The holidays can be very overwhelming for dementia caregivers and their loved ones. For you, it's about the stress of more responsibilities, more obligations, worry about staying on budget and more worry about how everything will go--on top of all the hard work you already do.
For the person with dementia, Christmas can be a sudden, chaotic upheaval of their normal routine. The house changes, people are hurrying about, and "strangers" are dropping by. All in all, Christmas can be noisy and visually hectic, which can exacerbate the already-present sense of disorientation.
To make the holidays more enjoyable for everyone, here are some tips for reducing stress and anxiety for the elderly with dementia so that you don't have to be stressed or anxious as a caregiver:
1. Put Safety First, Always
One of the perpetual issues in the nursing home, at Christmas, was keeping the residents away from the decorations. Naturally, they were filled with curiosity and awe when they saw the tree with all the merry lights and shiny baubles.
A few residents would forget the tree as soon as it was out of sight. When they saw it again, they would want to touch it, pull on it, and walk around it. This can be hazardous.
Make sure that any cords for holiday lights are tucked up along the wall, or pushed back behind furniture. Don't run cords across the floor, and if possible, place the tree against a wall so that the plug is in the back, with no room to walk around the tree.
Real trees are lovely, but heavy. If your loved one has the habit of "messing" with things then pulling or tugging at the ornaments and light strands could cause the tree to topple over.
A fake tree will still fall if tugged, but weighs less and will cause less injury. If this may be a real issue, then a table top tree might be a better idea, or a discreet tie can be placed around the tree pole and anchored to the wall.
Other safety issues to take into consideration include:
- Candles--Never leave lit candles and a person with dementia in a room together unsupervised. Don't place candles on tables where they can easily be bumped, or sitting close by someone who cannot see them.
- Glass--To avoid cuts, lacerations and puncture wounds, consider plastic, satin, wood, or smooth metal ornaments that will not break if handled and dropped.
- Toxic Greenery--cedar berries, poinsettias, holly berries and ivy can all be toxic if ingested, or may cause skin reactions. Although a large quantity has to be consumed in order to be fatal, a bad case of digestive upset is not fun during the holidays.
- Choking Hazards--hard candy, nuts, dried fruit, ornaments that look like candy and other small things that are set about for decorations can be a choking risk for some persons with dementia. If dysphagia is an issue, consider keeping these things in out-of-reach areas, or set out only when supervised.
- Alcohol--'Tis the season when many toast each other with wine, cider, bourbon and other liquors. Remember that alcohol can be dangerous to people with certain health conditions, and can be deadly when taken with certain prescription medications. Make sure non-alcoholic beverages are handy, and that no one tries to spike the punch secretly as a joke.
Don't forget basic safety, like avoiding slick floors from tracked-in snow. Keep your outside steps and sidewalks clear of snow and ice, and always making sure your loved one is appropriately dressed when going outside, even if it is only for a few moments.
2. Decorate Slowly
Many residents became fearful or anxious when their environment changes. In the nursing home, Christmas was especially hard for them, because everyone was excited. They weren't sure how to interpret that energy, and it made them restless.
Also, the home went from being plain, beige and familiar to being awash with lights, inflatable decor, a tree, and people walking around in Santa hats.
In your own home, you have complete control of the environment. One of the easiest ways to reduce anxiety is to do a gradual transition.
Instead of coming in one evening and decorating the entire house in a couple of hours, start earlier in the season and introduce changes at a slow yet consistent rate.
Go ahead and put the tree up first. Many people with dementia still have fond memories of the holidays, even if they can't express them, and the tree is the "main centerpiece" of Christmas. They can focus on that one change instead of being faced with a hundred new things to look at and absorb.
From there, add your decorations a few at a time. A wreath or two and some garland today, the knick-knacks the next day, the Christmas linens in a couple more days. This is especially helpful if you rearrange your furnishings in any way to accommodate the decor.
3. Tone Down the Lights
Lights are pretty and fascinating, but to someone with dementia, they may be scary too. Multiple strands of lights that flash, race, fade or twinkle can intensify disorientation. Blue motion lights hung outside can mimic police lights when glimpsed through frosty windows, which can create as sense of fear.
Instead, try static lights or ones that do a slow fade. Keep them consistent.
Color is important too. Streamline your color options to just one or two for indoors. You can be as wild as you like outdoors, but if your loved one is agitated by thing outside their window, hang up a room darkening curtain or avoid decorating near their room.
4. Be Mindful of Motion Sensors
Have you ever walked through as store, calmly browsing, only to be startled when a holiday figurine or toy suddenly started laughing, squealing, barking, singing or dancing?
Imagine how that would feel if you didn't know what the item was, or why it was doing that. Imagine not knowing if it were real or imagined. Imagine not knowing how to tell someone it worried or frightened you?
That is what happened one Christmas when someone generously donated a snowman to the nursing home. Whenever you walked by, it would start to shimmy, sing, and call out Christmas
greetings.
Most of the residents loved to sit and watch it, but it scared one of our ladies so much that she injured herself trying to run away from it. She was so petrified of it, that we eventually had to move it to the patio area.
If your loved one startles easily, suffers from hallucinations, or is simply scared of unexpected noises, you might want to skip the motion activated decorations. Opt instead for the kind that repeat a gently activity on a cycle or loop, or things that have to be activated by hand, such as wind-up music boxes.
Besides motion sensors, be careful too about large outdoor figures that can cast silhouettes on your loved one's window. An acquaintance had to relocate his yard display because his mother was convinced that Santa's shadow was a burglar outside of her room.
5. Plan Parties and Visitors Carefully
You might dream of having a big houseful of people surrounding you for Christmas. Your elderly loved one however, may not be so enthusiastic.
Even if everyone who attends is a close relative, large crowds can make your mom or dad uncomfortable. They may feel embarrassed that they don't recognize names and faces, that they can't recall certain events.
Not being able to recognize who is there, or to understand why they are there, can lead to anxiety. This can intensify if there are vision or hearing problems or if memory loss is advanced. Guests can accidentally make this worse by asking your loved one things like "Don't you remember?" and "But you know who am, don't you?"
Confusion, anxiety, disorientation and fear can lead to behavioral issues like wandering or aggression. It can also increase the "clinginess" many caregivers know all-too-well.
If strangers or even familiar visitors seem to agitate your loved one, especially in groups, you might want to trim the guest list down to the most important people.
If your heart is set on a party, you may have to arrange for a trusted relative or companion to provide care until the bulk of the guests depart.
At the very least, maintaining a low-key atmosphere that closely resembles the usual routine (i.e meals at the same time) may help.
Have a Safe, Happy Holiday with Your Elder!
Although it is not impossible to share and enjoy a wonderful holiday when you care for someone with dementia, it can bring up some new issues to deal with.
Just try to see Christmas from their point of view (their home suddenly changing, tons of unfamiliar objects, furniture out of place, strange people doing odd things and asking them questions, and a break from routine) and customize your holiday to match their needs.
Since not every elder is the same, you may be able to alter the events only minimally, and yet still produce a wonderful day that everyone can enjoy, safely and stress-free!
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