For most families, holidays are filled with opportunities for togetherness, sharing, laughter, and memories. But holidays can also be filled with stress, disappointment, and sadness.

Because of the changes he or she has experienced, the person with early to middle stage Alzheimer's may feel a special sense of loss and time passing during holiday seasons. At the same time, caregivers may feel overwhelmed in their effort to maintain holiday traditions on top of caring for the person with the disease. In addition, caregivers may feel hesitant to invite other family and friends over to share the holiday for fear they will react negatively to the changed behavior of the person with dementia.

If you're feeling guilty, angry, frustrated, or trapped before, during or after holiday celebrations, it may help to know that these feelings are normal and that you're not alone. Here are some suggestions that may help to ease the burden of caregiving and make holidays happy, and memorable occasions.

Adjust expectations. Discuss holiday celebrations with family and friends to make sure that they understand the situation and have realistic expectations. While continuing long standing family traditions such as special family dinners and gatherings can give the family identity and support, it is also important to give yourself permission to do only what you can reasonably manage. If you've always invited 15 – 20 people to your home, consider inviting 5 for a simple meal, or asking someone else to host the event.

If people will be coming to your home who have not visited in a while, it is a good idea to prepare them for changes in the person's behavior and appearance, if practical. You may want to send a letter or e-mail with the following points:

"I'm writing this letter to let you know how things are going at our home. While we're looking forward to your visit, we thought it might be helpful if you understood our current situation before you arrive.

You may notice that (Person's name) has changed since you last saw him/her. Among the changes you may notice are (list the changes). I've enclosed a picture so you know how (Person's name) looks now.

Because (Person's name) sometimes has problems remembering and thinking clearly, his/her behavior is a little unpredictable. Please understand that (Person's name) may not remember who you are and may confuse you with someone else. Please don't feel offended by this. He/she appreciates your being with us and so do I. Please treat (Person's name) as you would any person. A warm smile and a gentle touch on (Person's name's) shoulder or hand will be appreciated more than you can know.

I would ask that you call before you come to visit or when you're nearby so we can prepare for your arrival. Caregiving is a tough job and I'm doing the very best I can. With your help and support, I hope we will be able to enjoy the holiday."

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• Involve the person with Alzheimer's in safe, manageable activities. This can help to prepare the person for the holiday and give you an opportunity to spend quality time together. You may want to begin slowly by asking the person to help you prepare food, wrap packages, hang decorations or set the table.



• Maintain the person's normal routine so that holiday preparations don't become too disruptive or confusing. Try to blend seasonal rituals into the daily activities that you both depend upon, such as taking a walk.



• Build on past traditions and memories . For instance, the person with dementia may find comfort in singing old holiday songs.



• Experiment with new holiday traditions , such as renting seasonal videos that the less active person may enjoy.



• Use name tags if the person has difficulty recalling names . This will assist in communication.

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• Avoid using candies, artificial fruits/vegetables or other edibles as decorations. Blinking lights may confuse the person.



• Try to maintain regular routines, such as sleeping patterns, dinnertime or medication schedules, when possible.



• Limit and control over-indulgence of rich or special holiday foods and drinks and avoid alcohol. Too much rich food or drink may cause the person with Alzheimer's to become hyperactive or confused.
• Treat yourself well during the holidays. Consider taking advantage of people visiting to take some time for yourself.



• Ask for help and support. Create a bulletin board for listing tasks and responsibilities. If someone ever asks, "What can I do to help?" you can respond with a specific idea.



• Have a quiet area for the person with memory loss to retreat when things become hectic. Have a familiar person stay with them so they do not feel isolated or left out.



• Give yourself permission to say no to an obligation.

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Holidays are a time for family traditions and family gatherings. When a family member is a resident in a long term care facility, families are often required to adjust expectation and perhaps create new tradition in the residential care setting. Remember, persons with dementia like having a sense of security and routine. It may not be in their or your best interest to bring them home for the holiday. Here are some hints for celebrating the holidays with a resident in a long term care facility:

• Test tolerable driving times and new environments before the holidays.
• Plan for a short visit and have a backup plan to return the person to the facility early if necessary.
• Be aware – High activity levels or disruption of routine may cause unnecessary increases in agitation.
• Be aware of the setting – increased noise, increased stimulation, small areas and large numbers of people may be very disorienting to the person.
• Label all gifts before returning to the residential care facility.
• Adjust expectations – prepare for a less then enthusiastic response to gifts and visitors.

If you are planning to bring the person home:

• Plan to participate in the facility's holiday events.
• Visit in small numbers -- try not to have all the family members visit the same day.
• Consider a visit near the holidays.
• Prepare yourself and visitors -- The individual with the disease might have changes. Some resident are very ill. Visiting might be distressing for young children and others who have not been exposed to that setting.
• Remember – It is not the tangible gist or the traditions which matter most to someone with Alzheimer's or related dementia at the holidays. It is knowing, by feeling, at any given moment they are loved.

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• Call ahead and ask when is a good time to visit. Do NOT drop in unannounced. Be flexible. The unpredictable behaviors of some people with Alzheimer's may make last minute changes unavoidable.



• Speak directly to the person with Alzheimer's , and do NOT talk about them to the caregiver, while they are within listening distance.



• Make visits to the person with Alzheimer's short and quiet and limit the number of people who are visiting at one time.



• Offer to help with errands; or other needs which may be different or increased during this time of year. Shopping, baking, and holiday decorating are good examples. If your offer of help appears as if it is an easy part of your routine, the caregiver is more likely to accept. For example, "I have to stop by the grocery store on my way to your house. Can I bring something?"



• Do not feel that you must "entertain" the caregiver. At the same time, do not expect the caregiver to entertain you. The greatest gift you can give is your presence and your warm, genuine concern. As much as possible, be available emotionally and in concrete ways by following the verbal and nonverbal leads of the caregiver.



• Arrange time for the caregiver to get away during the holidays . Try visiting the person with AD while the caregiver takes a break. Consider taking them shopping, out for a walk, or to your house to do an activity.
  Click here to see more information on Activities you can do with the person with dementia .



• Remember the caregiver , even if you cannot visit during the holidays . Telephone, send a note or find other ways to say , "I care. I am thinking of you."



• Stay in touch with the caregiver , when the holiday is over . It may be easier for you, rather than the caregiver, to keep in touch. Respect the caregiver's judgment about if, and when to receive guests. Be sure your visits are a distraction and a pleasure rather than an added burden.

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The following are some suggestions of gifts that might be appreciated by a caregiver.

• Something frivolous – a makeover, massage, art
• An invitation to a holiday meal
• A supply of frozen homemade dinners
• A telephone gift certificate
• A sample of teas or coffees and a pretty mug
• Cable TV or VCR rental membership
• Regular promise of respite time for beauty shop, golf game, shopping trip
• A house cleaning service
• A gift certificate to a take-out restaurant
• "Because I Care" coupons – to provide respite, transportation, a lunch date, a visit or even a hug – to be redeemed on request by caregiver.

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Most people who are in the early stage of Alzheimer's are able to communicate fairly well, and are active. They are usually aware of their condition and struggle to remain independent. Gifts that enhance their independence or encourage activity are good choices. The following are some examples:

• Simple, but familiar games such as dominos and large numbered cards, or an invitation to a bingo game.



• Tickets for the person and a companion to a concert , musical, ball game or circus.



• An account at a local taxi company , so that the person can maintain a sense of independence even when they can't drive.



• A scrapbook of old family photos highlighting the major events in the person's life. These can be enjoyable throughout the course of dementia.



• A fruit basket or flowers.

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People who are moderately impaired often have some difficulty communicating, need help dressing and are unable to manage daily activities without supervision or assistance. The following are some gift ideas for this stage:

• Simple to manage clothing, such as tube socks, and shoes with Velcro closures. For more clothes ideas,
  Click here to go to an article on Dressing.
• Tapes and CDs of favorite old music.
• Bird or squirrel feeders to watch on a patio or out of a window.

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People who are severely impaired are often unable to speak coherently or make their needs known. Their attention span is also very short. The following gifts are appropriate:

• Photo albums, family pictures and memory scrapbooks.
• For people who liked animals, visits by dogs, cats and other small animals can be very enjoyable.
• Recordings of old music.
• A life-like baby doll or large soft teddy bear or other soft stuffed animal.
• Video tapes with pleasant sights, such as garden, fish tanks and sounds.
• Hand/body lotion and a hand, foot or back massage. (Note – do NOT massage legs as there may be a risk of blood clots because of reduced activity)

Remember that holidays are opportunities to share time with the people you love. Try to make these celebrations easy on yourself and the person with Alzheimer's disease so that you may concentrate on enjoying your time together.

Sources: The National, Alzheimer's Disease and Related Disorders Association, Inc.; The National Capital Chapter of the Alzheimer's Association and Enhancing Life for the Older Adult with Alzheimer's Disease or Other Dementias: Some Gift Ideas by Stephanie Zeman, RN, MSN

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