffled steps and foot drag that are common gait disturbances make catching the feet on the edge of or becoming entangled in a rug easy. Rugs also catch walking aids such as canes. Long-pile and textured carpets are also difficult walking surfaces for people with Parkinson’s. If practical, replace them with short-pile carpet or leave the floor uncarpeted.
Subdued lighting is wonderful for making a room feel comfortable and cozy, but it makes walking difficult for the person with Parkinson’s who has vision problems. Bright, but not glaring, lighting is best in areas such as hallways, kitchens, and bathrooms. Bedrooms, living rooms, and other common areas should have variable lighting that can be bright for walking and dimmed when the person is seated.
• Replace conventional light switches with broad toggle switches that are easy to activate.
• Consider lights that are turned on automatically, such as at darkness, or through motion sensors.
Water, Faucets, and Fixtures
The most important safety factor in bathrooms and kitchens is hot water temperature. To reduce the risk of scalding and burns from water that is too hot, keep the hot water heater set no higher than 140 degrees. This temperature is hot enough to satisfy the person who enjoys a hot shower or bath but is below the point that can cause damage to skin and tissues. Most faucets have knobs that turn, push, or pull. These can be difficult for someone with limited coordination and dexterity to operate. Replace them with lever-style controls that move smoothly and freely.