How To Adjust The Holidays For Family Members With Dementia

While the holiday season can be a wonderful time for families getting together with lights and traditions, it can be a difficult time for people struggling with dementia.

News Director Eric Douglas spoke with Jennifer Reeder to get some tips for families. She is a licensed clinical social worker and is the director of Education and Social Services at the Alzheimer’s Foundation of America.

This interview has been lightly edited for clarity. 

Douglas: What is the problem? What happens for somebody who’s struggling with dementia or Alzheimer’s around the holidays?

Reeder: With the holidays comes many traditions that families love to engage in. And when a person has dementia, it can become more of a challenge for people to maintain those traditions, because there may be certain things that might be more difficult for them. Whether that’s remembering how to make a certain recipe, or being able to decorate the home, or large groups starting to become overwhelming for the person. That’s why education is so important, I think, for families to really have some ideas as to what the challenges may be for the individual so they can reduce the potential challenges and the person themselves can have a happier time with their loved ones.

Douglas: So tell me about what some of those challenges would be. What’s the person experiencing? What are some of the reactions they’re having, such as, to a large crowd or blinking lights — that sort of thing?

Reeder: Dementia, especially Alzheimer’s disease, it affects the five senses. So a person’s sight will start to be affected by the disease, which means that things may start to look more two dimensional instead of three dimensional. They may start to have a hard time with depth perception. Walking can become more difficult. The overstimulation of lights, of noises, all of that can affect the individual. If somebody used to love going to parties with bright lights everywhere, and the crowd and all the noise and the music playing for them, that may have brought joy. But now since their senses are all being affected, they can have a more challenging time, it can become overstimulating for them in that type of environment.

Douglas: A press release discussed four steps to make things better for people with dementia during the holidays. Let’s walk through the four steps. (Full description included below.) 

Reeder: One of them is to avoid over-decorating. When we talk about those bright, blinking lights or some houses have decorations galore everywhere, although it may look very beautiful, it can cause that over-stimulation. It can cause disorientation and confusion for the person. We want to reduce the amount of decorating that we do and also be aware where cords are because we always want to be avoiding tripping hazards.

Douglas: One of the other steps was finding ways for people to meet one-on-one or in small groups, kind of a quieter, separate environment for somebody to meet with family and talk with family.

Reeder: Creating a safe space, creating a calm place for the individual. We want to try to reduce the number of people in the home if the person does become overstimulated by large groups. But if you just can’t do that, if you have a large family and they’re coming, then create a safe space in a room for the person to be able to go if they need to be able to reduce any bit of distress that they may be experiencing.

As I said before, that’s where people can visit with them. We always, always want to be continuing to engage the individual. It’s never about putting the person in a chair and then bringing them their food and their water, we always want to be continuing to engage the person in group conversations when they can still do that — when it’s not overstimulating for them.

Douglas: What are some of the other ways to help somebody with dementia during the holidays?

Reeder: Another one is about adapting past favorite traditions or creating new ones. For instance, if you always had an evening party for Christmas, or another holiday, and that’s when everybody would always come, let’s say Christmas Eve. The evening time can be very difficult for people with dementia, they can experience sundowning sometimes. So that’s when people can start to experience more irritability, confusion as the day is going by.

But for the individual, it can be more difficult to communicate that. It might come out as irritability, as confusion. So that’s where you might want to shift when you have your holiday events, instead of having them in the evening time, you might want to have them in the earlier part of the day. But you also want to be able to maintain the person’s routine as well, because routine is really, really helpful.

Douglas: So, what have we missed? What else do people need to know going into the holiday season?

Reeder: I always say any plan that we are providing, any type of planning that we are creating, especially when it involves the individual, we want to involve them in the planning aspect, too, so that they can give their input about how many people they want to come over or how they’re feeling that day — and what type of traditions that they may want to continue to do. We always talk about taking a person-centered, strength-based approach. Talking with the individual about what they want to do for the holidays, but what they want to be involved in, and maybe things that they never really enjoyed doing at all. And so it would be better for somebody else to take over on that task or whatever is happening.

It’s really about taking the time to engage the person, taking the time to talk with the individual, about how they view the holidays coming up. And just really doing that preparation, that planning and educating family about the disease. Because I feel like education is what ultimately is going to eliminate stigma. And there’s so much stigma that’s attached to dementia. And the best way to do that is by people learning about the disease and what’s happening for the person so that no one’s ever fearful or wary about engaging with the individual.

Tips from the Alzeheimer’s Foundation of America

Avoid overdecorating. Decorating is part of the fun of the holiday. However, too much stimulation may be challenging for someone with dementia. Keep decorations festive, but simple — too many flickering lights or noisy items could be overwhelming. Instead of elaborate decorations, try choosing a few favorite items. Phase in decorations over a period of days instead of all at once, so that changes to the person’s environment are less confusing.

Create a safe and calm space. Don’t use fragile decorations (which can shatter and create sharp fragments) or ones that could be mistaken for edible treats. Be mindful of potential tripping hazards on the floor, such as wires for decorations. Securely hook Christmas trees to the wall to avoid falls and use menorahs or kinaras with electric candles to reduce fire hazards. As well as a physically safe environment, create a space where your loved one can sit in comfort and where guests can visit in small groups or one-to-one. As much as possible, maintain the person’s normal routine when scheduling visits.

Adapt past favorite traditions or create new ones. Build on old traditions when appropriate, such as enjoying favorite music or movies, or looking at pictures of past holiday celebrations. Start new ones that center on activities and events the person enjoys and can do, such as touring neighborhood holiday lights, and do it together. Take a strengths-based and person-centered approach and incorporate what the person can do and what they choose to do now, rather than dwelling on what they used to do. Focus on those things that bring joy and let go of activities that seem too stressful.

Involve the person in the planning and preparations. Whenever possible, involve the person by asking what traditions are important to them — it keeps them active and involved and helps you prioritize and plan appropriately. For example, if they always sent out holiday cards or cookies and still want to do so, do it together with them. If they can no longer shop for gifts for their loved ones, invite them to help with wrapping the gifts so that they feel they are contributing.