Family having a Christmas dinner together

Dementia-friendly Christmas for you and your loved ones

Christmas day is, for many people, the most joyful day of the winter holidays. Decorating the house, spending time with our loved ones and enjoying a Christmas dinner is something most of us are looking forward too. At the same time, it can be a very challenging day for people with dementia as unfamiliar settings and situations can be confusing for them. Even if they spend the day at their home, the abundance of decorations, the large number of people visiting and the noisy atmosphere of a Christmas party will not only upset their usual schedule but also present them with an environment that is essentially unfamiliar to them. Thus, we must ensure that people with dementia are included in Christmas day celebrations in ways that are meaningful and non-threatening to them.

Decorating the house marks the beginning of the festive season, helps the family get together and brings back good memories. Many decorations have their own story and remind us of past Christmases. It is also a way to care for our guests as we have the opportunity to make the house festive and beautiful for them and showcase the decorations they might have gifted us in the past. It is important to involve our loved ones with dementia in Christmas decorating. It will make them feel included in our festive activities and make the changes in the environment more incremental and manageable. Make sure that you remind them the reason for decorating and discuss the history of some of the family’s most treasured Christmas ornaments. Also take note of anything that may causing too much anxiety or agitation. If twinkling or flickering lights are unbearable for them switch to regular lights.

If you are inviting people over for a Christmas party, talk to the person with dementia and remind them who each visitor is. Showing them photographs of each guest can help too. Also let your visitors know about your loved one’s dementia and how it can affect their interaction with them. Make sure that the person with dementia is sitting in a spot where they can see visitors entering the room so they don’t suddenly get overwhelmed by the presence of people they were not expecting. Ask your guests to keep the noise down as much as possible to avoid auditory overstimulation. It is also a good idea to have a quiet room where the person with dementia can retreat if they feel overwhelmed.

The Christmas dinner is usually the highlight of Christmas day and it should be something our loved ones with dementia can participate in and enjoy. As people with dementia can have difficulties eating, don’t overwhelm them with an overloaded plate. Ensure that they are served their favorite foods in small and manageable quantities and consider creating finger food versions of their preferred foods if they have trouble using cutlery. Also, ensure that there is enough contrast between the tablecloth, plates, glasses and cutlery. Be mindful of alcohol consumption as your loved ones may have trouble remembering how much they have drunk during the dinner.

What is more important though, is remembering that each person and each family celebrates Christmas in their own way. And the way we celebrate can change as our lives change. If your lives have been changed by dementia it is important to find ways to celebrate Christmas in ways that work for you and your loved ones. Remember and treasure past Christmases and family traditions but make space in your hearts and in your minds for change and for the Christmases to come and make sure you stay together as a family throughout your loved one’s dementia journey.

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Happy family enjoying dinner in garden

Weight loss in the elderly

In western societies, overeating and obesity is a major health problem. This does include older people as well, with more than fifty percent of Americans over the age of 65 having a Body Mass Index (BMI) of 25 kg/m2 or over, a value considered a cutoff for being characterized as overweight by the World Health Organisation. Although weight loss seems beneficial for young adults, this is not necessarily the case for the elderly. Numerous studies have shown that weight loss in the elderly is associated with poor outcomes, certainly if weight loss is involuntary, but possibly even when it is deliberate. 

Energy restriction in the elderly is likely to result in loss of lean body mass, nutritional deficiencies, reduced function, and adverse effects. For these reasons, caution should be exercised in recommending significant calorie restriction to people over the age of seventy. There is evidence that the adverse effects of being overweight are not as great in the elderly as in younger adults. The ideal weight seems to be higher in the elderly and there is evidence that a body mass index above normal seems to have a more protective impact especially in women as compared to men.

Elderly people, however, demonstrate in general gradual weight loss, as documented in epidemiological studies. Studies have shown that there is an involuntary weight loss of 0.5-5% of body weight per year. At the same time, numerous studies have shown that involuntary weight loss in the elderly is associated with poor outcomes. There are many reasons why weight loss in older people has adverse effects. It some cases, weight loss is due to an illness, such as an underlying malignancy. In these cases, it is the malignancy which is mainly responsible for the poor outcome and the weight loss is partly an ‘innocent bystander’. Nevertheless, the weight loss and associated undernutrition are themselves often a significant problem. This is because a loss of body weight after the age of 60 years represents disproportionately loss of lean body tissue, what is known as sarcopenia. On average individuals lose up to 3 kg of lean body mass per decade after the age of 50 years. Unlike the loss of fat tissue, such a loss of lean tissue has adverse effects. Sarcopenia is associated with metabolic, physiological and functional impairments and disability, including increased falls, diminished strength and increased risk of protein-energy malnutrition. What is important to understand is that an elderly person may be sarcopenic, without demonstrating significant weight loss. So individuals with a high body mass index may demonstrate what is known as sarcopenic obesity.

Older persons tend to eat fewer calories than younger adults due to several reasons that are related to physiological changes (reduced appetite, reduced resting energy expenditure), socioeconomic and psychological reasons (depression, isolation, loneliness) or pathologic causes such as difficulty in chewing (e.g. problems with their teeth or dentures), problems with swallowing (neurodegenerative diseases) or anorexia due to serious underlying conditions (cancer, heart or kidney failure etc).

Another mechanism for weight loss in the elderly is cachexia, a combined protein and energy store loss due to the effects of disease. Cachexia is an inflammatory response mediated by molecules called cytokines. Patients with cachexia lose roughly equal amounts of fat and fat-free mass. Common conditions associated this cachexia are amongst others, infections like AIDS or tuberculosis, cancer, end-stage kidney disease, rheumatoid arthritis, chronic obstructive pulmonary disease and congestive heart failure. 

Weight loss can also occur due to anorexia, the lack of appetite. This can be a result of underlying acute illness or occasionally may also result from changes in the physiological regulation of appetite and satiety, as a physiological response to aging. A lot of interest and discussion focuses on the effects of dementia in the nutritional status of the elderly. As the disease progresses, malnutrition may manifest itself as a result of many factors. In advanced stages of dementia, there is a reduced capacity for communication, loss of pleasure in eating, changes in mastication leading to difficulty in swallowing certain consistencies of food, and culminating in dysphagia. Also, advanced dementia may be related to the presence of higher rates of infection, the burning of energy due to repetitive movements and cognitive deficit that compromises the patient’ s independence.

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Young positive lady showing photos on smartphone to senior man while sitting at laptop

Older adults and new technologies: a troubled relationship no more (?)

The stereotypical image of an older adult struggling with the most basic functions of a computer interface is pretty much ingrained in our subconscious through countless movies and anecdotes. Apart from the obvious ageism of such a depiction of older adults is it even close to the truth, especially now that computers and similar devices have become so widespread? It might seem as a detour but in order to answer this question we should embark on a brief journey through the development of computing and digital consumer products.

When they first entered the market, personal computers and other devices such as digital cameras were the domain of tech-savvy people and early adopters who could put up with complex interfaces in order to enjoy those technological marvels previously reserved for scientists and industry people. Many of us may remember, with some amusement, the “arms race” between various manufacturers aiming to make faster processors and more detailed digital camera sensors. It was a battle fought with gigahertz and megapixels and at that point it seemed logical enough since existing hardware could not cater to the ever-increasing needs of the users of such devices. Predictably when too much emphasis is placed on performance, ease of use tends to be overlooked. With the amount of money being invested in computing however it was only natural that at some point this arms race would end simply because the hardware did in fact improve dramatically. 

Essentially this was the impetus for a dramatic shift. The focus shifted from raw power to user experience and usability. Multimedia became the new buzzword and as more people started using computers, companies strived to make their interface more user friendly. One could say that we entered the present age of ubiquitous and easy to use technology as the first smartphones and tablets appeared. And the driving force behind that forward leap? Well it is of course the touch screen! Many dismissed it as a flashy gimmick when it first appeared but it fundamentally changed the way we interact with a computer interface. It was the first time we could physically interact with digital objects. We didn’t have to move the mouse and click on an icon, we just touched that icon. In essence we could operate digital items much like we would operate mechanical buttons. This is particularly important for older adults who may be more accustomed to mechanical systems where one has to physically interact with switches, buttons and other aspects of the interface. It is not surprising that tablets and smartphones are becoming increasingly popular among older adults who now represent an ever-increasing segment among users of these devices. 

It may seem ironic but computing became more user friendly and accessible to older adults when devices deviated from the paradigm of a classic personal computer. What tablets have taught us though is that older adults are interested in new technologies as long as they are accessible to them and also that all user groups appreciate more intuitive interfaces. Computers and the internet are intertwined with our daily lives and we should do anything in our power to make sure that older adults are not excluded from today’s digital society. Luckily the tech industry’s focus on usability remains strong with software applications becoming increasingly user friendly and being offered in various platforms (PC, tablet, mobile). This approach not only allows older adults to choose the platform that is easier for them to operate but also makes using the same application across platforms easier as they retain their core design and operating principles. Furthermore tech companies have begun to design software and hardware specifically for older adults as they begin to understand their importance as a distinct user group. Even when it comes to products aimed at diverse age groups, efforts are often made to ensure that they can be operated by older adults. This is done both to expand the range of users but also because it is a good indicator of effective design and intuitive operation.

After an admittedly long detour I believe we can finally answer the question presented at the beginning of this article. Nowadays technology is far less intimidating to older adults offering better interfaces and a variety of hardware allowing users to select what better suits their needs. One can expect computing to become even more accessible but that should not keep older adults from engaging with presently available technology. Indeed the increasing percentage of older adults that are using digital devices and surfing the internet indicates that they are not willing to wait anymore! We are at a unique point in time where everyone can reap the benefits of new technologies with little effort, safe in the knowledge that they are not left out of societal interaction which has now moved to the digital domain. At the same time the future looks even brighter or at least more accessible and user-friendly.

What can I do?

  • As an older adult: Get to know technology. Focus on devices and technologies that cover your needs without being distracted by unnecessary features that can increase cost and complexity.
  • As a relative: Encourage your loved ones to embrace technology. Focus on their needs and the practical benefits of technology. 
  • As a nursing home / assisted living owner: Integrate technological solutions into the senior living community’s routine. Focus on issues faced by your residents such as boredom, isolation and lack of communication with relatives/ friends etc. 
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Old couple walking while holding hands

How to cope with challenging behaviors in dementia

Most challenging behaviors in dementia are mild or moderate and can be treated at home. Appropriate, non-pharmacological handling is usually sufficient and there is no need addressing to a physician or to specialized dementia care. Proper education is essential to deal with challenging behaviors at home. 

When a new behavioral symptom is observed or changes its character, it is very important to rule out a medical condition as a possible cause. Urinary tract infection, constipation, pain and other conditions, such as arthritis may be the cause of a challenging behavior. It is very important to visit a GP, not to miss such a diagnosis.

Proper observation and detailed recording of the behavior is also essential. What are the characteristics of the behavior? How often does it happen? What time of the day? Is the person with dementia alone or with others when the behavior appears? Is s/he easily reassured? How severe is the behavior and how easily does it resolve? Has the person eaten? Has s/he gone to the toilet? 

What can I do as a caregiver?

Let’s take a look at some key strategies for dealing with challenging behaviors:

  • Arm yourself with patience, no matter how difficult it is. Do not take it personally. It has nothing to do with you, nor does the patient want to bother you. It is common for challenging behaviors to be directed towards primary caregivers or others providing care. 
  • It is important to understand that patients’ suspicions and false accusations are caused by the disease and are not a reflection of them.
  • Try to listen to the person with dementia and understand their own reality. In fact, people with dementia have a different idea of ‘reality’ – or sense of what is really going on – from our own. Their own reality must not be disputed and cannot be fixed. If, for example, the person with dementia believes we are in 1987, we have no reason to correct him/her. They will not remember it anyway. They will only be upset.
  • Do not argue, do not try to convince them. Unfortunately, reasoning does not help with dementia. If they believe they are in their native village, it makes no sense to try to convince them that they are in the city. Respect their own idea of reality, without making fun of them.
  • Instead, reassure them. Make them feel safe and show that you care about what they tell you, that you take them seriously.
  • Change the topic of discussion or find an activity to keep them busy. You can tell them, “Yes, we will do what you say, but please I need to do something first and I need your help.”
  • If they keep repeating the same question, try to answer it each time without criticizing them. If you are tired, you can walk away and take some time for yourself.
  • If they lose objects, you could get duplicates or more of the items they are looking for and place them in different parts of the house (e.g. their watch or wallet).

How can I communicate with a dementia patient?

  • Regarding communication with the person who has dementia and exhibits challenging behaviors:
  • Use a calm and reassuring tone of voice. Use simple words, short sentences and ask one question at a time.
  • We always prefer a positive approach instead of a negative one (no “do not do it” but “let’s do something else, help me”).
  • Maintain eye contact
  • Approach the person from the front and not from behind
  • Avoid sudden movements and voices, they can be scared and get upset
  • Humor and laughter usually help
  • Reduce the stimuli of the environment that can distract them, turn down the bright lights and loud music, on the contrary relaxing music can help

Before resorting to medication, there must always have been previous non-pharmaceutical interventions.

However, in cases where the patient’s own safety or the caregiver’s safety is at risk or if despite proper handling, symptoms persist, medication may help.

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Senior man standing beside senior woman on swing

Don’t play the waiting game

The value of early cognitive assessment

Older adults’ relationship with cognitive examination and dementia screening remains complicated. The progressive nature of the disease and limited treatment options often lead older adults to forgo cognitive assessment until they feel they are facing serious cognitive issues which impact their daily life. It is true that often the early symptoms of dementia may go unnoticed and one should not underestimate the fear of getting tested for a disease that cannot effectively be cured. Until now the best option for older adults was to hope that they don’t develop dementia and wait for issues to appear before getting tested. Dementia experts however were growing tired of the “hope and wait” approach.

Not content with just diagnosing dementia and then trying to slow the disease progression, the global scientific community has led an effort to diagnose cognitive problems at an earlier stage, before a person develops dementia. Lately there has been a lot of discussion about mild cognitive impairment or MCI for short. But what is MCI? In essence it is a diagnosis that refers to the existence of cognitive problems beyond those expected due to age however it is not (yet) dementia. More importantly people with MCI can live autonomously and there is a good chance that their situation may be stabilized or even improved with targeted cognitive training activities. Furthermore intervention at the MCI stage is imperative as people with MCI are at a higher risk of progressing to dementia. In essence an MCI diagnosis is a call to action and an opportunity to avoid progression to dementia.

In order for this new approach to be effective though, older adults themselves must change their attitudes towards brain health. Awareness campaigns have highlighted the importance of prevention and regular testing for various diseases. Indeed when it comes to diseases like breast cancer we tend to be proactive instead of waiting for symptoms to appear. We should now apply that mentality to brain health and recognize that our brain is a complex instrument that needs to be monitored regularly as we enter old age. We are used to scheduling yearly blood tests and now it’s time we started scheduling yearly cognitive screening not just for dementia but also for milder cognitive issues such as MCI.

Nowadays we recognize that brain health is an issue that affects the whole of society therefore everyone should be involved in addressing it. Gone are the days of scientists working alone in dimly lit laboratories. If we want to defeat dementia we must step forward and take part in the struggle no matter if we are older adults, relatives or simply concerned citizens. A society-wide mentality shift can often be more effective than a thousand scientific articles and strengthening the ties between society and the scientific community can only lead to progress and better health for everyone.

What can I do?

  • As an older adult: Maintain an active and healthy lifestyle. Make sure you integrate an annual cognitive examination in your preventive healthcare schedule.
  • As a relative: Encourage your loved ones to examine their brain health yearly even if they feel healthy.
  • As an assisted living / nursing home owner: Offer a yearly cognitive examination service for your residents. Offer cognitive training / rehabilitation programs for those residents with cognitive problems.

Further resources

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Woman holding a glass of water

Dehydration in the elderly

Dehydration is a very serious problem in all ages and has potentially deleterious consequences if not diagnosed and treated promptly. Dehydration is often encountered in the elderly, both in the community and long-term care settings and it is important to understand some basic principles to reduce the risk of dehydration in this sensitive age group. 

Water accounts for about 60% of body weight in an average human. Two-thirds of this water is located in the cells of the body and one-third is located extracellularly. Part of the extracellular fluid is in our veins and arteries (the intravascular space) and this is tightly regulated by complex mechanisms based on pressure and osmotic receptors. The total amount of water in our body depends on a fine balance between intake and output of fluids. 

Water can be lost from our body from the kidneys through urine production, the skin through sweating, the lungs through breathing and the gastrointestinal tract through defecation. The kidneys filter our blood (around 150 liters of fluid per day) but only 1% of that fluid (1.5 liters) are excreted normally as urine. This shows the remarkable capacity of our kidneys to ‘economize’ water in order to keep us alive. The same happens in the gastrointestinal tract where the six to seven liters of fluids that the intestine receives per day (adding up the amount of liquid we consume in our food and drinks, the salivary, gastric, pancreatic and biliary secretions), the amount of water in the feces is only around 100 ml. This is another amazing mechanism of water conservation in our body. Of course in cases of gastroenteritis this absorptive mechanism is disrupted and therefore one can become dehydrated within hours in cases of severe diarrhea or vomiting.

As mentioned above water is also lost through sweat – normally 500 ml per day, but this amount may be increased during a hot day or if the person has fever. Sweating is a thermoregulatory mechanism and one should always take into consideration the increased losses through sweating in a feverish patient. Finally, a small amount of water is exhaled through the lungs via respiration – around 200 ml per day. To summarize, dehydration can occur in cases of decreased intake of water or/and increased losses as may happen with conditions like vomiting, diarrhea, kidney problems, administration of diuretics, high fever, hot environment, etc.

How can someone assess body water loss and dehydration in general? In conscious adult patients with no cognitive impairment, dehydration would normally bring thirst and a desire to drink water to replenish the losses. The mechanism of thirst is based on complex systems that are triggered through specialized osmoreceptors and baroreceptors in the body that sense water loss. In cases of altered consciousness or impaired cognitive function as in dementia or even in other conditions, the mechanism of thirst does not function well. The patient may not feel as thirsty or may feel the thirst but may not be able to communicate this. Bedridden patients with motor disability may not be able to get to the water if it’s not within reach. Progressively with age these regulatory mechanisms start to fade gradually and therefore older persons exhibit a decreased thirst sensation and reduced fluid intake.

So are there any ways of detecting dehydration in the elderly patient with impaired cognitive status that will not communicate to us that he is thirsty? A good rough guide is to look at the tongue and its moisture. A moist tongue without furrows argues against the presence of dehydration, whereas a dry furrowed tongue is suggestive of dehydration, but not diagnostic as this can also happen due to other causes, such as mouth breathing, various drugs, salivary gland dysfunction and so on. Another sign of dehydration is the presence of a dry axilla. Finally, a more reliable sign for dehydration, is what is called postural hypotension, during which the patient becomes dizzy when he assumes an upright position and there is a drop in the blood pressure and a rise of his pulse rate.

The diagnosis of dehydration is associated with an increased in-hospital morbidity and mortality. Dehydration has been proposed as a quality of care indicator in long-term care facilities. The diagnosis of dehydration in a patient admitted to hospital from a nursing home may imply a failure in the quality of health care delivery. However, the difficulty in diagnosing dehydration in older populations results in dehydration performing poorly as a quality of care indicator.

It is paramount to prevent dehydration in the elderly, especially the ones who are totally dependent on care provided by others. Provision of 1500 ml to 2000 ml of water per day is sufficient for an average sized person. Water is contained in food, soups and beverages and therefore all this water should be calculated. Most community-dwelling elderly consume about 1000 ml per day. The problems are worse when an elderly adult is dependant on others to provide them with hydration. Giving water to patients that due to dementia or other conditions are not co-operative takes time and patience. Serious complications can occur when there is a danger of aspiration due to poor swallowing reflexes as often happens in people with neurodegenerative conditions. In cases like that, water should be given with extreme caution but often is not adequate. Using a thickening powder to change the consistency of the water facilitates swallowing, but often a feeding tube may be necessary in order to deliver fluids (and food) more safely.

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Joyful adult daughter greeting happy surprised senior mother in garden

Holiday season: be joyful, stay vigilant

Things to reflect on after holiday visits with older adults

During the winter holiday season many of us were lucky enough to visit older relatives, while taking all the necessary precautions to keep ourselves and our loved ones safe from COVID-19. Festive gatherings are a big part of family life and something most of us look forward to every year. The holiday season is joyful and familiar yet complex and demanding at the same time. Grocery lists grow larger, meals become more elaborate, we interact with more people and there are a myriad of things to remember: calling all of our friends and family for holiday wishes, mailing all those cards and gifts etc. While this complexity is usually a welcome change from our normal daily routine, it can be challenging for many older adults and it can often highlight health issues that would otherwise have remained undetected during the rest of the year.

Familiarity and repetition make our lives easier as most of us settle into our habits and daily schedules. These schedules, reinforced through daily repetition, become second nature to us and allow us to lead complex lives with minimal effort. Furthermore, their familiarity makes us feel safe and in control. Indeed, they provide us with a controlled and safe daily life even during those times when we might be physically or mentally exhausted and unable to expend much thought or effort on our daily chores. Normally we can cope easily with deviations from our set schedules and habits with a bit of effort and we often relish this change as something novel and refreshing. That’s why people go on holidays and take up new hobbies. At the same time, older adults are often faced with health issues that can affect their body and mind and therefore their ability to cope with change in their daily lives. In that case, change is no longer refreshing and inability to cope with it can lead to disturbances in an older adult’s daily life. Thus, many older adults may stick to familiar routines and schedules in order to mitigate the effect of health issues on their lives and furthermore they are often unaware that they’re using familiarity as a means to mitigate the effects of declining health.

Declining health can often remain invisible due to the often-reduced demands of our usual daily life but also due to its usually gradual nature. Older adults themselves and people sharing the same home with them may often fail to spot the decline as it is usually mitigated by subtle changes in activities and routines that often go unnoticed. People who visit an older adult sporadically on the other hand may be able to spot decline more easily as the changes may be more pronounced in the span of many weeks or months. Thus, people who visit their older relatives sporadically should be on the lookout for signs of decline especially during the holiday season which places increased demands and stress to older adults. There are many signs one should look out for but most of them fall under the following categories:

  1. Home environment: Modern living is complex and taking care of all the chores around the house can be physically and mentally demanding. As people cope with declining health, they tend to neglect chores starting from the ones that are less important for their daily functioning. As decline progresses one can neglect more chores to the point where they might be unable to live safely on their own. One should always use a person’s previous status as a reference point. An unkempt lawn might not be concerning if that person never cared about lawn maintenance but it can be a warning sign if that person used to have a pristine lawn a few months ago. The same is true for general tidiness around the house. On the other hand, expired medication, scorched cookware and spoiled food indicate behaviors that can present clear danger to the health and well-being of the individual regardless of their previous status. Changes in the home environment are usually easy to spot so they are often the first signs of decline noticed by friends, family and acquaintances.
  2. Physical appearance and grooming: The way our loved one looks and dresses can also alert us to possible decline. Significant weight loss often accompanies physical and cognitive decline. An older adult may lose weight due to illness or through the effects of medication. At the same time, cognitive decline can make the preparation of a meal too challenging and confusing for an older adult and even cause them to neglect eating. Unkempt appearance, dental issues and a general lack of hygiene can also signify possible cognitive decline as the older adult may be experiencing difficulties in dressing and grooming and they may be forgetting or be unable to bathe and brush their teeth.
  3. Balance issues and fear of falls: Balance and gait issues are very common signs of decline in older adults. An older adult may have difficulty maintaining their balance and they may compensate by changing walking patterns so they are close to things they can lean on or hold on to in case of unsteadiness. Their gait can grow shorter and they may limit walking to mitigate the possibility of a fall. As an older adult may sometimes be unwilling to admit or discuss their balance issues and fear of falling, noticing such early signs of mobility issues can allow a relative to open up the subject and help the older adult get the appropriate care, support and physical rehabilitation if needed.
  4. Mental and cognitive issues: Changes in cognition and mood can signify the onset of neurodegenerative diseases such as dementia or mood disorders such as depression. Depression in older adults often goes undiagnosed since the person experiencing it may not feel or exhibit the usual sadness that people often associate with depression. It usually appears in subtler ways which include withdrawal, loss of interest in hobbies and favorite pastimes and a lack of interest for house care and personal grooming. At the same time sudden mood swings and/ or aggression can be a sign of mental or cognitive disorders and they may also be caused by physical issues such as dehydration and improper use of prescribed medicine. Mental and cognitive disorders can be frightening thus when someone is worried that an older adult might be suffering from them it is best to reach out to a brain health expert for a thorough assessment so they and their loved ones can receive appropriate care and support.

The holiday season is first and foremost a time to relax and spend time with our loved ones. We all need time to enjoy ourselves, worry less and get away from all the things that are stressing us. This holiday season doesn’t have to be stressful and being vigilant about the health and well-being of our loved ones doesn’t mean we should over-analyze everything and stress about every little detail. If we trust or instincts, our knowledge and our connection with our loved ones, we can go on enjoying the holidays with them while remaining alert enough to spot any obvious or worrying changes.

What can I do? 

  • As an older adult: Be willing to hear the concerns of your loved ones. Don’t view any possible health issues as weaknesses or personal shortcomings. They can be frightening or exhausting at times but they can be managed with the help of your loved ones and support from experts. Engage with your family and friends and allow them to provide you with the care, love and support you need and deserve.
  • As a relative: Reflect on any possible signs of physical or cognitive decline when you visited older loved ones. Try to compare their current situation to their previous status and trust your instinct if anything seemed odd or worrying. Be open and talk to them calmly and supportively. Don’t be afraid to reach out to an expert who can help you, your loved one and your whole family identify and mitigate any issues. 
  • As an assisted living or nursing home owner / manager: Reflect on cases of residents who may have experienced difficulty with the holiday season schedule and activities. Talk to them about their experience and difficulties and reach out to their family if needed. Acknowledge the concerns of your residents’ relatives and listen to their feedback after visits. They know the personality and habits of a resident and can alert you if they feel something is concerning. Reach out to experts if needed. 
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