Decorations and Dementia: A Few Things to Consider
My Mom has always decorated our house for the holidays. At Christmas we had a huge tree with more ornaments than should have been put on it. She hung green garlands with red berries around the doors and put electric candles in every window of the house. She had two life-sized wooden Nutcracker cutouts and a beautiful Santa statue. And of course, we always switched out our daily dishes to the Christmas Spode, and made sure the tablecloth matched the plates.
My Mom has had Lewy Body dementia for eight years, and for many years we kept up all of the decorations in the house. First with Mom helping us decorate, and now we take care of it because she no longer can. After a while, the amount of decorations decreased, not only because it was a lot of work, but also because people with dementia function best in a clutter-free, familiar environment. Noticing that fewer decorations made Mom’s living space easier to function in helped me see the many issues that can come up when we think about decorating a house or care community for people with dementia. I wanted to share some of the issues that can happen with decorations in the hopes that you can assess how many decorations would work for your loved one with dementia in order to help them have a pleasant holiday season.
Decorations can make a once familiar space very unfamiliar. Knick-knacks, trees, holiday cards on the mantle, statues, etc… all add clutter to the environment. A distracting and unfamiliar environment can increase agitation and bring about some negative behaviors.
Decorations can make it harder for a person with dementia to find the items they use every day, and can decrease their independence. For example, a simple snowman shaped soap dispenser may be so unfamiliar, that your loved one stops washing their hands, or it makes the sink look so different that they can no longer turn on the water.
There are also many safety issues with decorations. A cute holiday throw rug is perfect for ending up with a fall and broken hip. Food shaped decorations can lead to an attempt to eat the item and are a choking hazard.
Lights on a Christmas tree cast shadows and can make it harder for a person with dementia to see and function in a room. Twinkling lights are highly distracting and jarring. This can not only lead to falls, but it can trigger or worsen the visual hallucinations often found in dementia. We also tend to use a lot of electrical decorations at the holidays, and the cords can increase the risk of falls.
Decorations can also increase behavioral issues. If the person with dementia feels the decorations should not be there, you may end up with negative behaviors, such as throwing the decorations in the trash, or your loved one rearranging all the decorations. It could even increase or trigger wandering outside of the house. If the house looks so different to them, they may think they are not in their own home and thus try to leave. Going after them and trying to convince them that this is their home can lead to arguments, or physical behaviors such as pushing or hitting.
Be careful when changing the plates and utensils you normally use. My Mom loves the Spode Christmas pattern and we used to change out our daily plates for the Spode every year. However, a patterned plate is cluttered and can cause frustration and picking at the plate after their food is already eaten. The pattern can also make it hard for a person with dementia to see what is food, and what is not. If they are unsure, they may just not eat, which is very common for people with dementia. Solid colored plates that have high contrast to the food you will be eating is best. For instance, turkey and mashed potatoes are hard to see on a white plate, but you could eat those items on a green plate. Fancy utensils may not only be uncomfortable because your loved one is not used to them, but also because they may be harder to hold if the handles are carved and curved, or very delicate.
When considering whether or not to decorate for the holidays, it is very important to know your loved one well. They may not be at a point where decorations make the house unfamiliar, and in fact, if you did not decorate, they may feel that is too much of a change. Assess whether or not you need to bring out all the decorations, or just some really important ones. In any stage of dementia though, decorate in the least cluttered way possible. For example, don’t tack holiday cards on the wall, or arrange them in the middle of your kitchen table.
It may also be good not to decorate in places where the person with dementia takes care of activities of daily living. Leave the decorations and changes out of the bathroom, kitchen table, bedroom, and around their main sitting or working area.
Think about the reason for your decorations and what you want to get out of decorating. Many of us are attached to tradition and decorating. We do it because it is a way to express love and care for our family and friends. It is a way to make our time together more festive and beautiful. If decorating the house brings more confusion and discomfort to our loved one with dementia, we have defeated the purpose of the meaning of the decorations. Rather than increasing joy and interaction, we increase confusion, which then can drastically increase feelings of worthlessness in our loved one.
Any event is about the relationships we foster, and the quality of time we get to spend with each other. Assess if your decorations meet the needs of your family interactions at this time, taking into consideration the changes brought about by dementia.
To start, I would suggest picking a few of your most favorite decorations and see if putting those up do not change the environment too much for your loved one, and work from there. This way you can still create the holiday atmosphere and keep your loved one comfortable and safe.