Do you ever find the holidays overwhelming? There are lights and music, decorations and crowds, shopping and cooking, parties and dinners, rich food and alcohol, late nights and busy days— sometimes it feels like you need a holiday to recover from the Christmas season!
If we feel overwhelmed during this season—and we are cognitively well, our brain is fully working—then imagine how overwhelming the holidays may be for someone who has dementia. Someone with dementia may not remember what “Christmas” or “the holidays” mean because they become abstract terms.
Here are some holiday tips to help a loved one with dementia through the holidays!
Beware of Decorations
You see an impressively life-like St. Nicholas welcoming people to your front hallway, but what does your loved one with dementia see? Is she concerned about “the man in the hallway who isn’t having dinner?” Life-like or oversized decorations can be confusing or even scary to someone with dementia. Consider from their perspective how the decorations could be misinterpreted.
Flashing lights draw a mixed response. Some people with dementia are mesmerized by flashing lights; others become alarmed or agitated. Keep consistent bright lighting in all rooms. Dark rooms with candlelight or just the tree lights may be fearful for someone with dementia.
Remove all ornaments that are not edible but look like real food. Fake gingerbread men or houses, fake candy canes or apple ornaments should all be avoided. Someone with dementia may not realize that it is just an ornament and may attempt to eat the decoration.
Have a Quiet Room
You want to include your loved one who has dementia, but you also need to provide a space where they can retreat and have some peace and quiet. People with dementia typically interact best in small groups or one-on-one. If a loved one with dementia is attending a large family gathering, set up a separate room—well lit with comfortable furniture—and recommend that family take turns visiting that person, one at a time. This allows for quality interaction in a way that best matches your loved one’s needs.
Maintain Routine
Routine is often the first casualty of the holiday season. We stay up late at night, we don’t eat meals at the usual time and we often stray from our usual, healthy diet. Remember how you felt last January after eating heavily and having your routine interrupted? Now imagine someone with dementia. The person with dementia cannot rationalize why they feel different, all they know is that something doesn’t feel right.
As much as possible, keep routine familiar and consistent. Try to maintain regular meal times (even if that means eating separately from the party), and try to limit intake of rich, sugary foods or excessive alcohol. Respect nap times and bedtimes—sleep is as important as ever! By maintaining routine as much as possible, your loved one may be able to better handle the surprises that come with the season
Forewarn Family
If family members live at a distance, they may be visiting for the first time since the last holiday season. Your loved one may have changed significantly since last holiday season. Advise family and friends in advance so that they know what to expect. Request their assistance in making the holidays easier for your loved one, and outline exactly what you need them to do. Here are some suggestions:
Please do not ask “do you know who I am?” this causes undue stress. While she may not be able to name you, grandma knows you are an important person whom she loves.
Please be aware of the fact that mom now needs to take some time away from the crowd. She finds noise and groups over-whelming. We will have a Quiet Room set up and we invite you to visit mom one at a time in the quiet room.
Please do not encourage alcohol consumption by saying “it’s only one drink!". Dad is now on a medication that does not react well to alcohol and he will not enjoy the event as much when he is trying to process the alcohol.
Set Realistic Expectations
Set realistic expectations for your loved one by limiting the number of events they attend. No more than one event or activity in a given day; only a few in a week with recovery time between events. Step back and try to asses what is realistic for your loved one. Maybe a dinner with 50 people will not be a successful event, but attending a hymn sing would better match your loved one’s preferences and current abilities.
Your loved one will not be able to suddenly do more or handle more because it is the holiday season. If anything, their coping abilities may be taxed and they may become agitated or stressed more easily than usual. Be realistic when scheduling the season.
Select the Top Priority
What is more important—that your loved one attend every event and every tradition is followed in detail, or that your loved one has a merry Christmas feeling loved and happy?
If the top priority is your loved one having a wonderful Christmas season, then focus on the elements that create that sense of joy, peace, and love for them. If you really analyze it, you’ll realize it has nothing to do with decorations or traditions. It has everything to do with family and interaction.
If you are stressed because of holiday prep, your loved one will feel that stress and not enjoy the season. A person with dementia would rather have you slow down, match their pace, and be patient than present a tray with 15 varieties of home-baked cookies that stressed you out!
Your loved one with dementia might enjoy singing a few familiar Christmas carols (because the words of those favourite tunes tend to stick), rather than feel the pressure of keeping up with an animated conversation at a cocktail event.
What will make your loved one smile? When will they seem most at peace? What will have them feeling safe, secure, and loved? Aim to focus on those elements and your loved one will have a truly blessed Christmas.
The holiday season has busy and joyful energy to it. It often feels like there’s a buzz in the air where everyone is rushing somewhere or hurrying to do something.
Many people with dementia are sensitive to the energy and emotional state of those around them. They will often pick up on this energy of hurrying and they may want to help.They’ll want to join in the activity and be part of the buzz of energy.
Human nature desires a sense of purpose.
We want to feel productive and we want to provide meaningful contributions. This sense of wanting to contribute and be helpful and productive is not impacted by many forms of dementia, so people very much want to be involved and be helpful. When someone with dementia can sense that everyone else around them is hurrying to complete tasks, they will want to join in and assist too.
If someone’s functioning level has been impacted, it may be difficult for them to contribute in the ways they did previously. In the past, your father may have gone to select a Christmas tree and cut it down himself, then tie it to the roof rack, drive home, and set the tree up. That may no longer be possible for him to do entirely on his own. Perhaps he doesn’t drive anymore; perhaps his physical strength or sense of direction is impaired.
Even though he cannot complete the task in full, is there a way that he can still be involved in the process? Can he be part of the trip to select the tree? Can he manage some of the cutting? Or hold the tree steady while a grandson saws away? Continuing to involve him in the process will be important to his sense of self-esteem and his need to feel productive.
Many forms of dementia interfere with the brain’s ability to sequence an activity.
Many tasks are actually a series of separate, smaller tasks that must be done in a particular order. Baking, for example, involves many separate tasks that are all sequenced in the right order. Perhaps your mother-in-law baked countless cookies and squares during the holiday season. Now, she makes toast and tea, but not much more. Expecting that she can bake a dozen varieties of cookies is not reasonable, but involving her in a few favourite recipes will help her to shine.
When approaching a complex task like baking, break down each step into a separate task. If there are any tasks that can be a stand-alone job, get your mother-in-law to be in charge of that step. Maybe the walnuts need to be crushed for one recipe. You can get your mother-in-law set up crushing walnuts. It may be faster to do it yourself or tempting to use the electric food processor, but the purpose isn’t to be fast and efficient.
The purpose is to involve your mother-in-law in the traditions that she founded. It’s pretty likely that she didn’t have an electric food processor when she first started baking that recipe. Breaking the walnuts by hand is likely a familiar task from years gone by and something which she can feel successful contributing.
All too often, someone with dementia will say “what can I do?” or perhaps “I don’t know what to do…” and well-meaning family members will respond “you don’t have to do anything! You just relax and sit over here.” In some cases, if someone is overstimulated and needs a break, that might be the kindest option. But in most instances, the person with dementia is genuinely reaching out and wanting to feel productive by contributing something meaningful to all that is going on around them. By finding a task that matches their ability level, you are helping to meet that fundamental human need for productivity.
Remember that the task might not be about doing. It might be more about being—being close to you, being part of the action, being a contributing family member. If many tasks are just too difficult or overwhelming, perhaps they can be involved in a being type of way.
Maybe the dog is overly excited by all of the activity and you can ask your father to hold the dog on his lap and pet the dog to keep him calm. He is being a comfort to the dog…or perhaps the dog is a comfort to him, but either way, they are both content.
Perhaps you’re wrapping presents and the roll of tape keeps disappearing under all the wrapping paper and boxes. Your mother-in-law might like to be the keeper of the tape as you’re wrapping. She’s right there with you and she’s involved in her own way. You may even get to chuckle about how you lose the tape and she’s keeping you on track.
It may take more effort on your part, and it will definitely take more time and some creativity to find tasks that match ability levels and provide meaningful contributions, but the rewards will almost certainly be worth it!
Are you hosting any holiday gatherings where you have invited elderly relatives who have health conditions? You have probably already thought about accessibility accommodations such as helping them into your home and ensuring they have access to a bathroom. Those elements are very important and should not be overlooked.
Another element that should not be overlooked is how to make the overall
environment more manageable for your elderly loved ones, especially when there are health conditions to consider.
If someone has a chronic illness such as CHF or COPD, they may fatigue very quickly and need an opportunity to rest.
If someone has edema in their feet or legs (swelling) they may need a chance to sit with their legs elevated.
A stroke survivor may find the environment overstimulating and may need relief.
Someone with dementia may need some peace and quiet and a break from the noisy environment.
Hearing aids may blur the sounds into a din so that individual voices are difficult to discern, and someone with hearing loss may need an auditory break.
To help facilitate these needs and more, you can create a Quiet Zone for your holiday gathering.
Part of the beauty of a Quiet Zone is that it can meet the needs of so many different health conditions. It is one solution that actually meets numerous needs simultaneously. It may even be appealing to younger family members too!
A Quiet Zone is a space dedicated to quieter interaction and less stimulation. Ideally, the Quiet Zone would be a separate room, but if that’s not possible, then a nook or area that can be allocated as the Quiet Zone.
The Quiet Zone should be less stimulating than the environment of the main event. If there are Christmas carols blasting on repeat in the dining room, the Quiet Zone does not have any music. If the Christmas tree in the living room has blinking lights and a miniature train set zooming past, the Quiet Room has steady, ambient lighting that isn’t distracting.
While the main event likely includes loud chatter, many people speaking at once, laughing, and loud voices to be heard over the din, the Quiet Zone is where people can have one-on-one conversations that can be more easily heard and understood. For relatives of any age, the chance to step away from the noise and engage in a more in-depth one-on-one conversation might be a welcome relief.
Someone who tires easily in a crowded room of people might appreciate the relief of settling into the Quiet Room. Other guests can then take turns, one at a time, visiting within the Quiet Room. This way, everyone is supported to be part of the family gathering, but they can participate in a way that matches their individual needs. Having a space to retreat may allow people to reserve their physical and mental energy to join the group for dinner.
The Quiet Room makes it possible to have a quick cat-nap if needed. Giving the brain an extra boost of sleep can make the difference between enjoying the rest of the event, and just feeling overwhelmed and overstimulated. Family members who are stroke survivors or who have dementia will particularly appreciate the opportunity to have a power nap.
When the brain has been impacted by stroke or dementia, part of the brain may not be working the way it once did. The remaining parts of the brain are functioning on overdrive to compensate for the losses. Those over-active brain areas tire easily and benefit enormously from rest. A Quiet Room creates the space and permission to invite such guests to rest their brains when they need it most.
This holiday season, consider creating a Quiet Room for large family gatherings. The Quiet Room will be a retreat space to ensure that all your guests find the event manageable and can enjoy it fully.
Most of us can agree that the holiday season often ends up feeling frenzied and hectic. We’re fully aware of which season it is, we’re mentally prepared for the change in routine and all the additional activities and events that come with the season, and even still, we seem surprised each season that it’s frenzied and hectic.
Imagine how much more this feeling is magnified for those who have dementia.
The frenzied holiday season feeling may have different causes for you versus your loved one who has dementia, but it is important to acknowledge that the stress is still present regardless. For you, the stress may come from trying to fit too much into too little time—shopping, wrapping presents, decorating, baking, cooking traditional meals, attending extra events, etc.
You might think that someone with dementia is exempt from all this stress, and indeed, they may be blissfully unaware of some of those holiday elements. They may not have a shopping list to attend to, and they may not be worried about decorating or baking, but the holiday season can be stressful in other ways.
For someone with dementia, the ability to preplan and mentally prepare is inhibited. They are not able to reassure themselves that “this is December, and this month tends to be hectic, but it’s just temporary.”
When someone with Alzheimer’s has very limited short term memory, they will not be able to remember your explanation that the change in routine is due to the holiday season. For example, the day program they typically attend two days weekly is cancelled for Christmas Day, Boxing Day and New Year’s Day. Not attending day program for a few weeks will feel disorienting. They will need constant reminders of why and how the routine has changed.
Keeping track of events and holiday gatherings may be challenging or impossible. Looking at a calendar and interpreting what is happening today versus tomorrow versus next week is quite abstract and becomes difficult when someone’s brain is impacted by dementia. A calendar is of limited use when someone has trouble remembering which day it is today. Someone with dementia may not be able to keep track of additional holiday gatherings and events.
Familiar environments suddenly look different now that decorations, trees and blinking lights have been added. For some people, decorations will feel comforting and bring memories of holiday seasons of the past. For others, the sudden change in their familiar environment may feel disorienting.
Likewise, large gatherings can have a disorienting effect. Even when it’s gatherings of family and friends, large groups can be overwhelming for some people. Too many of these gatherings over a short time period can increase someone’s stress level.
People with dementia are often highly sensitive to the emotions of others around them.
If you are highly stressed or feeling frenzied, they will pick up on that emotion and respond to it. If the context is not entirely clear to the person with dementia, they may even conclude that you are stressed or frenzied because of them.
While your loved one may not be keeping track of the shopping list and cooking for the family gathering, they are still experiencing the holiday frenzy, just differently than you are. Be aware of what may be contributing to their stress or disorientation and try to reduce those factors as much as possible. Since you do have the ability to pre-plan, you can mentally prepare yourself for the holiday season knowing that your loved one may have stronger or different reactions than usual because of disrupted routine or change to their environment. Just being prepared for different behaviours, reactions, or functioning levels can make a huge difference.
For more tips on how to support someone with dementia through the holiday season, please click here.
I know an elderly gentleman who is a veteran and whose story stood out to me. His medals are proudly displayed in a showcase on the wall in his home; hung below the showcase is a framed photo of him in uniform.
He is both proud and dismissive of his service. He is proud in the sense that he still smiles fondly when remembering his comrades, and his identity is closely linked to his military service. He is dismissive in the way that he doesn't feel he was any different than any other young man who readily volunteered for service. He felt it was his duty, and he wouldn’t have it any other way.
As a young man, recently married his beautiful new bride, he heard about recruitment for the Korean War. He discussed it with his wife, and of course, she didn’t want her new husband heading off to war. As he tells the story, the call of duty meant he couldn’t forsake his country; he felt he was married first to the military, and secondly to his wife.
He enlisted for service and then had to break the news to his wife. To ease the announcement, he invited one of his comrades over for dinner and waited until dessert was served to benignly ask his buddy, “so, how long do you think it will take us to get to Korea?”
As you might imagine, his new wife was less than impressed! She eventually came around though and understood her husband’s devotion. His loyalty has served her well too; the same devotion he showed to his country, he has shown to his wife and family ever since. He is a true man of valour.
It is to gentlemen—and women—such as him that we owe our thanks and appreciation as we reflect on Remembrance Day. From everyone here at Warm Embrace, we express our deepest gratitude for the sacrifices of veterans who have served and continue to serve our country. It is our absolute honour and privilege to care for such distinguished veterans in their hour of need.
In 2014, a number of organizations across Canada came together to promote a campaign called Fall Prevention Month. During the month of November, this campaign encourages organizations and individuals to come together to coordinate fall prevention efforts for a larger impact. The goal is to collectively raise awareness about fall prevention strategies and to help everyone see their role in keeping older adults safe, active, independent and healthy.
What are the impacts of falls?
Unintentional falls are the leading cause of injury for Ontarians aged 65 and over.
Recovering from a fall can be very difficult and with an increasing number of falls, it is important we take measures to prevent them.
How can we prevent falls?
The good news is that falls are preventable injuries! There are five key factors that caregivers and seniors should consider in order to prevent falls.
1) Eyesight – vision is an important part of balance and good vision helps to prevent falls. Everyone who is over the age of 65 should have their vision checked every year.
2) Your home – if you have clutter on your floors or stairs, it increases the chance of tripping and/or slipping. Make sure cords, scattered rugs, pet toys, books, etc. are in their proper place. Also, if your home is dark it increases the chance of falling, especially on stairs. Make sure to create a space that is well-lit!
3) Exercise – the most important thing you can do to prevent falls is to stay and remain strong! Walking, fishing, gardening, tai chi. Light yoga – whatever you enjoy! – do it to increase activity levels.
4) Medication – some medications cause dizziness on their own, or when mixed with others. It’s important to properly manage your health! Always take medication as directed and ask your pharmacist to review them if you are taking more than 2 medications.
5) Eating a healthy diet – Vitamin D and calcium help to keep strong bones. A diet to include more greens, lean protein, and less sugar will help you in remaining strong. You may want to talk to your doctor about supplements or other alternatives.
Most of all, don’t do it alone! It takes a community to prevent a fall and we all have a role to play. Here at Warm Embrace, we have a wonderful team of caregivers who can help you and your loved one to remain safe at home.
What is the difference between curing and healing? When we seek medical attention, are we hoping to be cured or hoping to be healed?
Dr. Mark Greenberg grapples with the issue of being cured versus being healed on a daily basis. Dr. Greenberg is a pediatric oncologist at The Hospital for Sick Children and has received the Order of Canada (2011) for his work.
In his TEDx address, Dr. Greenberg outlined the difference between being cured and being healed. When we seek medical intervention, we are looking to be cured of whatever ailment sent us to the doctor in the first place. We believe that we (or at least the doctors) have some semblance of control over the health care being provided. If we follow doctors’ orders, we expect to be cured.
Healing, however, is an entirely different issue. When someone suffers from a life-threatening illness, being physically cured is only the beginning. Life-threatening illness requires healing. Healing is more than just a physical process; it is also a psychological, social, and societal issue. It includes the patient directly, as well as the patient’s family, social network, and support system. Healing involves adapting to the new physical state of the patient and may include coping with emotional scarring.
Dr. Greenberg explains that coping with a life-threatening illness is the ultimate loss of control. It defies our Western mythology that if we work hard enough and are good people, then all will be fine. Grappling with this loss of control in the face of life-threatening illness plays out in family interactions and in dealing with doctors. Far too often, patients are physically cured, but they never fully heal. Dr. Greenberg asserts that compassion for the individual, rather than a focus on control of outcomes, leads to more comprehensive healing.
Healing is a psychological, social, and societal issue with implications beyond the individual, reaching to the health care system as a whole. Therefore, your family physician alone cannot help your loved one through the healing process; what your loved one needs is a team of people.
Adapting to a new physical state can be difficult that is why your loved one needs a team comprising of you, their doctor(s), nurses and caregivers. Wherever your loved one might be living, the help of a professional caregiver can provide them with social and physical support.
You don't have to go through the curing or healing process alone.
A resident named, Delores, fell three times in two weeks. Her third fall landed her in the hospital where she remained for 10 days. She was at risk of falling previously, but now, after 10 days of deconditioning in the hospital, her risk is even higher.
Delores has long been on the waitlist for long term care, but now that her needs have escalated, her care is beyond what can be safely managed within a retirement setting.
To escalate her placement on the LTC waitlist, Delores had to be discharged from the hospital under the Home First LHIN strategy. She went back to her residence after her 10-day hospital stay.
Now that Delores is in the community, she can be reassessed for long term care and be considered a crisis level. Even if someone is on the crisis list though, it doesn’t mean that a bed is immediately available.
Delores may still be waiting for weeks—or longer—for a suitable LTC placement to become available.
In the meantime, Delores is in your care, and she’s at an extremely high risk of falling. You are now worried that she cannot be left alone since she forgets that she is at risk of falling and she is inclined to get up and try to walk without her walker. Since her previous three falls were all attempts to make it to the washroom, you are very well aware that she may attempt to rush to the washroom and fall yet again.
Warm Embrace can help to meet this need!
If Delores is on the crisis waitlist for LTC and she needs 24/7 attendant care, the LHIN may provide some PSW support for various shifts. Warm Embrace can provide the rest. We can cover up to 24/7 care to ensure that Delores is never left alone. We can help to bridge the gap before Delores receives a suitable placement in long term care. This way, Delores is safe and has the one-on-one attendant care that she needs.
Just think how relieved you will feel, knowing that you can utilize the support of Warm Embrace when someone you know is awaiting crisis LTC placement.
One of your long-standing residents, Jean, has just been discharged after a ten-day stay in hospital. She has been discharged back to your residence, but she has declined considerably in the past 10 days.
She lost quite a bit of her strength from being in bed all day at the hospital, and since she was catheterized, she’s struggling with incontinence now as well. Previously she was independent with personal care and was able to get to the dining room on her own. Now, she’s needing help with toileting and sometimes she’s not even a one-person transfer.
Your care team were already stretched thin across residents with high needs. There are key times of day when you simply don’t have enough staff available all at the same time.
That’s where Warm Embrace comes in.
Jean needs a dedicated caregiver who can attend to her increased needs as she recovers from her hospital stay. If she requires a two-person transfer assist, our caregiver can be one of the two required people. Jean’s caregiver can attend to her toileting needs and assist her in getting to and from the dining room at a time when your staff have many other residents who need help getting to meals.
Jean’s caregiver can work together with her on some strengthening exercises to help her return to a greater state of independence. Of course, the goal is to help Jean remain independent enough to remain in your residence much longer.
If, however, Jean’s medical condition deteriorated while in the hospital to the point that she now qualifies for long term care placement, Jean’s caregiver will provide the assistance she needs while she remains in your residence awaiting placement. With her increased needs, Jean may require more than your staff have the capacity to provide, especially when other residents also have many complex needs.
If you have a resident like Jean who is returning from hospital, you can recommend that they implement a dedicated caregiver from Warm Embrace to help them as they recover. We recognize that our role might vary depending on the goals of the resident and their health. Any combination of the following are possible:
Temporary assistance as your resident recovers from hospitalization/surgery/recent illness until they regain their strength and abilities and no longer need our help
Ongoing support to match your resident’s new ability level and needs, allowing them to remain living in your residence even though their needs have increased.
Crises support if your resident is awaiting long term care placement and their needs have drastically increased.
Our support ensures the resident has all the care they need after returning from the hospital, while also reducing strain on your staff.
The next time you have a resident with a pending hospital discharge, remember to make Warm Embrace part of the planning process and have care in place for a smooth return to your residence.
Bill was a dairy farmer and spent his entire life outside. He was up before sunrise milking cows before the birds had even started chirping. Every evening, he was out milking again. His entire life was set by the rhythm of farm life.
Bill now resides in your long term care home in your secure unit since he is adamant he needs to get outside and milk the cows. With his advanced dementia, he does not realize that he hasn’t milked the cows in nearly 25 years, but his circadian rhythm is indelibly marked by the farm rhythm and he’s bound and determined to get outside.
Of course, Bill is safe on your secure floor and he cannot leave. But as dusk arrives, Bill becomes increasingly agitated as he feels the need to be out on the farm, and his agitation is contagious. He paces the floor back and forth, he looks out each window longingly and he searches for the exit. Other residents can sense his unease and though they don’t know what he’s anxious about, they share the sentiment.
The approaching evening as the sun is setting can be a challenging enough time within long term care as many residents have competing needs at that time of day. Bill’s increasing agitation only compounds those needs.
What Bill really needs is a dedicated caregiver companion who can address his personal needs. A caregiver can take Bill on safe outings, fulfilling his desire to be outside. When evening approaches Bill’s caregiver can reassure him “not to worry, you milked the cows a little early today; everything is fine on the farm.”
His caregiver can keep Bill occupied so that he doesn’t start looking for something to do—his history dictates that if he had a moment of boredom, he cured it by heading out to the barn. Instead of letting Bill feel bored—and likely to want to exit seek—his dedicated caregiver can keep Bill engaged in conversation and activities until dinner time when he typically settles into a routine.
Of course, Bill receives the most direct positive impact from his caregiver, but the incredible part is that he is not the only recipient! Other residents also benefit when Bill is calm and redirected. The source of the anxiousness and agitation that spread contagiously is solved. By extension, staff benefit when residents are content and happy. Bill’s caregiver addresses his emotional need, which frees staff to care for other residents who may be in need.
When you have a resident who is intent on leaving the secure floor, remember that one of the most effective strategies may be a dedicated caregiver who can address emotional needs and redirect attention. The positive impact will have a ripple effect across the entire floor!
Routine is often the first casualty of the holiday season. We stay up late at night, we don’t eat meals at the usual time and we often stray from our usual, healthy diet. Remember how you felt last January after eating heavily and having your routine interrupted? Now imagine someone with dementia. The person with dementia cannot rationalize why they feel different, all they know is that something doesn’t feel right.
