December 2003

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Suggestions help Alzheimer's patients enjoy holiday celebrations

By Anissa Anderson Orr

To make her feel part of holiday celebrations, Joyce Bunch lets her 89-year-old mother-in-law with Alzheimer’s disease set the table with coasters or rinse and stack dishes after the holiday dinner. Later, the family looks at old photos albums together.

“We like to reminisce, look at photos and talk about things that happened in the past, because Mrs. Bunch is good at remembering,” Bunch said. “Looking at albums leads the conversation in a direction that she can participate in.”

The holidays can be a challenging time for families who want to include loved ones with Alzheimer’s disease in the holiday activities. Too much holiday noise and activity can confuse patients with Alzheimer’s disease, causing them to withdraw from surrounding social activity. Knowing the patient’s limitations is key.

“Disruption of routine for those with Alzheimer’s can trigger behavioral symptoms, which makes care giving more difficult,” said Mary Kenan, PhD, a psychologist with the Alzheimer's Disease Research Center at Baylor College of Medicine in Houston.

To cut down on confusion, Kenan suggests asking family and friends to arrive at different times or visit in small groups. If everyone is coming together, find the Alzheimer’s patient a room to the side with soft music and lighting. There, he or she can escape with one other person.

“Conversations can be very hard for people with Alzheimer’s to follow if many people are participating,” Kenan said. “One to one conversation allows them to focus their attention and engage.”

To make this season with your loved one as joyful and meaningful as possible, Kenan and Bunch offer the following suggestions to caregivers:

Don’t:

• Compare the present with the past. If you aspire to a picture-perfect holiday, you are likely to be disappointed.
  
  “As a family, we try very hard not to get caught up in feelings of guilt, or being sad that she can no longer be the sweet, outgoing grandmother she used to be,” Bunch said. “We try to include her for snippets of time in the holiday activities, but also understand she can’t be included in everything.”
  
• Test your loved one’s memory by asking, “Do you remember who this is?” Testing memory does not preserve it, and often demoralizes the person with Alzheimer’s disease. Instead, introduce the family member to your loved one by name and state his or her relationship. For example, say, “Bob, your nephew David wants to wish you happy holidays. Say hello to your nephew David.”

Do:

• Include the person with Alzheimer’s in the activities of the day. An Alzheimer’s patient may help with meal preparation, such as peeling vegetables, stirring batter, tossing salad, folding napkins or setting the table.
  
• Be aware that active, loud children may distress the person with Alzheimer’s. Try to have some activities planned for the kids, ideally those that they can do with the Alzheimer’s patient such as making holiday decorations or decorating cookies. Watch for any signs of anxiety or distress and intervene immediately by redirecting the children to another room or by taking the person with Alzheimer’s on a walk, sitting together for awhile in a quiet room or taking a short drive around the neighborhood.
  
  "To make it less confusing, we keep an eye on for our grandchildren to make sure they don’t get too rambunctious,” Bunch said.
  
• Try to maintain routine as much as possible. If your loved one customarily takes a walk after eating lunch, try to maintain this activity and go with him or her.
  
  "In keeping with her normal routine, my mother-in-law stays at our house for about an hour tops before we take her back to Barton House, a special care facility for people with Alzheimer’s disease," Bunch said. "She becomes anxious if she stays longer."
  
• Develop new ways of marking the holiday season. For example, ask family and friends to come prepared to tell a favorite story from past holiday seasons involving the loved one with Alzheimer’s. Reminiscing is an important therapeutic tool that benefits those with Alzheimer’s.
  
• Use the sights, sounds, smells of the holidays to stimulate your loved one’s senses. Your loved one may be able to participate in the singing of well-learned holiday songs.
  
• Ask for help. Your stress increases the stress of your loved one with Alzheimer’s. Delegate holiday responsibilities to family or friends.
  
  "Patients with Alzheimer’s disease can still enjoy the holidays," Kenan said. "Be sensitive to your loved one’s strengths and limitations, as well as your own as a caregiver, and celebrate accordingly."
  

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