Bright lights. Relatives crowded around a festive table. The loud hum of different conversations happening at once.
Although it seems worthy of a Norman Rockwell painting, a Thanksgiving celebration with family can be overwhelming for many older adults with Alzheimer’s or other dementias, depending on their stage of disease.
The festivities scene can cause an abrupt change in behavior for seniors with dementia, making them feel agitated and unsafe. Before the turkey is even carved, they may announce, “I want to go home,” a signal this happy occasion has morphed into a catastrophic event.
“Dementia causes changes to the brain that affect how a person relates and connects with others,” explained Chris Petrik, RN, BS. “If we continue to relate to them as we normally relate to others, we might find them feeling lost, isolated and alone, even if we’re sitting next to them.”
Petrik is the director of education at Elderwerks Educational Services, a social service agency for older adults in Illinois, who spoke during a recent webinar, “When dementia has a seat at your holiday table.”
Petrik shared easy ways to modify family gatherings for older adults with dementia, to help prevent sudden changes in behavior and make the occasion enjoyable for everyone.
First, understand the stages of dementia
- Early-stage: Symptoms are not widely apparent. A person may function independently, drive to work and participate in activities, despite memory lapses, such as forgetting familiar words or the location of valuable objects like keys. Difficulty remembering names when introduced to new people and trouble performing tasks, recalling material they just read and planning and organizing are hallmarks of this phase.
- Middle to moderate stage: The longest stage, it can last for many years and causes a person to require more care as it progresses. Damage to nerve cells in the brain makes it difficult to perform routine tasks without assistance. Symptoms may include confusing words; becoming frustrated or angry; acting in unexpected ways; being forgetful of events or personal histories; feeling moody or withdrawn in social settings; unable to recall information about themselves (like their address or phone number); confusion about time and place; more trouble controlling bladder and bowels; and sleeping during the day, restless at night.
- Late-stage: The final stage of the disease, symptoms worsen. Individuals are unable to respond to the environment, carry on conversation and control movement. Assistance with activities of daily living, such as eating and dressing, is required. They may speak with words and phrases but communicating is difficult. “They lose awareness of recent experiences and surroundings,” Petrik said. “How we celebrate the holidays has to change. Family members may not understand why it’s changing, so you need to advocate for them.” Explain this stage and why the celebration is limited to immediate family.
The cognition and behavior of individuals in various stages of dementia move backward, causing them to communicate and act like children, according to the Reisberg Theory of Retrogenesis. But don’t treat them like a kid, Petrik warned. They’re still adults, so try to keep them happy and safe with their dignity intact.
Plan ahead and make accommodations
Before the festivities begin, look around your home and prepare:
- Put away throw rugs and unnecessary furniture. Secure lighting cords. Use nonflammable candles and minimal lighting. (Lights may add to anxiety.)
- Designate a quiet room to relax in when they become anxious.
- Make sure the toilet has a riser and grab bars.
- Let family members know the stage they’re in, what to expect and how they can help. It might be as simple as keeping their voices down, as loud noise can cause stress.
Knowing what stage of dementia your loved one is in will help you decide where you’re going to celebrate the holidays. In middle- to late-stage dementia, the older adult should be in familiar surroundings to feel safe. If that’s their care community, eat the holiday meal with them there.
If celebrating at your home, serve dinner at the usual time they eat—routines are important. If that’s not possible, have them eat beforehand to balance their blood sugar and mood. Be realistic, and schedule a short visit if they don’t have the cognitive stamina to stay for four or five hours.
It’s also important to be inclusive when they’re at the celebration:
- Involve them in the party. In the early stages of dementia, they can help set the table or fold napkins.
- Introduce them to people they know, even if they may not remember everyone’s names. By saying, “Mom, this is Cousin Suzy,” it might trigger more memories.
- Bring photo albums to reminisce, but never say, “Do you remember?” or “Don’t you remember?” Instead, open with, “I remember when,” and tell them the memory. It might elicit a conversation with engagement.
- Ask one question at a time and allow 15 seconds for them to respond. It gives them time to process the information. For example, ask mom, “Do you want potatoes?” When she doesn’t immediately answer, pass the potatoes to someone else and then bring them back to her.
- Go with the flow. If you ask them to say grace and they recite the Pledge of Allegiance, say it with them.
If they become stressed, they might say, “I want to go home.” Tell them, “It seems like you’re anxious. Can you tell me what you like best about home?” The distraction may calm them down. If they start getting loud and aggressive, you have to make a change, Petrik said. Sit with them in a quiet room, and try to determine what triggered the turn in behavior: hunger, thirst, noise? Do they need to use the toilet, cool off or warm up? Did they calm down once their needs were met? If not, it’s time to leave—and that’s OK.
The party may not resemble a Norman Rockwell Thanksgiving, but it can still be beautiful. All you have to do is try—your efforts will be appreciated.