"Holiday Hints for Alzheimer's Caregivers"

By Lisa M. Petsche

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Many people consider the holiday season a hectic time, due to the preparations and festivities that typically take place. Staying sane, not to mention enjoying this special time of year, is even more of a challenge, though, when you're caring for someone with Alzheimer’s disease or some other type of dementia.

If you are relatively new to this role, or your relative has changed dramatically over the past year, you may be particularly anxious about the approaching holidays.

Follow these suggestions to help keep stress manageable for everyone in your household.

Gifts

• Shop via mail order if it’s hard to get out to stores. Buy gift certificates to cut down on shopping time and eliminate the need to make returns.
• For gift wrapping, use decorative bags and boxes to streamline the process and make it easy for your relative to participate.
• Keep presents stored away until it’s time to exchange them.
• Be prepared when friends ask for suitable gift ideas for your relative; suggestions should take into account not only his cognitive deficits but also any physical limitations. Request that gifts remain unwrapped or, at most, placed in a bag for easy access.

Decorating

• Don’t decorate too far in advance.
• Keep decorations minimal and out of reach as much as possible if your relative is prone to rummaging or hiding things. Don't put out anything that's valuable or fragile.
• Avoid lights that flash or play music, as well as sound- or motion-activated items that can startle.
• Don’t keep food out in the open - for example, a gingerbread house or dish of candy; avoid artificial food as well.
• Don’t let extension cords dangle or run across walkways.
• Don’t rearrange furniture (consider a tabletop tree if necessary) or allow decorations to block pathways.
• Ensure your Christmas tree has a sturdy base so it can’t easily be toppled.
• Steer clear of toxic holiday plants, including mistletoe, holly and poinsettias, and potentially harmful substances such as tinsel, angel hair and artificial snow spray.

Entertaining

• Whenever possible, entertain at home rather than take your relative to an unfamiliar place.
• Prepare guests for your relative’s cognitive and physical functioning, appearance, general mood and any unusual behaviors.
• Enlist a friend to supervise and, if necessary, occupy your relative while you're engaged in hosting duties.
• Forego mood lighting in favor of well-lit rooms, since shadows may cause confusion and fear.
• Ensure constant supervision when candles or a fireplace are in use.
• Keep music soft and stick to familiar selections.
• Keep gatherings small; especially limit the number of children. Otherwise, situate your relative in a quiet spot and have guests visit one or two at a time. Keep these contacts short, focusing on quality rather than quantity.
• Instruct guests to introduce themselves to your relative by name and relationship – for example, “I’m Mary, your brother John’s wife.”
• Unless you’ve arranged one-to-one supervision for your relative, place guests’ belongings in a secure area so he can’t rummage through them or remove them. (Coat pockets and purses may contain lighters or medications; keys may end up in a garbage can or drawer.)
• Clean up immediately after entertaining - empty ashtrays and glasses, scrape plates and store leftovers - before your relative has a chance to eat or drink anything that might make him ill.
• Before inviting overnight guests, consider how disruptive this might be to your relative's routines.

Outings

• If you accept a holiday invitation, do so on condition that you may back out at the last minute if your relative is having a bad day.
• Limit the time and ensure there's a quiet place your relative can retreat to if he can't handle the stimulation.
• Take along medications, adapted dishes and utensils, a bib, extra briefs and a change of clothes as applicable, depending on the timing and duration of outings.
• For dinner invitations, bring your relative’s preferred foods and beverages if you’re not sure what’s on the menu, or if it’s something he has never tried. Recognize that he may not eat as well as he normally does, due to anxiety or distractions.
• Attend an event without your relative, if it's not feasible to take him with you. Don’t feel guilty about it; you need - and deserve - a break.

Further Tips

• Keep holiday plans simple and let family and friends know your needs and limitations.
• Don’t provide your relative with details of festivities too far in advance, as this may cause anxiety.
• Include him in preparations to the best of his ability. Not only will this help orient him to the season, it will also make him feel valued and create a feeling of partnership.
• Share holiday memories. Bring out photo albums or home movies, and play favorite seasonal music.
• Schedule holiday activities during your relative’s best time of day. Space them out, and stick to routines as much as possible.
• Be prepared for challenging behaviors and have a plan in place to deal with them.
• Don't pressure your relative to participate in festivities. Previously enjoyed events may now cause distress if he doesn't understand what's going on or no longer recognizes family and friends.

Recognize that feelings of frustration, loneliness, guilt, sadness and anger are all normal reactions - for both caregivers and care receivers. Rather than dwell on them, however, focus on how you can make this holiday season as enjoyable as possible, given the present circumstances. Be realistic, and don’t hesitate to modify or forego traditions that are no longer practical.

Last, but not least, don’t forget to practice self-care: look after your health, find something relaxing you can do to give yourself a mini-break each day, and treat yourself to a special holiday gift.

Lisa M. Petsche is a medical social worker and a freelance writer specializing in health and elder care issues.