Guernsey’s Dementia Specialist Admiral Nurses have made a series of suggestions in the lead up to Christmas to help relatives and carers of those living with dementia.
Colette Bonner, MSc Dementia, and Michelle Martel, BSc (Hons) RMN, have collated a wide-range of suggestions based on their experience to support those at a time when lots of things change, which can be difficult for people living with dementia.
Ms Bonner has nursed in care of the elderly for over 35 years in the UK and Europe, specialising in dementia whether that be hands on care person centred care, training staff, or designing and implementing dementia friendly environments and developing dementia policies.
Mrs Martel is a Mental Health Nurse with substantial experience in Dementia Care, most recently within the Memory Clinic assisting in the diagnosing of dementia and supporting the subsequent pathway defining the unique needs of the family through individual assessments.
The Dementia Specialist Admiral Nurses know that many families find that Christmas can be the most anxious time for them watching their loved ones decline and wanting to make final memories.
Ms Bonner said: “It is common to hear the phrase that people with dementia have ‘Challenging Behaviour’ but it is a distressed reaction and usually caused by their inability to process what is going on around them. We can reduce distressed reactions with thought and preparation and responding using positive dementia skills.
“As with any aspect of dementia, keeping a routine is important to promoting wellbeing and calmness. During the month of December in particular, there are many changes taking place which can break away from this and induce a sensory overload.”
The most prominent changes in December which can affect people with dementia are in the following areas:
Mrs Martel said: “If possible, decorations should be introduced slowly into the home over a few weeks, and not all at once overnight as this can cause complete confusion for the person with dementia getting up in the morning and not recognising where they are.
“One tone colours, using matt shades rather than shiny may be preferable. This is to avoid reflections and ‘seeing faces or people’ in the baubles or tinsels that may appear real to the person with dementia. Keep it simple, maybe try one colour scheme rather than multicolours all over the house.
“Avoid moving the furniture around to accommodate Christmas Trees or extra chairs and tables as some people with Dementia may have poor spatial awareness and changing familiar objects may cause falls or the inability to find the way to the bathroom or bedroom as they do not recognise their usual routes. Try to use static fairy lights rather than flashing and use single colour lights rather than multicolour.
“Decorating safely would also include usual precautions such as avoiding real lighted candles and avoiding decorating stair/hand rails and bannisters.”
Ms Bonner said: “Christmas is a good time for buffets, and it may be that your loved one is much more able to manage finger foods than knives and forks and spoons. Otherwise for a sit-down meal it may be better to keep the decorations simple on the table.
“If the table is too lavishly decorated with a Christmas cloth, centre pieces and decorated napkins and crackers, wine glasses etc it may be an array of colours and too complicated for the person with dementia to work out where the food is and if served they may not be able to see what they are eating. Simple solutions are to have one place set with a plain white/contrasting square and no decorations around it and a contrasting plate (black or navy for example) that stands out so it is easy for the person to see their plate and food.
“Be mindful of pulling the crackers without warning. However, crackers may also be a happy memory so inform the person about what is happening and maybe pull them one at a time, face to face, to avoid an array of popping noises and flying objects from the insides.
“If music is being used in the background be aware of the volume. Christmas carols may sound lovely but playing in the background at the meal for example, can be confusing as there will be chatter at the table and if everyone is chatting together voices tend to raise with the merriment resulting in a muddle of noise.
“Be aware of the seating arrangements and whether it is best to have an end chair where the person may get up and move away from the table at will or if they are better seated in the middle where they feel more secure? You will know what works best for your family.”
3. Increased numbers in the gatherings
Mrs Martel said: “The most important things to monitor are the amount of interactions compared to the usual routine. Cousins, children, aunts and uncles, family from off-island suddenly appearing, friends, neighbours, there can be a significant increase in faces, conversations, house visits, excited children to name but some. While some people with dementia may embrace the moments and respond positively to the atmosphere of excitement and joy, others may find the constant changes of routine and the house visits, and trying to remember who is who a struggle, which quickly turns to frustration.”
4. Atmosphere and the loss of quiet space
Ms Bonner said: “Visitors can interrupt the usual naps and snoozes during the day which may be vital for the person with dementia to recharge. Being overtired and over stimulated can lead to distress.
“Ensure there is a break away space for them to go to. Perhaps a bedroom or spare room or conservatory, somewhere that is quiet and even where they can take a nap and switch off from the constant hustle and bustle.
“Christmas can mean noisy laughter, shrieks of excitement from little ones, after dinner games or television, the opening of presents in a group; whatever the
tradition just check in from time to time with your loved one to make sure they are comfortable and not overwhelmed.”
Mrs Martel added a final suggestion: “As individuals, every person responds or reacts differently. As family and friends, it is up to us to try and read the body language and detect the signs of distress before they escalate. The main thing is to be flexible, facilitate changes at short notice and don’t be disappointed if your loved one wants to be away from the festivities in the quiet.
“We know that many families have expressed that Christmas can be the most anxious time for them watching their loved ones decline and wanting to make final
memories. Be gentle with yourselves and perhaps realise that for some, Christmas Day has merged into just another day and it may be much more meaningful to be together a few days before or after, with less happening, so it becomes relaxed quality time together.”