Season greetings! I'm Mary Blazek, M.D., a geriatric psychiatrist at the University of Michigan. I specialize in care of people with dementia and their families.

As we head into the season of Christmas, Hanukkah, Kwanzaa and the New Year, I've observed that family members can be surprised that what were once joyful holiday traditions can be distressing or taxing for a person with dementia. I thought it might be helpful to share some of my experience in successful approaches to the holidays.

The festive season of cheer, hustle and bustle, and family celebrations can also be marked by changes in routine, increased stress and high expectations. How can we maintain warm, happy feelings without causing distress for the person with dementia or burnout for their caregivers?

The key is: flexibility.

Take advantage of familiar rituals to rekindle fond memories, but at the same time be willing to adapt to the functional level of the person with dementia. A person with dementia who previously enjoyed big parties might now be overwhelmed by the chaos of music, overlapping conversations, and running children. Smaller gatherings or subgroups of family in a quieter atmosphere might be more enjoyable and relaxing. Lowering your expectations and acknowledging that everything is not likely to be "the way we've always done it" lessens the likelihood for disappointment.

Adapting traditions keeps the person with dementia engaged. Activities take longer, but the pleasure can come from participation, rather than task completion:

Cards and caroling

Signing holiday greeting cards provides the opportunity to discuss each recipient and relationship. A person with moderate to severe dementia can still apply a postage stamp and seasonal seal to an envelope. Holiday music evokes happy memories of times gone by. Rather than just using it as background music, take time to sit and listen deliberately, and sing along. Speech, singing and reading aloud are controlled in different parts of the brain. Singing is often preserved, even after verbal abilities are diminished. And some people who can no longer participate in conversation are still capable of reading aloud from a familiar story.

Baking with love

Many holiday traditions involve cooking and baking. These activities can also be adjusted to the functional level of the person with dementia. Although grandma used to bake dozens of cookies by herself, now that she has dementia, perhaps (with supervision) she can combine premeasured ingredients or decorate prebaked cookies. Once again, the process and the interaction is more important that the product. Give the person with dementia his or her own ball of dough to knead or shape. Use the technique we see on cooking shows; the batch she sees you put into the oven might not be the same one you take out and serve. And include grandpa too! Just because he didn't cook in his younger years doesn't mean he won't get a kick out of joining in.

Givers of gifts

Gift giving is also associated with many holidays. Remember that it is as much fun to give as to receive; that holds true for the person with dementia, who might not be able to plan ahead. One woman with dementia confided to me that although she was happy to receive presents, she felt left out that she didn't have gifts to give to others. Her family thought they were sparing her the trouble, and didn't expect anything from her. She might have enjoyed distributing small candy bars or gift cards. The symbol of sharing is more important than the value.

Selecting a gift for a person with dementia can be challenging. My colleague, nurse practitioner Laura Struble, recommends the following ideas:

"The type of dementia and cognitive deficits vary from person to person. Dementia is a moving target and ever-changing," Laura says. "Knowing the person's unique qualities and strengths will help you find the perfect gift."

  • Outdoor bird feeder that is easily seen through a window
  • Memory book—collection of photos of the person with dementia as young with parents and siblings followed by spouse and children (digital photo album)
  • Large (blown up picture) of family with names to hang on wall
  • Subscription to magazine (Reminisce magazine is popular or other magazines of interest with lots of pictures)
  • White board or a large calendar to write daily schedule on
  • Comfortable sturdy shoes and slippers (no open heels or floppy to prevent falls)
  • Large soft socks (feet and ankles swell so may need larger size)
  • A heated towel rack or other bath items such as soft towels and scented toiletries
  • Electronic devices (e.g. simplified TV control, telephone with pictures to identify phone numbers, pill reminders gadgets)
  • Computer or Video games to keep the mind and body fit
  • DVD of sitcoms, musical or comedies (e.g. I love Lucy, Golden Girls, Sanford and Sons)
  • iPod and head phones with favorite music
  • Bright quilts and lap robes
  • Coordinated outfits that are easy to put on (e.g. elastic waistband, no buttons)
  • Bright scarfs
  • Medical alert bracelet or engraved jewelry (e.g. heart locket with phone number and memory loss engraved on the back)
  • A decorative, distinctive box that a person with dementia could put valuables in (e.g. glasses, hearing aids, wallet, keys).
  • Puzzles, games such as bingo, and stuffed animals or toys that move and sing (needs to be at the appropriate for level for the person with dementia).

Finally, caregivers should remember to take time to relax and enjoy themselves. The person with dementia doesn't need to be involved in every holiday outing or activity. It's okay to plan or participate in parties or other diversions without them.

I hope these next few weeks go smoothly. As you reminisce about happy times past, savor these special days in the present. I wish peace and joy for you and those you love!