The plan was a good one. Everybody comes to the house, Mom sits in the middle of it all, the grandchildren get to see her, and it feels like a normal Thanksgiving for one more year. By two in the afternoon she is agitated and asking to leave, one of your brothers is upset, and you are standing in the kitchen wondering what went wrong.
Nothing went wrong with her, and nothing went wrong with you. What went wrong is that a holiday gathering asks a person with dementia to do the two things dementia takes away first: keep track of a lot of people at once, and cope with a day that does not look like yesterday.
You can still have the holiday. It just has to be built differently.
Why an ordinary good day is easier than a holiday
It is worth being concrete about what a gathering actually demands, because once you see it written down the fixes become obvious.
A holiday changes the room, the noise level, the smells, the number of faces, the time of the meal, and often the time they get up and go to bed. Every one of those is a demand on a brain that is already working hard to keep up with an ordinary Tuesday. Several voices at once is the hardest of all. Following one conversation in a quiet room can be manageable when following four in a loud one is not, and the result looks like withdrawal, or irritation, or somebody quietly trying to leave.
Add to that the plain fact that a long day is tiring, and that being overtired makes late-day restlessness worse. If you have already read our piece on why late afternoon is the hardest part of the day, you know the shape of this. A holiday tends to put the biggest, loudest, most crowded part of the day at exactly the hour that was already the hardest one.
Pick the hour, not just the date
This is the single highest-value change most families can make, and it costs nothing.
Almost everyone with dementia has a better part of the day and a worse one, and for most people the better part is the morning. So instead of building the visit around when the turkey comes out, build it around when they are at their best, and let the food be whatever fits around that.
- Late morningVisit here if you can. Rested, better light, fewer hours of accumulated effort behind them. A late-morning hour is worth three in the evening.
- MiddayEat at the usual time. A meal pushed three hours later than normal is a bigger disruption than most families expect. Keeping their mealtime and moving the family’s is the easier trade.
- Early PMBuild in a rest. Not a suggestion made at the moment it is needed, an actual planned gap with a quiet room. Protect it even when things are going well.
- Late PMWind down, do not ramp up. If the evening is their hard stretch, this is when the visit ends, not when it peaks.
Smaller is genuinely better, and it is worth the awkward conversation
Four people at a time in a quiet room is a real visit. Fourteen people in a loud one is an ordeal that everyone will describe afterwards as a lovely day.
If the whole family is coming, stagger it. Have people arrive in waves and take turns sitting with her, rather than all twelve filling the living room at once. Put her in a chair with a wall behind it and a clear view of the door, not in the middle of the traffic. Turn the television off, because background noise competes directly with the voice she is trying to follow. Keep one room in the house quiet and lit and available all day, and tell everyone that is where she goes when she has had enough.
The awkward conversation is with the relatives who think that sounds unfriendly. It is worth having once, in advance, rather than managing in the moment.
Should you bring them to your house?
Families ask this every year and the honest answer is that it depends on how far along things are, and that the default should be more cautious than most people expect.
An unfamiliar house is genuinely hard. The bathroom is not where it should be, the route back to a chair has to be learned, and the person is working all day without the automatic knowledge of the place that normally carries them. For someone in the earlier stages, and especially somewhere they have been many times before, it can go fine. For someone further along, the trip out plus an unfamiliar building plus a crowd is three demands stacked, and the disorientation can last well past the drive home.
If they are living somewhere with care, the alternative is usually better than it sounds. Bring the holiday to them. A small group, food from home, an hour in a familiar room they already know how to be in. It feels like less. It is very often more, because everything they have left goes into being with you instead of into working out where they are.
If you do travel, go in their best hours, take a familiar blanket or cushion for the chair they will sit in, keep the trip short, and decide before you leave who is driving them back early. The person who leaves at the first sign of tiredness is not missing the holiday. They are the reason it worked.
Walking in the door
The first sixty seconds set the tone for the whole visit, and the most common mistake is made with the best intentions.
Do
- Lead with your own name every time. “Hi Mom, it’s Sarah.” Not a test, just information.
- Come at her from the front or the side, where she can see you, at or below eye level.
- One thing at a time, then wait. Five to ten seconds of quiet is normal processing, not a failure to hear you.
- Match the feeling rather than the facts. If she is worried, “that sounds worrying” works when a correction does not.
- Brief the children beforehand, plainly and without drama, on what to expect.
Don’t
- Ask “do you remember me?” or “do you know who this is?” It is a test with a wrong answer and it starts the visit with a failure.
- Quiz about the past. “Remember when we…” puts her on the spot. “I was thinking about…” gives her the same memory as a gift.
- Talk about her over her head as though she is not in the room. Comprehension outlasts speech.
- Pile on. Several people greeting at once is the hardest possible opening.
- Argue with a wrong fact that is doing no harm. Being right is not the goal of the afternoon.
When the same question comes six times
Repeated questions are almost always a sign of anxiety rather than a memory failure being displayed on purpose. The person is not trying to retrieve the answer so much as trying to settle the worry underneath it, and the worry comes back as soon as the answer fades.
So answer it briefly and calmly the sixth time in the same voice you used the first time, and then deal with the worry instead of the question. “What time are we eating?” asked repeatedly is often really “am I going to be all right here?” A written note on the table with the time on it, a cup of tea, a task to do, or simply sitting down next to her will do more than the seventh answer will.
The version of this that hurts most is when someone asks for a person who has died. Blunt correction means fresh grief, delivered over and over. Flat agreement is not the answer either, and it is not something to reach for casually. The approach most families land on is to go at the feeling first: “you’re missing him.” Very often that is the whole of what was being asked, and it is answered honestly. If she is genuinely distressed and going back over it plainly is making it worse each time with nothing gained, most clinicians would rather you redirect gently toward something else than keep re-delivering the news. That is a judgment about this person on this day, not a rule.
“I want to go home”
Home is usually not an address. It is a feeling of being safe and in the right place, and it is often a house from decades ago rather than the one they left last year. Arguing the geography does not work because the geography was never the point.
What tends to help is agreeing with the feeling and buying time. “I know. Let’s have a cup of coffee first and then we’ll sort it out.” Then change the room, change the activity, put something in their hands. Going outside for two minutes resets more arguments than any sentence does.
Food, drinks, and the cabinet nobody thinks about
Three small things cause a lot of avoidable trouble on holidays.
The plate. A loaded holiday plate is visually confusing. Less food, served in courses, on a plain plate that contrasts with the food is easier to manage than a full one with a patterned rim. Finger foods rescue a meal for someone struggling with a knife and fork, and they let the person keep eating with everyone else rather than being helped in front of an audience.
The drinks. Alcohol at a holiday is worth a conversation with their doctor or pharmacist rather than a decision made at the table. It interacts with a long list of common medications, and on its own it adds to confusion and unsteadiness in someone who may already be at risk of a fall. If a glass of wine has always been part of Christmas dinner and their doctor is comfortable with it, that is their call to make with you. The thing to avoid is the extra one that gets poured because it is a party.
The cabinet. This one is genuinely not obvious. Over the counter sleep aids and the “PM” version of ordinary painkillers usually contain an older sedating antihistamine, most often diphenhydramine. That particular group is specifically flagged as one to avoid in older adults, because it can worsen confusion and increase the risk of a fall. This is not a reason to stop a daily non drowsy allergy tablet, which is a different kind of drug. After a big day, reaching for something to help them sleep is an understandable instinct and it is the wrong one. If sleep is a problem, that is a conversation with their doctor, not a trip to the medicine cabinet.
Give them a job
The instinct is to seat the person with dementia comfortably and let them be waited on. It is kind, and it is usually the wrong call, because it turns them into a guest at their own family’s holiday.
Old, well practiced tasks survive in a way that new learning does not. Folding napkins, drying and sorting silverware, stirring a bowl, putting names at places, greeting people at the door, shelling pecans, holding the baby. Pick something with no wrong answer and no time pressure, and accept the result however it comes out. Being useful is different from being included, and people can feel the difference long after they can explain it.
Gifts that actually land
- A photo book with big pictures and names written under them, not a device with a screen to learn.
- Clothes that are easy to get in and out of. Elastic waists, front fastenings, cardigans over pullovers, non slip shoes.
- Music from when they were fifteen to twenty five, which is the window that stays reachable longest. A simple player with one button beats a streaming subscription.
- Something for the hands. A soft blanket, a warm shawl, textured fabric, a firm cushion.
- Hand cream, a decent hairbrush, a favorite soap. Ordinary comforts get used every day.
- Your time, written down. A card promising a standing Tuesday visit is a better gift than an object, and it is the one that helps the person doing the caring.
And for whoever is providing the care day to day: the most useful thing in the room is usually an afternoon off, offered specifically, with a date on it.
What families notice at the holidays
Because a holiday puts everyone in the same room, it is often when the family sees plainly what the person doing the caring has been living with for months. Weight loss. An empty refrigerator. Unopened mail in stacks. Bills unpaid, or paid three times. Scorch marks on a pan. A parent in the same clothes as yesterday. A caregiver who has aged a year in six months.
That is worth writing down rather than arguing about at the table. It is also worth saying to the person who has been doing the caring, in private and without an audience, that you can see it.
When to call the doctor, not wait until January
A gradual decline since last year belongs in a regular appointment. These do not:
- The change arrived over a day or two rather than over months, and it comes and goes. Clearer in the morning, markedly worse by evening.
- They are drifting, hard to rouse, or unable to hold attention on a sentence in a way that is new.
- They are seeing or hearing things that are not there, and this is new.
- There is fever, vomiting, pain, or a new fall.
- They have stopped eating or drinking for more than a day.
- A medication started or changed around the time this began.
Describe to the doctor exactly what you saw and when it started, rather than asking for a specific test. Sudden confusion has a long list of treatable causes, including dehydration, constipation, pain, a new medication and infection, and the useful thing you can provide is the timeline nobody else has.
If someone is in immediate danger, or you see sudden weakness on one side, a drooping face or slurred speech, call 911 and tell the dispatcher that the person has dementia.
If this was the year you noticed
For a lot of families, the holidays are when the question stops being theoretical. Someone drives home in December already knowing that next year cannot look like this one.
If that is where you are, it is not a failure and it does not have to be settled this week. Our piece on the signs it may be time is the direct read, what families need to know in the first year covers the ground behind it, and having the conversation is worth reading before you start it, because that part is harder than the decision.
Front Porch of Bowdon is a licensed personal care home in Bowdon, Georgia, serving families across Carroll, Haralson and the surrounding West Georgia counties. Come look at it, in person, on an ordinary day. We will tell you honestly whether we are the right fit for your family, including when the answer is no.
Where this comes from
- Alzheimer’s Association, Holidays and Alzheimer’s.
- National Institute on Aging, Adapting Activities for People With Alzheimer’s Disease, holidays section.
- National Institute on Aging, Communicating With Someone Who Has Alzheimer’s Disease.
- HealthInAging.org, from the American Geriatrics Society, Medications and Older Adults, on the drugs older adults should avoid or use with caution (the AGS Beers Criteria).
Photographs. The aerial view is Front Porch of Bowdon. The other three are stock photographs by Tolga Ahmetler, Roman Odintsov and T Leish, via Pexels and used under the Pexels License. They are not photographs of Front Porch residents.
This is general information, not medical advice. Every person with dementia is different. Talk to their doctor before changing medications, before adding alcohol to the day, and before assuming a behavior change is caused by dementia rather than by something treatable.
Written by the team at Front Porch of Bowdon, a licensed personal care home in Bowdon, Georgia. Our owner, Paul Kennedy, is a registered nurse.
