Supporting a person with dementia during visits, holidays and celebrations

Religious festivals, public holidays and celebrations such as weddings are important social occasions, but they can be stressful for people with dementia, their carers and family. It is important that people with dementia have the opportunity to enjoy these special events, however a change in routine can be very disorienting and they may become distressed or confused. This factsheet offers tips to people who are hosting or visiting a person with dementia, so that everyone has a relaxing and enjoyable time.

Having a guest with dementia

Many people with dementia will spend festival periods with the person who cares for them and who they live with year-round. However, others may be invited to stay with friends or relatives for a short time over the festive period. If someone with dementia is visiting you, there is much you can do to prepare for the visit and make things easier for both yourself and your guest.

Planning for the visit

Seek advice from the person who normally cares for the person with dementia. In many cases, they will know the person best and will be able to help you to prepare for the visit. 

If the house is unfamiliar to your guest, or they become easily confused, putting labels on doors could help - for example, the bathroom, the kitchen, and the person's bedroom. You could also label kitchen cupboards and drawers to help your guest find their way around more easily and feel more at home. Research suggests that using labels with both pictures and words is more helpful than using words alone. If your guest forgets people's names easily it may also be helpful for people in the house to wear name badges.

Think about any specialist equipment you might need, and buy or borrow it well in advance. For example, does the person need slip-proof mats, a raised toilet seat or large-handled cutlery? Will they bring a supply of incontinence pads or should you order some? Information about how to obtain specialist equipment can be found in our factsheet, Equipment to help with disability (429).

Asking for help

Don't be afraid to ask your friends and neighbours for help. They may be happy to bring over a cooked meal for you, do a little bit of shopping, or sit with your guest for an hour or so while you have some time to yourself. Try to resist the instinct to refuse help if somebody offers it - they may not think to offer again. If you have children, try to enlist their help too. Give them some tasks that they can be responsible for, and explain what a difference their help makes.

Safety and security

The house may become quite noisy and busy during a celebration, or over the entire festive period, making it easier for people to leave the house unnoticed. If you are worried about your guest leaving the house on their own and getting lost, talk to other members of your family and decide on a plan of action. Keep doors leading onto busy roads closed or locked. Try to enlist someone to accompany the person outdoors if they want to go for a walk.

Remember to keep spare keys in a safe place. Check the house in the evening to make sure that doors leading to the outside are locked and that  windows have not been left open.

Check your house carefully for anything that might be dangerous. Consider the following tips:

• If your guest is likely to get up at night, leave a light on in the hall when you go to bed and offer them a nightlight for their bedroom.
• Make sure there is a light on in the bathroom or toilet so they can find their way at night.
• Leave the toilet door open when it is not in use, to help the person identify where it is.
• Tidy away or tape down any trailing flexes, remove rugs that a person could trip on, and remove clutter or objects lying on the floor. Make sure that nothing is ever left on the stairs.
• Lock away any medicines and dangerous substances, such as bleach or paint.
• If your guest no longer seems to recognise risk, make sure that potentially dangerous implements, such as sharp knives, are removed from the kitchen.
• If you have an open fire, fit a fixed fireguard.
• Remove all poisonous plants or flowers and any artificial fruits or food-shaped fridge magnets that might appear edible.

Food and mealtimes

Food and eating usually play a large part in any festivity, and you may feel anxious about how to fully involve your guest in this, especially if they have lost their appetite or they have difficulties eating.

Here are some tips:

• Avoid having lots of different patterns and decorations at the dinner table. It is a good idea to use a plain coloured table cloth with plates that are a different plain colour.
• Think about the size of the meal you serve. Although many people eat a lot on special occasions, a very full plate can be quite daunting for someone who has difficulties eating.
• It's okay if the person cannot, or will not, eat everything on their plate.
• If the person eats very slowly, consider buying an insulated plate to keep their food warmer for longer, or heating food up in the microwave if it gets too cold.
• The person may feel self-conscious at a large dinner table, so avoid making them the centre of attention. They may feel happier to eat in a different room, at a different time, or on their own - flexibility is the key.
• Take an open-minded approach to any unusual food combinations that your guest chooses. They may also enjoy their food with strong or spicy sauces or seasonings that seem strange to you - if this is the case, try not to object.
• Drinking alcohol in moderation is fine for many people, but remember that alcohol can increase confusion or contribute to falls. Some medications do not mix well with alcohol so check what has been recommended by the person's doctor if in any doubt.

Emergencies

Make sure you know where your nearest accident and emergency department is and, if the person is coming during a public holiday, such as Christmas, Easter or a bank holiday, make sure you know which doctors and chemists are open during that period. Keep a list of emergency numbers in a safe place.

Social services have an emergency duty team operating during holidays. In case of emergency or crisis you can call them. You will find the details listed in the phone book under the name of your local authority.

Medicine

Check whether your guest is taking any medication and ensure that they have enough to get through the festive period. Remember that getting repeat prescriptions may be difficult during public holidays. If the person usually lives in a care home, talk to their care manager about this situation. Make sure the person knows where they have put their medication, and ask whether they would like you to look after it.

Emotional needs

Festivals and family gatherings can be periods of heightened emotion for all involved. This section looks at how to make sure the needs of the person with dementia are met, as well as the needs of those who are caring for them during this time.

The needs of the person with dementia

The person with dementia may find it unsettling to be in an unfamiliar place. Even if they are spending the festive season at home, the atmosphere during festivals or celebrations may be very different from usual, and their routine may be disrupted. People will react to this differently, but some may become more confused, upset or even aggressive. Annual festivals at which the family traditionally come together may also trigger emotional memories, which could be difficult for the person to deal with.

Be prepared for changes in the person's behaviour. Think about how they might be feeling and spend some time listening and offer reassurance.

It may help if you can think of some activities and tasks that the person will enjoy doing in quieter moments. What do they enjoy doing in their normal day-to-day life? What might make them feel more at home? They may have some happy memories of bygone celebrations that you can reminisce about. Do you have any old photos you could look at together? The person might also enjoy puzzles, games, walking, or household tasks such as cleaning or cooking. Try to involve them in your own activities and reassure them that their help is valued.

Try to help your guest get a good night's sleep, as this may make a big difference to how well they are during the day. Unless it is part of their usual routine, the person should try not to take too many daytime naps. To avoid this, involve them in conversations and activities. Limit fluids in the evening, and avoid stimulating drinks such as tea, coffee and soft drinks. Try giving them a warm, milky drink at bedtime.

If the person is staying with you during a religious festival and the person is religious, they may also get some solace from spiritual activities. Think about their usual or past religious attitudes: would they like to listen to church hymns, or visit the local temple or mosque? Talk to them about their views. Try to accommodate any particular wishes they may have.

The needs of the carer

If you are caring for someone with dementia during a festive period, you may become quite exhausted or stressed yourself. The following tips may help:

• Remember to take some time for yourself, even if it's just a few quiet minutes in the evening. You might also find it helpful to get out for a brief walk in the fresh air every now and then.
• Try to pace yourself and set realistic goals - if a task is not urgent, perhaps you can just let it go.
• If you are struggling and feel that you need to talk to someone impartial and in confidence, you can call the Samaritans. They offer emotional support 24 hours a day. Alzheimer's Society's online discussion forum, Talking Point, may also be a source of comfort and advice (see 'Useful organisations' for details).
• Check your local TV, press and radio for details of local helplines. These can be very helpful if you need some advice or information about local services, or if you just need somebody to talk to. You can also call Alzheimer's Society's National Dementia Helpline.

The family

Festive occasions are supposed to be fun, but stress and anxiety are also common during these times, and many families experience arguments or tension. This will impact on everyone, but in particular the person with dementia. Try to avoid known triggers - for example, if you tend to argue about politics in your family, try to avoid the subject. It might help to plan a group activity such as playing cards or watching a film after lunch so that everyone is busy and entertained.

Many people drink more alcohol than usual during these occasions, and this can make arguments and accidents more likely. Although sociable drinking is all part of the fun for many people, being aware of the impact this might have could help to avoid difficult situations.

If the house becomes very busy, it may be helpful to designate a room as a 'quiet room', and to agree not to watch television or listen to music there. If anyone is feeling stressed or tense, there will then be somewhere quiet for them to sit and relax for a while.

When your friend or loved one is staying in a care home

You may have a family member or friend who will be staying in a care home during a festival or holiday. This is a very difficult situation for many people. Try to remember that there is no right or wrong way to handle the situation. Some people like to visit their relative and spend a large part of the day with them in the home, while others are not able to do this, for a variety of reasons. Whatever your situation, try not to feel guilty, and do your best to enjoy the holiday. If you need to talk about your feelings, you can call the Alzheimer's Society National Dementia Helpline or you can log in to Talking Point to chat online with people who may be in a similar situation (see 'Useful organisations').

For details of Alzheimer's Society services in your area, visit alzheimers.org.uk/localinfo
For information about a wide range of dementia-related topics, visit alzheimers.org.uk/factsheets

Useful organisations

Alzheimer's Society's Talking Point

W alzheimers.org.uk/talkingpoint

Alzheimer's Society's online community offering information and support for anyone affected by dementia. People can join in online discussions or simply read about the experience of others..

NHS Direct

T 0845 46 47
W www.nhsdirect.nhs.uk

Official website and 24-hour telephone helpline. Provides information about health problems and how to keep healthy.

Samaritans

T 08457 90 90 90 (24 hours, seven days a week)
E jo@samaritans.org
W www.samaritans.org

Samaritans provide confidential non-judgemental emotional support, 24 hours a day, for people who are experiencing feelings of distress or despair, including those which could lead to suicide. To find your nearest branch look in the phone book or look on the website.

Factsheet 455

Last reviewed: October 2011
Next review due: October 2013

Reviewed by: Professor Roger Watson, Professor of Nursing, University of Sheffield, Sheffield and Dr Claudia Metzler-Baddeley, Research Associate, School of Psychology, Cardiff University, Cardiff.