Dec 8, 2011

On Pins and Needles During the Holiday with a Loved One with Dementia

It becomes a matter of letting go of past expectations, and embracing this elder exactly where they are today. You can enjoy the holiday with the elder when you keep their routines, likes and dislikes in mind at all times.

By Cindy Keith

When you have a loved one with a type of dementia such as Alzheimer's in the family, do you find yourself on pins and needles with the approaching holidays?

You may even be dreading the upcoming holiday season.

That feeling is certainly understandable given that these elders often act unpredictably, and unintentionally say hurtful things to family members.

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I would like to offer some tips to help you avoid those pins and needles, keep your loved one safe and happy, and for all of you to survive the holiday emotionally intact:

  • Give up the idea that you can have all of the traditional foods and activities this year. You may have to pick and choose a few of the least upsetting for the elder. Large crowds of people (family) cannot be tolerated for very long, and they certainly will not remember names or relationships and will become agitated when asked to do so. Always give them clues such as "Dad, here's your little brother Davy and his family." The less they have to figure out for themselves, the more calm they will be.
  • If the elder is confused and believes a daughter is his wife, he may her by his wife's name. You may be able to simply laugh and say something like "Dad, I'm not Mom! I know I look at lot like she did when she was younger, but I'm Alice, your oldest daughter." If that doesn't work and the elder still insists, you must agree, and slowly change the subject. Possibly changing your appearance in some way will help him let go of his belief.
  • Tone down the noise on all activities. Rousing family sing-a-longs may only upset the elder, not only because of the noise level, but because they may not be able to participate as they used to. Small children running about making noise can also upset the elder who may think they are being injured if they are squealing or screaming in delight.
  • If your parent has dementia and the tradition is for you and your family to always visit for a week or two and stay at the family home, you will all be more comfortable if this year you choose to stay elsewhere and just visit the family home daily. Routines are very important to elders with dementia, and when "new" people are introduced into that daily routine, they become more confused and upset. You goal is to keep the elder calm and happy because, as you are well aware, when they are calm and happy, then you are also calm and happy!
  • Remember that your goal, and the goal of everyone in the family, is to keep the elder with dementia safe, happy, calm and treated with dignity at all times. They cannot change the way they are responding to their environment. You and the rest of the family, whose brains are not damaged, are the ones who must do the changing and work to achieve the goal at all times. That means if the elder insists it's not December, but February instead, then you must apologize and say something like "Oh, I'm sorry. I am really confused here. Of course, you're right. I think you would enjoy coming with me now and ..." It will serve no purpose whatsoever to try to continually reorient that elder to your reality and they will only become agitated and possibly combative if you continue to try.
  • Try to never say "Do you remember..." You are just setting them up for failure and frustration when they cannot remember. Instead, give them clues such as "I remember when this picture was taken, that's me, and that's you...." Keep photo albums out where they can be easily accessed. The long-term memories are still there, and they will enjoy looking through the photos and remembering. If they do not remember, or tell you you're wrong, don't argue, simply apologize, and move on to the next picture.
  • Preserve rest periods for the elder if that is their routine. They can become more confused and unsteady on their feet when they become over tired.
  •  If the elder is starting to become agitated, first check for all the likely reasons such as needing to use the bathroom, hungry, thirsty, too much noise, etc., and then remove them to a quiet place and bring up some wonderful memories that you know will help them become calm again. Possibly remembering a favorite pet, or the story of a treasured vacation. Don't correct errors in the their stories. This is their new reality and trying to change it for them will only upset them.
  •  If you are all gathered together in a large family group, try to appoint one person to sit beside and attend to the elder the entire time. That person must be someone the elder is comfortable around, and it is entirely possible that the elder may wish to be removed from the activity to a quiet area so having appointed the “sitter” in advance will make it easier on everyone.
  • Music is stored in a different area of the brain, and so many elders with dementia who can no longer speak or know what words mean, can sing an entire well-remembered song. Be sure to tap into those songs.
  • If you have small children who will attend a holiday mealtime with you and the elder with dementia, it's a good idea to prepare them in advance for some behavior that they will notice and comment about. For example, if the elder can no longer use utensils to eat with and will use their fingers, you may have to tell the child in advance that "Grandpa is having some trouble with his brain, and sometimes he can't remember how to use his fork and spoon. We know you're a big boy now and no longer eat with your hands, but that is the only way Grandpa can eat right now. We must all just remind Grandpa that we love him and help him in any way we can."
  • Traveling with an elder with dementia will challenge your patience and the abilities of the elder. If you must travel, it will be much easier and safer if you have a third person present to help you. If the travel involves an overnight stay away from home, you will need to be especially vigilant about the likelihood that the elder will awaken in the night and not recognize his/her surroundings, and leave the house in search of “home.” Barricading doors in the hotel rooms with suitcases (moving the suitcases would make noise and awaken you), or rigging a simple noise to sound if the elder tries to exit the house is crucial and could save a life.
  • Allow the elder to participate in any way they can. If Mom used to always make the holiday bread, can she still participate by gathering ingredients and helping knead the dough? Don’t assume the elder can no longer remember how to manage a traditional activity. They may not be able to complete the activity alone, or need help with most of it, but they still remember what it was and how good it made them feel, and that’s what you want them to remember.

You and your loved ones can still create many new and happy memories of the holiday with the elder with dementia when you keep the above tips in mind so the elder does not become overstimulated, or too tired, or more confused or angry.

It becomes a matter of letting go of past expectations, and embracing this elder exactly where they are today. You can enjoy the holiday with the elder when you keep their routines, likes and dislikes in mind at all times.


Cindy Keith, RN, BS, CDP has extensive experience working with Alzheimer's and dementia patients. As a nationally known speaker, Cindy regularly travels throughout the United States giving day-long seminars on the importance of facility staff training in all aspects of dementia care. Cindy is the author of Love, Laughter, & Mayhem - Caregiver Survival Manual For Living With A Person With Dementia. She an be reached through M.I.N.D. in Memory Care

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Original content Bob DeMarco, the Alzheimer's Reading Room