Holiday Tips for Your Loved One with Dementia - Julia Nickrosz

The holidays are a time when we want to celebrate family, traditions, and the joy of being together. But when a loved one is living with dementia, the season can feel a little more complicated. While we still want to enjoy all the magic and warmth the holidays bring, it’s important to be mindful of our loved one’s needs and make adjustments to ensure they feel safe, comfortable, and included. Here are some ideas to help make the holidays a little smoother for both caregivers and those living with dementia.

 Create a Familiar and Comfortable Environment:

Familiarity is key. People with dementia tend to do best in their own homes, where they feel safe and comfortable. If it’s not possible for them to be at home, gatherings should be in a space as familiar as possible. This can help reduce anxiety and confusion.

Plan Small, Quiet Gatherings:

Large, noisy family gatherings can be overwhelming for someone with dementia. Instead, encourage family members to visit in smaller groups throughout the day. If you do decide to bring your loved one to a holiday event, try to keep the guest list small, and consider leaving earlier if they start to feel overstimulated.

Stick to Routine and Avoid Late Nights:

People with dementia, especially in the later stages, thrive on routine. Try to keep routines as consistent as possible. Keeping things predictable can help prevent confusion and stress. It’s also important to be mindful of timing—dementia can cause increased confusion and agitation later in the day. If possible, try to schedule holiday activities earlier in the day, when your loved one is most alert and comfortable, and avoid keeping them out too late.

Incorporate Quiet Breaks:

The holiday season can get loud and chaotic, so make sure to set aside time for quiet moments. If your loved one seems overwhelmed, gently guide them to a quieter space with less stimulation where they can visit with loved ones in a calmer environment. 

Reminisce and Connect Through Memory:

Long-term memories tend to remain intact. The older the memory, the more likely they are to remember it. Take advantage of this by talking about the "good old days." Reminisce about their favorite holiday traditions or ask about their childhood memories. This can be a wonderful way for them to connect with the present, even if they struggle with recent events. Avoid saying “Do you remember?” If they start to talk about a tradition you don’t remember or confabulate, that's okay. Meet them where they are in their reality.

Play Music They Enjoy:

Music has an incredible ability to reach people with dementia. The parts of the brain that process music are less affected by the disease than other areas of the brain. Music can help people with dementia feel connected, calm, and comfortable. Play familiar music, and if possible, let your loved one choose what they’d like to listen to (offer two choices). Avoid sources of music that may be interrupted by commercials, as it can break the flow.

Have a Backup Plan:

No matter how much we plan, sometimes things don’t go as expected. It’s important to have a backup plan in place, whether it’s a quiet space to retreat to or an early exit strategy if the event becomes overwhelming. Consider bringing an aide with you to the holiday gathering if your loved one may need to leave early, or if they require assistance with activities of daily living like using the bathroom. An aide can provide comfort and care, which may be less stressful for your loved one than relying on family members who are unfamiliar with their care needs. This can be a huge relief for family members as well, as caregiving can sometimes be overwhelming during busy holidays, without taking on unfamiliar tasks such as assisting with toileting. Keep in mind that your loved one can pick up on your stress, so having extra support and minimizing your stress can help you and your loved on enjoy the day to the fullest.

Get Them Involved in Simple Activities:

Even if someone with dementia can’t do everything they used to, find ways to involve them in simple tasks. Maybe they can help decorate the tree, set the table, or even husk the corn (my grandmother’s trademark way of helping, besides insisting on giving me a dollar at every toll booth!). It’s not about perfection—it’s about maintaining that Long-term memories tend to remain intact. The older the memory, the more likely they are to remember it. Take advantage of this by talking about the "good old days." Reminisce about their favorite holiday traditions or ask about their childhood memories. This can be a wonderful way for them to connect with the present, even if they struggle with recent events. Avoid saying “Do you remember?” If they start to talk about a tradition you don’t remember or confabulate, that's okay. Meet them where they are in their reality.

Don’t Forget About Safety:

Make sure their environment is safe. Look out for tripping hazards. A safe, well-organized space will help everyone relax and enjoy the moment without worry. If your loved one wanders, bring an aide with you.

These recommendations are meant as general guidelines to help navigate the holidays with a loved one who has dementia. However, it’s important to remember that every individual is different. You know your loved one best, so it’s crucial to pay attention to their cues and adjust accordingly. Adopt the recommendations that work for you, knowing that not all of them will apply in every situation. Ultimately, the goal is to make the holidays a time of connection, comfort, and care for everyone involved.

The holidays might look a little different when caring for someone with dementia, but that doesn’t mean they can’t be enjoyable and meaningful. By adjusting traditions, focusing on smaller, quieter moments, and remembering to stay patient and flexible, you can still create beautiful memories. And most importantly, take care of yourself as the caregiver. The holidays are about connection, and that includes taking care of your own well-being too. We wish you all a happy and peaceful holiday season.

Please know, if you would like to talk through your holiday plans, I am available. Sometimes talking things through can help when people are struggling to find the solutions that feel right to them with regards to how to include your loved one in holiday traditions.

Fall Prevention - What Makes Older Adults at Risk?

In our practice, we see many clients who are experiencing falls. Whether they are at home, in assisted living communities or nursing homes, their age, lifestyle and the progression of multiple types of disease states contribute to their fall risk. What we are told by geriatricians is that if an older adult has multiple falls, they are at grave risk for a catastrophic fall that will change their life. In our work as Care Managers, we are very focused on our client’s goals. We collaborate with our client’s families, Physical and Occupational Therapists, our client’s physicians, specialists, and private caregivers to put in place a plan to proactively support our client’s safety in their home and prevent these major events from happening. During the holidays, be especially mindful about fatigue as well as boxes and “stuff” from celebrations changing your loved one’s environment creating tripping hazards. Although falls can still happen even with the best laid plans, let us look at this very informative article from the National Institute on Aging at the National Institute of Health to help you learn the causes of falls and what we can do to prevent them.

NIA/NIH: Falls and Fractures in Older Adults

What causes falls in older adults?

Many things can cause a fall.

• Your eyesight, hearing, and reflexes might not be as sharp as they were when you were younger.

• Certain conditions, such as diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels can affect your balance and lead to a fall.

• Conditions that cause rushed movement to the bathroom, such as incontinence, may also increase the chance of falling.

• Older adults with mild cognitive impairment or certain types of dementia are at higher risk of falling.

• Age-related loss of muscle mass (known as sarcopenia), problems with balance and gait, and blood pressure that drops too much when you get up from lying down or sitting (called postural hypotension) are all risk factors for falling.

• Foot problems that cause pain, and unsafe footwear such as backless shoes or high heels, can also increase your risk of falling.

• Some medications can increase a person’s risk of falling because they cause side effects such as dizziness or confusion. The more medications you take, the more likely you are to fall.

• Safety hazards in the home or community environment can also cause falls.

Steps to take to prevent falls

If you take care of your overall health, you may have a lower chance of falling. Most of the time, falls and accidents do not just happen for no reason. Here are a few tips to help lessen your risk of falls and broken bones, also known as fractures:

• Stay physically active. Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. Exercise also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis, a disease that makes bones weak and more likely to break.
  

• Try balance and strength training exercises. Yoga, Pilates, and tai chi can all improve balance and muscle strength. You can also try lifting weights or using resistance bands to build strength. Learn more about different types of exercises to improve balance and strength.
  

• Fall-proof your home. Check out these tips for changes you can make to your home that will help you avoid falls and ensure your safety.
  

• Have your eyes and hearing tested. Even small changes in sight and hearing are linked to an increased risk for falls. When you get new eyeglasses or contact lenses, take time to get used to them. Wear your glasses or contacts as your eye doctor advises. If you have a hearing aid, be sure it fits well and wear it.
  

• Find out about the side effects of any medicines you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
  

• Get enough sleep. If you are tired, you are more likely to fall.
  

• Avoid or limit alcohol. Too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries.
  

• Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly. Get your blood pressure checked when lying and standing.
  

• Use an assistive device if you need help feeling steady when you walk. Using canes and walkers correctly can help prevent falls. If your doctor tells you to use a cane or walker, make sure it is the right size for you. Walker wheels should roll smoothly. If you borrow walking support equipment from a friend, ask your health care provider to make sure the equipment is the correct size and is safe to use. This is exceptionally important when you are walking in areas you do not know well or where the walkways are uneven. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely.
  

• Take extra caution when walking on wet or icy surfaces. These can be very slippery! Use an ice melt product or sand to clear icy areas by your doors and walkways.
  

• Keep your hands free. Use a shoulder bag, fanny pack, or backpack to leave your hands free to hold on to railings.
  

• Choose the right footwear. To fully support your feet, wear nonskid, rubber-soled, low-heeled shoes. Do not walk on stairs or floors in socks or in shoes and slippers with smooth soles.
  

• Consider staying inside when the weather is bad. Some community services provide 24-hour delivery of prescriptions and groceries, and many take orders over the phone.
  

• Always tell your doctor if you have fallen since your last check-up, even if you did not feel pain when you fell. A fall can alert your doctor to a new medical problem or issues with your medications or eyesight that can be corrected. Your doctor may suggest physical therapy, a walking aid, or other steps to help prevent future falls. 

nia.nih.gov

Strategies for Staying Engaged and Connected in the Cold Winter Months Reducing Isolation Joan Harris, LSW, MBA, CMC

In the spring of 2023, Surgeon General Vivek Murthy released an advisory illuminating the dangers of loneliness. “It is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day, and even greater than that associated with obesity and physical inactivity,” he wrote in his introduction. Jody Gan, faculty at American University wrote in a 2023 American University Press article, “Loneliness can increase the incidence of dementia by 50 percent”.

During the pandemic we kept our client’s “safe” by eliminating social contact that could expose them to Covid 19. For client’s living at home, we stopped the teams of multiple caregivers who were coming in throughout the week, canceled longtime housekeepers and many other services that were coming in to support our clients as well as the activities outside of their home that they enjoyed that provided social engagement and intellectual stimulation. We opted for one live in caregiver so that they were in their own “bubble” together, “safe.” Although we added technology such as elder friendly tablets with video access for families to stay in touch and be seen, what we did was terminate nearly all of our client’s social interaction. Although we kept our clients safe through those frightening days, we watched them decline mentally and physically in so many ways. Many of our clients with beginning stages of cognitive impairment progressed rapidly through Alzheimer’s and related dementias. These disorders are not reversable when progression occurs due to the changes that had occurred in their lives. As we reflect on those years, we know definitively that we must find creative ways to keep older adults  with their unique histories engaged in their lives with the people they love, with purpose and with joy.

As we enter the holiday season that is filled with wonderful traditions and gatherings, it is a perfect time to be aware of those around us that may have suffered the loss of their loved ones and possibly do not have family to share the holidays with. Isolated individuals are very at risk for depression, sadness and decline in their ability to function.

What can we do to minimize this isolation and the effects?

1)    Group activities:

Senior Centers: Most towns and cities have senior centers with weekly activities and holiday events. Many senior centers have volunteers who will provide transportation for older adults or taxi vouchers. For many of the clients in our practice who no longer drive, we schedule companions weekly and often multiple times during the week to take them to these activities, stay with them and drive them home safely.

Day Programs: For our clients who have the goal to remain at home but can benefit physically and mentally with the consistency of social engagement, there are wonderful day programs that are very cost effective they can go to from 2-6 days a week. A client’s family reported to us that “Mom is brighter and more alert the day after she has gone to her day program.” That good feeling of connection that is so needed tends to stay with people. Some programs provide transportation. If not, we can always find a way to get our clients there and home. If they live alone, we may have their caregiver pick them up and then make dinner and spend the evening with them. This can all be personalized to the individual’s needs.

Note: Clients may be eligible for funding for day programs through their area agency on aging (https://www.mass.gov/info-details/home-care-program).

Assisted Living Communities: For many older adults, having robust structure and engagement in a residential community is truly preventative of decline for them. When it becomes too much to manage their home, meals, medications, laundry, shopping, and activities of daily living such a showering, dressing and possibly mobility impairment, assisted living can provide a high quality of life. Residents can choose what programs they want to enjoy and come and go as they choose. This proactive option can slow cognitive decline and prevent living “reactively” when problems consistently arise.

One to One Companion: Many of our clients want to remain at home. We support their goals and assist in layering in high quality caregivers and/or companions who can take them to all their activities. Continuing to do the interactive daily tasks that provide purpose and joy is key.

2)    Other ways of connecting:

• Support Groups

• Maintaining regular communication with friends and loved ones via phone or video.

• Adopt a pet: If a client will find comfort and companionship with a pet, often their caregivers will assist with the care of the pet. They can also hire a dog walker to assist them. Pets can be extremely therapeutic for anyone who has anxiety or has suffered loss.

• Chaplains or religious affiliations: For some individuals, a visit from a Chaplain or religious leader that they affiliate with can provide comfort and fulfillment of their spiritual needs which are sometimes neglected.

• Physical and Occupational Therapy: Often, when our clients experience weakness or functional decline, they feel empowered by having physical and/or occupational therapy visit them at home multiple times a week. Most people do not know that with a physician’s order, this can be covered under their outpatient benefits (see our blog on this: https://www.symphonycaremanagement.com/news/2024/12/21/celebrating-our-partnership-with-physical-therapists-learn-how-your-medical-benefits-will-pay-for-extended-physical-therapy-in-your-home

In conclusion ,the above suggestions are just a few ideas. No matter who our client’s interact with on a daily basis, feeling part of life and contributing to the enjoyment of others by being present improves their quality of life and slows progression of multiple disease states. We can help put a plan in place for your loved one with our client centered approach to Care Management.

Celebrating our Partnership with Physical Therapists: Learn how your medical benefits will pay for extended physical therapy in your home

Helpful Resources

Many older adults are discharged from the hospital with “visiting nurse” or Certified services as a step down from the hospital. This offers short term nursing, physical therapy and occupational therapy depending on what the patient requires and what their “skilled nursing needs are” The average length of services is 2-4 weeks. Physical and Occupational therapists focus on improving strength and balance and optimize safety and function at home with assessment for devices and home modifications as well as how to complete activities of daily living safely. We so greatly value these highly trained and effective professionals and our collaboration with them. 

Most people do not know that when this benefit terminates because Medicare and Medicare Advantage Plans under the hospital benefit only covers for short term “acute” episodes, that they can obtain additional Physical and Occupational therapy in their homes under their outpatient benefits with a physician’s order. There are numerous physical therapy companies we partner with who provide that 2–4-month ongoing support under our client’s insurance that can truly make a difference in their ability to remain safely in their homes. These professionals are incredibly passionate about their work with our clients and make a difference in their lives with this additional therapeutic intervention. 

Keep reading:

Physical therapy services

 

For more information about companies that provide this service, contact Symphony Care Management and we will help you obtain an order and navigate to the right providers.