Holiday decorations can provide a lot of meaning, connection, and joy at the holidays, but for someone living with dementia, they may also cause a lot of behaviors such as agitation, confusion, and even increase fall risk. Let’s talk about how decorations might affect a person with dementia and how to navigate decorations at the holidays.
Key Points:
- Decorations may lead to refusing to eat, agitation, and illusions (seeing things that are not there.)
- Decorations can be disorienting and cause sensory overload.
- Decorations can also be meaningful and provide connection.
- Decorations can be done in a way that support the cognitive, emotional, and physical needs of both your loved one with dementia and you. (You matter to!)
Decorations As Tradition
My Mom always decorated our house for the holidays. At Christmas we had multiple trees, there was even one that was dedicated to only Snow White ornaments. She put electric candles in every window of the house (which every night I had to go around the house and turn on) and hung green garlands with red berries around the doors. We had two life-sized wooden Nutcracker cutouts flanking the bay windows, and and we always switched out our daily dishes to the Christmas Spode.
Then my Mom got Lewy Body dementia and she was not able to decorate on her own. For a long time we helped her put us the decorations, and eventually decorated for her when she became immobile. We started to decrease the amount of decorations though, not only because for us, decorating that much and care partnering full time was exhausting, but because too many decorations made mom’s life with dementia more difficult.
For most people with dementia, they function better in a clutter-free (clutter does not mean messy, it just means a lot of visual stimulus for the person) environment that also looks the same consistently.
How Decorations May Increase Responsive Behaviors in Dementia
Here are a few of the issues that can arise when we decorate for the holidays. We hope this can help you decide what type of holiday decoration works for both you and your loved one with dementia this year.
Decorations can make a safe and familiar space very unfamiliar and scary.
Large trees indoors (when normally we don’t see trees indoors,) various statues of elves and Santas, garlands hanging around doorways, etc… all make the environment they know and recognize very unfamiliar. If the amount of items is also too cluttered for them, they can become more confused and agitated.
Decorations can decrease independence by making make it harder for a person with dementia to find the items they use every day.
For example, a Reindeer shaped soap dispenser may be so unfamiliar that your loved one stops washing their hands. Garlands around the doorway to their bedroom may make their bedroom unrecognizable to them and they can’t find it.
Statues and other items can cause illusions.
They may start to have illusions and see things that are not there. A Santa statue may make them think that there is a person in the house trying to hurt them.
Decorations can increase fear and falls.
Holiday rugs are not only a tripping hazard, but the patterns on the rugs may cause visual distortions and they may think that a dark Christmas tree on a rug is actually a hole that they might fall into. They may get scared, or they may try and take big steps over the rug and fall.
Holiday lights can be disorienting.
Hanging lights or the light on a tree can casks shadows that make it harder for a person to see, some of the lights may twinkle and cause sensory disorientation. This can lead to increased fall risk and/or confusion and agitation just from sensory overload. You also want to watch out for electrical cords that can cause falls.
New plates may decrease food intake or make them unable to eat.
Just the change in plates can cause confusion. Additionally, patterned plates are usually not recommended for people with dementia because they may think the pattern is food or bugs on the plate and be confused about what is food and what is not. They may also have a hard time seeing their food and just not eat.
Tips for making decorations better:
- Know your loved one with dementia. If there are decorations they LOVE and would really like to have, use them. You may need to experiment with placement of the items to be sure they can still find things they need and they do not cause confusion.
- Observe if decorations help support their knowledge of time of year. Some people are very used to the household decorations changing with the seasons or holidays and if we take those away, that may confuse them. It’s possible that for your loved one, a few decorations is actually helpful to them.
- Decorate the day before or day of the holiday. For some people having decorations up for the whole month will lead to repetitive questions “When is everyone coming over for Christmas?” “Where are the kids gifts?” “When are we taking the kids to see the Easter bunny?” Try decorating closer to the holiday to reduce this behavior.
- Take yourself into consideration too. If you love decorating and certain things have a lot of meaning to you, you deserve to have those things in your life. Experiment with placement of items so that you can have your needs met as well.
- Leave decorations out of Activities of Daily Living (ADL’s.) For many people, changes to the environment and process of hand washing, brushing teeth, showering, dressing, eating, and sleep can be a huge problem. It may be better to not change out soap dispensers, get new plates, and use holiday themed towels. Instead keep decorations to areas where they do not do their ADL’s.
- Decorations may support connection with reminiscence therapy. Reminiscence therapy, where visuals and items can be used to spark conversation and memories of the past (emotional or factual memories) are a great dementia activity. Showing your loved one special decorations and talking about the item (not asking memory questions like “do you remember who’s Santa this is”) can bring out a lot from your loved one with dementia. And, even if memories do not come up, talking about a beautiful object and noting it’s colors, texture, weight, and how you both feel about it is a meaningful connection.
Overall, balance out the meaning of decorations with the physical and emotional health of you and your loved one with dementia. Some of us feel required to decorate and like if we do not we are “ruining” the holidays. Decorations are supposed to bring joy, meaning, and connection into your life. If the decorations increase your stress, make your loved one confused or cause responsive behaviors, means the decorations are not brining joy, meaning, and connection anymore.
Use the Montessori dementia care principle of Objective Observation to see if decorations are helping or impeding your life, where and when to put out decorations, and which ones are helpful to your loved one and which ones are not. There is always a middle ground that keeps both you and your loved one safe and happy.
We hope that these tips help you have a great holiday season.