Calmer Environments for Seniors: Sensory & Communication Tips

All right, welcome back to this presentation on environments that help older adults feel safe and empowered. I'm your host, Dr. Donnelly Snipes. We all know it's easier to relax in an environment that you feel safe if you're constantly worried somebody's going to come up behind you or somebody's going to drop something or I startle at loud noises. So dropping something's a big deal for me. But it's important to recognize that you need to feel comfortable in your environment. And some of it can be done by arranging the placement of furniture so people can see the entrances and exits and they don't have people walking up behind them all the time. Some of it can be done by adding mirrors so people can see things around them, and some of it is just done by educating everybody about ways to not startle one another, basically about ways to help each other feel safe and empowered. So today we're going to identify issues that lead to increased stress, environmental issues. Recognize the connection between stress, confusion, cognitive decline, irritability, inflammation, worsening blood sugar regulation, and chronic conditions, and will identify strategies to create a safe feeling environment. As people age, they commonly experience impairments in hearing, vision, taste, smell, and touch, which develop gradually and often go unrecognized. If you're older, you probably didn't notice the. The loss, the gradual loss of your peripheral vision, but it's happening. When I was younger, I didn't need glasses, and I didn't notice the gradual loss of my vision until one day I was like, I can't read this, and I had to get glasses. But my vision didn't just suddenly go bad overnight. It was a gradual process, and people often don't realize it and the, the extra stress that it adds, they don't realize because it's gradual, it's granular, but it's there. Sensory declines can reduce a person's ability to accurately perceive and interpret cues from their environment. It increases the risk of accidents, falls, burns, and poisoning. For example, reduced touch sensitivity can increase fall or burn risk. And touch sensitivity, we're talking about proprioception, knowing where you are in space, knowing where to set your foot. So people who have reduced touch sensitivity, a lot of peripheral neuropathy, may not be able to tell kind of where their foot is and when they need to step up or when they're actually going to hit that stage step. It feels like they're kind of floating in space. You can also have reduced touch sensitivity. They're putting their tray on the counter and they don't know where the counter is. So they end up dropping the tray now probably just dropping it on the counter, but it may drop and make a loud noise. Impaired smell can prevent detection of smoke or spoiled food. I know in our house I'm bad about just giving food the sniff test. I'm like, yeah, it's edible. But if your sense of smell is going, then you may not notice when things are, you know, probably past their use by date. Sensory impairments contribute to increased stress and a sense of unsafeness, decreased independence, social isolation, depression and poorer cognitive health when we have sensory impairments. I mean, let's think about it. If you can't smell smoke, then is it safe to be in an environment where you may be using an oven? If you can't smell smoke, then you're not going to know if there's a problem. So are you still safe using an oven? It's a question, it's not a statement. Thinking about our different senses, if you can't hear what's going on, what things might, you may be more vulnerable to. And there are a lot of people who are completely deaf who live very independently. Thank you very much. I'm not saying it's a deal breaker, but especially for people who have been hearing abled all of their life, when their hearing goes away, they may feel very vulnerable and it may not be that they're in that any more danger, but they may feel like they're in more danger because they can't hear. And kind of like I suggested in the video on, on hearing impairment for this one, you know, put earplugs in your ears and walk around for go, go about your day for an hour or so or try to go to sleep and see how you feel. Do you feel vulnerable or do you feel just as safe in your environments when you can't hear? A dagum thing. And when I say earplugs, I mean really good earplugs, not just a little bit of cotton. So people may feel more vulnerable, they may feel like they can't live alone. And if they can't hear and so we need to look at what to do, there are visual cues we can add, there are things we can do to set up their environment that is conducive to someone who doesn't have hearing, is that going to make them feel safer? Is that going to reduce their stress if they decide to move in with their child or move into assisted living? That in and of itself has emotional impacts that go with it. And what does it mean to them if because of their Hearing loss and feeling unsafe living alone. What does it mean to them about their, about themselves if they move into assisted living? And a lot of older adults have some very poignant things to say about that. But social isolation, if you're in an environment where you can't, either you can't hear people or you can't, you don't, you can't see, so you don't want to go out and you know, bounce around in places you may not want to go out. So sensory impairments may cause people to withdraw, to isolate. They may contribute to depression because they're getting less oxytocin, they're having more inflammation. We know inflammation and low oxytocin are associated in the brain with increased depression, with reduced mood and poorer cognitive health. If people are. When people's senses are stimulated, it stimulates their brain. So the less their senses are stimulated and the more they withdraw from social activities and things, the less their brain is getting stimulated, so the less healthy their brain is. Sensory loss combined with age related cognitive changes can make individuals less able to respond effectively to hazards which can cause or worsen feelings of vulnerability or unsafeness. Remember earlier I talked about how when you're younger, you get a information from our senses and it just speeds right up to our brain. We process it and we act well. Older adults, their processing speed is slower, their reaction time is slower, so they may feel more vulnerable. What happens if I'm cooking and something catches fire? It takes me a minute, I see the fire, I've got to think, okay, what do I do? I've got to respond to it. You know, does my slower reaction to what's going on, does that put me in danger? Does that make me more vulnerable? Current trauma, whether it's physical, such as having a fall or, or maybe you had a heart attack, that makes people feel very unsafe and in their environment. And it's important to recognize it may not be a sensory thing, it may be a cognitive, emotional thing that results from when you have a heart attack or when your loved one has a heart attack. You may be worried it's going to happen again and so you feel more hype, you are more hyper vigilant for a period at least after that happens. And it's important for therapists can work with people or even physical therapists and part of the rehab team. It doesn't need to be. A mental health professional can work with the person after they have a heart attack, for example, to help them identify strategies to know that they're safe and recognize how long it's been, yes, you. You had a heart attack. It was awful, and it's been six months, and you haven't had another episode. You haven't had another issue. Isn't that awesome? Helping them recognize that today is a good day. We're just going to take it as we come. It's been a while, so they're not thinking that, you know, I'm going to have another one. Well, what are the facts in this context at this time? You had one. Yes. But you haven't had any other issues since then, so what makes you think you're going to have another one now? And helping them evaluate the probability. Is there a possibility you're going to have another one? Yeah, there's a possibility. Anyone can have a heart attack right now. What's the probability you're going to have one right now? And we're talking about your energy. Is this how you want to spend your energy, worrying about whether you're going to have a heart attack, or do you want to use your energy to do something else? We need to recognize that when people feel unsafe because they feel like their body is failing them, because they feel like the environment is unsafe, it increases stress. Historical trauma can be triggered by people entering their rooms, loud noises, certain smells, or being unable to see clearly and evaluate environmental threats. This can increase anxiety and hypervigilance. If you've got somebody, which you do, if you're in a facility, you've got at least one person, if not multiple people that have a history of trauma, they've been victimized in some way. And so there are things that may trigger memories of that trauma and emotional physiological responses. We store trauma not only in our brain, but also in our body. So that stress response kicks off when we start feeling like it's a similar situation. And that's when we have to check the facts in this context at this time. But we also want to mitigate and minimize exposure to things that we know are going to set the person off. We don't want to enter their rooms without knocking, without turning on a light. You know, you don't want to enter their room, especially without not knocking in the dark, and go over and put something on their bedside table when they're sleeping. If they wake up, that may freak them the heck out. Even if you do knock, if they can't see you, especially if they were in a deep sleep, they may not be oriented enough to think, oh, this is the night nurse bringing me my meds. So it's important that we figure out what People's trauma triggers are so they can feel safe. Certain loud noises can be triggering or reminiscent for some people. And knowing what to do in here in Tennessee, we have a lot of tornadoes and thunder. Loud thunder or really loud wind can actually be triggering for some people because they've lived through a tornado and, and they, it reminds them of that. And they're like, oh, crap, what if that happens again? Facts in this context at this time. So in your facility, making sure. Or wherever they are, making sure that they know what the plan is to stay safe, making sure that they know if they have tornado anxiety, making sure that they know where they can go and that there is something they can do to protect them themselves so they feel safe and empowered. Can you prevent a tornado from coming? Absolutely not. But can you have rooms where people will be safe? Absolutely. And that's what's important to help people feel safe and empowered. We'll take care of the rest of the stuff, but if you're safe, then we can move on from there. And that, that is really important because if one or more people start in your facility, start getting agitated, it spreads, it's contagious a lot of times. And people will either go to their rooms because they don't want to be around the, the stress energy, or other people will start getting cranky and they'll start ramping each other up, talking about, you know, worst case scenarios and oh my gosh. And sitting there glued to the weather channel. Oh, oh my gosh. Glued to the weather channel, which does nothing but for a lot of people, but increase their stress. So it's important to be aware. And for some people, it's helpful because you can see where those little areas of circulation or whatever they call them are popping up and know that, okay, that's nowhere near me. I'm good. For other people, it's just stressful. But figuring out what works for each individual is important. Taking into consideration sounds in your environment, doors banging. If they came from a abusive environment, maybe not recently, but maybe when they were a kid, um, they were in an abusive environment where people were harmed, where doors were slammed, where it was really ugly. When doors are slammed now, it can trigger that memory. We store that. Our body says, I'm not doing that again. We need to recognize that. Can we prevent doors from being slammed all the time? 100%. No. And helping people develop skills to re. To get grounded and remember where and when they are. I am in the year 2025. I am safe. I am not back there. I am safe. Where I am. That is helpful. But we can also do what we can to make sure that doors are have hinges that are set to do the soft close that, you know, there's to minimize, to minimize the slamming and the loud noises. Fire alarms can be very triggering for some people, especially if they've lived through a fire, but they're also just startling. And I know we've got to do fire drills on every shift and we used to have to do those in residential too. And it was problematic. It was challenging, but it was necessary. And it was important to make sure that the residents knew that, hey, this is to make sure that you're safe. If we don't do this, then it's a free for all and it's not going to be orderly and it's not going to be safe. So we're going to do this. The noise itself can be disorienting. Helping people get oriented and desensitized to it can be important. Loss of sensory input and slowed sensory processing also impacts communication and social engagement, raising risks of loneliness and distress. Have opportunities throughout your facility or throughout the person's home where they can engage in social engagement and activities. Whether it's virtual. Maybe you have like an Amazon Echo at home where they can video chat with the grandkids, maybe they can go out. That's the wonderful thing with Ubers. Not only do we have home delivery of groceries and stuff, we also have Ubers now. We always had taxis and stuff before, but Ubers are so much more responsive. That can take people to the senior center, that can take people to the library. For those who are independently mobile, Mechanisms linking feeling unsafe and health. Well, the stress response is an adaptive short term, but it's harmful when it's persistently activated because we're bathing our neurons in stress, which ends up killing them off. Stress increases cortisol, blood sugar and stress chemicals to help you fight or flee. But that's supposed to be short term. You run away from the hungry lion, you get safe, you relax. It's not supposed to be a ultra marathon. Chronic stress dysregulates the nervous system, increases inflammation, impairs sleep, and decreases overall bodily repair and resilience. Think about a car. And I'm really bad with my automotive metaphors, but I'm going to try it anyway. Think about a car that you never take to have its oil changed. You never take it to. You give it bad gas, you never take it to be tuned up. You know it's in chronic disrepair, you're not taking care of it. You're not letting it rest and heal. So it's not going to be as gas efficient, it's going to break down more often, you're going to have more problems with it. Adopt a trauma informed lens to identify triggers and increase safety and empowerment. You know your environment is safe and the person objectively probably knows that the environment is safe. What they know and what they feel may be very different because feelings can be triggered. Smell is one of our strongest memory triggers. Now, I know as we age, we lose our sense. Our sense of smell becomes impaired. It doesn't completely go away, but the sense of smell can be triggering. But there are a lot of things in the environment, sights, smells, sounds, etc. That can trigger memories of prior trauma. And we want to ask the person, what is it that in the environment that makes you feel unsafe? My stepfather's family, first family, unfortunately perished on Christmas Eve as a result of faulty Christmas lights. So guess what? Some of his triggers were Christmas trees and Christmas lights, which you know are up everywhere. But recognizing that my mother never put up a Christmas tree because she knew that it was going to be too triggering for him to have that up. And we can't expect everybody to forego a Christmas tree because the Christmas tree is triggering for one person. But it is helpful to make sure that there are spaces where the person can get away from that. You don't want Christmas trees and Christmas decorations in every single room because it might be triggering for somebody. But we don't know. We don't know until we ask. Are there particular things that trigger trauma memories for you? And if so, let's talk about what we can do. Smells, that's another one. And I mentioned smells as a strong reminder. My grandmother always cleaned with pine saw, so for me, pinel triggers happy memories. For somebody else, pinel may be associated with not so happy memories. The same thing. My, my son was a micro prey. So we spent weeks in the neonatal intensive care unit. And I swear, every hospital uses the exact same cleaner. You can go into a hospital in Florida and one in Tennessee and they smell the same. That smell reminds me of the time that we spent in the nicu. Not necessarily the happiest times, not the worst, but it does bring back memories. And just understanding how we work as human beings is important. So we can recognize that it could be somebody's cologne, it could be what we're cleaning with. And if it's stressing somebody out, what can we do? You may not be willing to change the cleaner you're using at Your facility because corporate bought it in bulk. Okay, fine. So what can we do for this person for whom this is triggering? Maybe they can. We cannot use that cleaner in their room. Maybe we can use an alternate cleaner in their room. Maybe, I don't know. You can brainstorm. We need to address sensory impairments in older patients through regular screening. Use of assistive devices like hearing aids and glasses and apps to help them retain as much independence as possible for as long as possible. Make environmental modifications. Improve lighting so they can see without glare, so it's bright during the day and, and less blue light at night and there's reduced clutter. Clutter apparently is stressful for everybody, which I know is stressful for me, but research has indicated that it's stressful for most people. But clutter often creates a trip and fall hazard. And that's really what we're worried about because we want to make the environment safe, and safe means people aren't going to get hurt. And provide supportive communication. Recognize the interplay between sensory decline, trauma risk and emotional well being. If my senses go down and I'm not perceiving dangers in the environment and I get hurt, then I'm going to be more anxious that I am vulnerable to get hurt again. Adopt slow and gentle care approaches to build trust and a sense of safety. When you touch a person, an older person, it takes a minute for them to register that you're touching them. And you don't want to just come up and, you know, pat somebody on the back. It may startle them, especially if they didn't know you were coming up from behind. So be slow, be gentle, and build trust so people know that they can. They're not going to be startled. Encourage the use of sensory aids and educate about environmental safety to mitigate feelings of unsafeness and trauma. This includes, for proprioceptive senses, the sense of touch. This includes using walking devices. Some people will refuse adamantly to use something that's going to help them with their balance. And that can be a real challenge at keeping them safe. We want to be as empowering as possible to help them make their own choices. But we also want to make sure that we are arranging our environment in a way, especially if they're in an assisted living facility or a nursing home, were making arrangements to the environment in a way that is not going to be risky for them. Feelings of unsafeness triggers chronic stress and anxiety leading to mood disorders. When we're feeling unsafe, when we're feeling vulnerable, that anxiety is up, it's going to increase irritability which decreases our energy. It also can increase emotional dysregulation, or that going from flat to furious. You know, I'm fine, and then all of a sudden I'm just popping off. And nobody knows exactly why. Emotional dysregulation is common in people who are chronically stressed. Heightened fear can alter personality traits toward avoidant or dependent patterns. So if a person is feeling ultra vulnerable and they may withdraw and just be like, no, I don't want to engage, I don't want to do any of those activities. I don't want to leave my room, just leave me alone. Or we may see people on the other end where they don't want to be alone. They want to be around staff all the time because they're afraid if they're alone, something bad's going to happen. We tend to see the dependent patterns happen more after somebody has something like a heart attack. And they're afraid that if they're alone, maybe nobody will find them. What can we do for that person? We can have fall monitors. We can, you know, there are a variety. There's technology is wonderful. We can actually use technology if they will allow us. Some people find technology creepy and they don't want cameras in their room. They don't want to wear this monitor thing there. Another issue, especially for people who are aging in place, is educating them about their device. My grandfather wouldn't use the, the fall alert thing because he was afraid that if he used it that the ambulance would come out and they take him to the hospital and he's like, I'm not going to the hospital. You can hang that up. When once we educated him that yes, they will come out, but you can refuse to go, they can't force you to go unless it's life threatening or something. But you, most of the time, you just sign a paper and say, I'm refusing medical intervention and everything, and they'll leave. After that. He was willing to use it. Hallelujah. So behavior is communication. Why are you refusing to use this? Because I don't want somebody to commit me. I don't want somebody to put me in the hospital, okay? I don't want somebody to take away my power, okay? Well, they're not going to, and this is how you avoid that. So educating blood sugar regulation is also important. Chronic stress from feeling unsafe activates the stress response, causing prolonged cortisol and blood sugar release. This can reduce insulin sensitivity, raising the risk of diabetes or worsening existing blood sugar control. A lot of times when people first are admitted to an assisted living facility or a nursing facility that change an environment is stressful and their blood sugar will be much more chaotic until they feel safe, until they get their groove. And that's one of the things, especially if they've got a continuous glucose monitor. I actually like using the data because we can see if their nutrition's staying pretty stable. We can see a reduction in stress by a reduction in the variability of their blood sugar over time. Blood pressure also is negatively impacted by stress and long term elevated blood pressure increases inflammation and the risk of developing hypertension, heart attack and stroke. We don't want somebody to be stressed and cranky and all the time because we don't want them developing hypertension. Now there's a lot of other things that can cause hypertension. Smoking is associated with hypertension, drinking, etc, and we may not be able to address those things, but we can help them feel safe. We can help them reduce their overall or undercurrent of stress. Chronic stress and anxiety cause inflammation and brain inflammation by activating what's called microglial cells in the brain, which ultimately lead to neuronal damage. This inflammation is linked to cognitive decline and increased risk of neurodegenerative diseases such as dementia. They have shown a direct correlation. We can't say causation, but we know that when we see chronic inflammation, the chances somebody is going to develop dementia or a neurodegenerative disease goes up exponentially. Likewise, when we pull down inflammation, when we reduce inflammation, their risk of developing dementia and neurodegenerative issues also decreases. Feeling unsafe can intensify chronic pain conditions like fibromyalgia and rheumatoid arthritis and trigger bodily symptoms. Stress also suppresses the immune system and, and increases inflammation, increasing vulnerability to infections and autoimmune diseases. So when people feel unsafe, they are just waiting to have their health health start to deteriorate. Prolonged stress impairs memory, attention and executive functions through hormonal, neurotransmitter and inflammatory pathways. Remember, remember when I said when you're in activating the stress response, you're not in your wise mind, you're not using the prefrontal cortex and you're thinking, you're planning, you're organizing all that stuff, you don't use it, you start to lose it. So chronic stress is associated not only with a decline in those things, because when you're stressed, those, those two parts of your brain aren't communicating as well. But even when you're not stressed, if you haven't been using that Part of your brain, it's probably not going to be as sharp as it was before. Adjusting to sensory issues common in older adults. Noise issues and interventions. If it's too loud, help them get some hearing aids or hearing earplug things and. And again, you can get them from Walmart or Amazon or those places that can help block out some of the ambient noise so it turns down the volume. If it's too soft, help them work with an audiologist to get hearing aids if needed. If they've got tinnitus ringing in their ears. Oh my gosh, it's maddening. It is maddening and it can feel deafening. Sometimes there are apps that you can get on your phone or you can use just videos that have ambient noise like birds or white noise or brown noise or pink noise that compete, if you will, with the buzzing, hissing, ringing. Whatever sound the person has, that's their tinnitus and it helps distract the brain from that sound. They haven't found a way to cure tinnitus yet, but that can definitely help if there are certain trauma triggers. Figuring out what they can do to feel safer. As I told you before, I startle easily. Loud noises make me jump, make me startle, and I can't completely eliminate that. We have wood floors, we have dogs, and we have Amazon delivery. So somebody's going to bark at some point and you know, I can jump, but I can remind myself I'm safe. It's all good. It's just the dog lighting issues. If it's too dim, invest in mobile lights or reading lights that you can put by each person's chair in order to like easy chairs in order to increase light in their particular area. There are a lot of ways to increase the brightness in rooms. Now they've got some really bright LED bulbs, but that's something between you and corporate and you know, whatever about what you're going to do to make sure that it's bright enough during the day. Flickering lights. Not only is it stressful and annoying, but if somebody has a seizure disorder, it can trigger a seizure. So get rid of the flickering lights. If you can get rid of all. What are they called? Fluorescent lights, that would be wonderful because fluorescent lights tend to flicker at some point. But recognize flickering can cause headaches, it can cause moodiness, it can cause seizures. If the light is too bright, too harsh or too much glare, what can you do? There are glare reducing shades that you can use. For example, if you've got a south facing window and the light just like beams in and is too Bright for people who are trying to watch tv. All right, arranging that so there's not a lot of glare coming off the television. And older adults, because those senses take longer, have difficulty, their eyes have difficulty adjusting to light. So when they go from dark to light, like when you leave a movie and you've been in the dark for two hours and your eyes are adjusted to that, you walk out and it's two in the afternoon and you're like, oh my God, it's bright. Well, older adults take longer to adjust, so be sensitive to that and give them a minute so they can see clearly. Same thing from light to dark. If they're going from a well lit room to a dim hallway, it's going to take their eyes a minute to adjust. If they are leaving their dark room to go into a lighted hallway, it's going to take their eyes a minute to adjust. That's going to be shocking. So allow them time to adjust and recognize they're not trying to be slow, they're not trying to be challenging. Their brain just needs a second to catch up in high movement environments. Because a lot of older adults have poor vision or poor peripheral vision. Announce yourself. If you're coming in the room, announce that you're coming. A couple of the facility, I wear heels, so a couple of the facilities that I went into, they didn't have carpet, so it was really hard not to hear me coming because I sound like a Clydesdale. But it is important to announce yourself so you don't walk up behind somebody and scare them. Preferably if you want to talk to somebody, walk around in front. Even if you think they did hear you coming up behind. Walk around in front before you start speaking to them. Position people so they can see entrances and exits and people moving around them. Most of us don't like a lot of stuff going on behind us and around us. It puts us a little on edge. So try to adjust your, your sitting areas and your group areas so the person doesn't have a lot of movement behind them. And make sure they can adjust their personal areas so they feel safe. And they can see the entrances, they can see the windows, they can see the doors. If the door is in a vestibule, consider setting up a mirror so they can see if somebody comes in. Allow the adult to adjust to changes in light levels. We talked about that. And if you're in, maybe you, you have somebody who's aging in place, or maybe you're having a family weekend at the facility and grandkids are coming, which is Wonderful. We all love the energy and enthusiasm of children and dogs and whatever, but it can be overwhelming. So it's important to have a slow movement zone. If you're in this area, you're not going to be running, you're not going to be, you know, moving around really quickly and stuff. It's a slow movement zone and that is a great place for people to be able to relax and know that they're not going to have some, you know, six year old zooming through like, like a little crazy person. For smells, we can add positive smells for reminiscence. Maybe people remember the smell of pine saw or, or they a certain type of coffee or whatever. Have people think about what smells do you remember that make you smile and add those to the environment. It is so easy to find a lot of those things in fragrance oils or essential oils or even just cooking spices. Now then there are the trauma, noxious or traumatic smells. Paint, oh my gosh, paint gives me a headache. So if they're painting, have to have the windows way open, have to have fans blowing. That can be really helpful. That may not always be possible with every noxious smell, but it is important to be sensitive to smells that people find particularly offensive. They may need to stay in their room if there's a smell that really bothers them. They may need to have air fresheners that they can spray in their room. They there, there are things they may need to put Vicks VapoRub underneath, underneath their nose, which is what a trick I learned from my husband when he was on patrol. It's what they did when they had to deal with a dead body, but so they didn't have to smell it. But putting Vicks VapoRub under your nose, you're not going to smell a lot. So that can dull any triggering smells that are in the environment. Identify with the person triggers for unsafeness and strategies to address those. For example, if I'm trying to live independently and I'm afraid I'm going to leave the oven on, which you know, is not uncommon because I get distracted doing something. So you know, they do have things. There's something called an I guard stove. It's a little device that you attach to the stove which is the upper part of the oven and it turns it off after a period of time. Some stoves now come with an automatic shut off. If it's been on for more than X number of hours it turns off. So there are safety things for stoves which tend to be more dangerous as far as fire is concerned than the ovens. But I also worry about the ovens. Another thing you can use is an induction cooktop. Those cooktops only heat up when a certain type of pan is put on top of them. You take the pan off the the stove top is not hot. It doesn't stay on. That can be really helpful. If you've got somebody who forgets microwaves sometimes it may be time to just say nope, I don't feel safe using the the oven any the stove anymore. I'm only going to use the microwave because I know when that thing cuts off, it cuts off. If you have an older adult who is aging in place but they are not safe using the stove without supervision anymore, then you can get stove knob locks so you don't have to remove the oven and the stove from the house. I mean you, I guess you could unplug it too, but then if you want to use it, it's a problem. But stove knob locks are helpful because then when you go over, if you're going to make a meal for them, you can easily take the locks off and then you can put them back on later. And there are oven auto shut offs. So if you put a roast in the oven and it needs to cook for three hours and you forget about it, it turns off after the oven off after a period of time so you don't end up with a charcoal briquette or worse. For adults who are afraid that they're going to forget to lock the door, there are programmable smart door locks. We have them on all of our doors and they're great because if the kids want to come over, I can turn on their code and they can let themselves in and then. But if I don't want them to come over for some reason or have free roam of the house, then I, I disable that. If I need my neighbor to come over and water my plants, she has a code and I can turn that on when I'm going out of town so she can come and go, but I don't have to leave it on all the time. If I want to know did I remember to lock the door? I can look and see if it's locked now. Our locks actually automatically lock after 15 seconds. So you know, easy peasy there. So for people who have an anxiety about forgetting to lock the doors, these new fangled locks can be super helpful. We also want to remember if they're living in a facility, being sensitive and not just using the master key to let your let yourself in willy nilly is really important. Fear of fire. Some people are afraid that they're going to be home alone or a fire is going to go off and they're not going to know. We want to have visual alarms and smart smoke alarms that will maybe vibrate on a mobile device or let the person know, hey, there's a fire. Fear of victimization. Well, we need to know what are you afraid is going to happen? For a lot of people, they're afraid somebody's going to break in. They're afraid to go to sleep. So ring type door cameras, so they can see what's going on around their house or around the area, they can see who's outside their door. Bedroom door locks can be really helpful. That so they know that nobody's going to come in when they're asleep. Fear and, and I know in facilities you have to have a master key just in case you need to get in there for a medical emergency, etc. But it's important to talk with the person about when somebody is going to come in and help them feel safe about it. Fear of natural disasters. We talked earlier about tornadoes. Tornadoes, fires, hurricanes, floods. If people have experienced those, or even if they haven't, if they've seen other people experience those, they may be afraid if this happens, I won't be able to get to safety. Making sure that they know what the plan is, they know how they will stay safe in the event of a natural disaster is important. And fear of strangers in the house, as people get older, they feel more vulnerable. And unfortunately, there are a lot of bad actors that will take advantage of older adults. We had a couple of bad actors that took advantage of my grandmother and ended up stealing all of her jewelry. And she felt so violated and she felt so unsafe and she didn't want anybody else to ever come in the house after that. How can we help people feel safe if they have to have a repair person come in to work on the stove or the air conditioning or what have you? Or if new staff in facilities, when new staff who are essentially strangers show up, how do they know that those people are safe? Now in facilities, ostensibly all the people coming in have been vetted and whatever. So a lot of people have a little bit more of a sense of security. But if they are aging in place and they need to have a plumber come over and they're by themselves and they may feel very vulnerable, so what do they do? Have somebody be with them so they're not alone. If somebody can't physically be be with them, have somebody be with them on their mobile device or on their Alexa on video chat so there's somebody else seeing what's going on talk with them about what's going to help them feel safer. There are also places that offer handyman and repair services that have safeguards in place. They will call ahead of time and they will say Jim is coming. They'll send email you a picture of Jim so you can look in your email or your maybe they'll text it to you and you know what Jim looks like. So when somebody shows up at the door and they says say their gym you can look and you can go yep your gym and you can feel safer that the person that you're expecting is actually the one that's there and that you're going to be safe. The environment can greatly impact a person's stress level. Adjusting the environment and empowering them to do things so they feel safe can help them maintain not only a relaxed state but maintain a greater sense of independence and empowerment.