For many people, the holiday season is a special time to connect with loved ones, share memories, and enjoy family traditions. However, for older adults with cognitive decline and family members who look after them, this time of year can be emotionally challenging.

A person experiencing cognitive issues from Alzheimer's disease or another form of dementia may have a sense of loss or feel excluded during the holidays because of changes in their abilities. Additionally, this time of year may be overwhelming for caregivers as they navigate family traditions while also providing care.

“Feeling excluded or not having a purpose is hard for anyone at any age, but especially with older adults,” said Annie Rhodes, Ph.D., a certified geriatric care manager and an assistant professor in the Department of Gerontology at Virginia Commonwealth University’s College of Health Professions. “Thankfully, there are many resources to help people with dementia feel healthy and supported, both during the holidays and year-round.”

“This time of the year can also be stressful for families who are concerned that an older relative may be starting to experience memory loss or other forms of cognitive decline,” said Lana Sargent, Ph.D., associate professor and the associate dean for Practice and Community Engagement at the VCU School of Nursing. “We struggle to ask for help as we age because of fear that independence will be removed from us. However, the intent of healthcare providers is to keep people aging at home as long as possible.”

VCU Health News spoke with Sargent and Rhodes about how to spot early signs of cognitive decline in older relatives, how to make those with memory loss feel comfortable and included at family gatherings, and what caregivers can do to manage their own mental wellbeing during the holidays. 

For some people, the holiday season may be one of the only times that they see their older family members. What are some signs to look out for if they think an older relative is starting to experience cognitive decline? 

Sargent: There are a variety of factors that can be signs of cognitive decline or dementia development, and not every person exhibits the same kind of symptoms. Memory loss is one of the most common symptoms, such as forgetting recent events or conversations, not being able to remember names or places at all, forgetting appointments, or being confused about time or place. 

Individuals experiencing cognitive decline may also stop speaking mid-conversation, get lost in familiar places, or struggle with making complex decisions. If you notice a family member is falling victim to scams, having trouble managing money, or confusing their medications, that could be another early sign of dementia. 

What kind of behaviors are a completely normal part of aging and not reason for concern?

Sargent: When our brains feel tired, it may take a little longer to remember certain things, such as the names of people or places or where we last put a certain item, yet eventually with time, our memory comes back to us. This condition is called “slow recall” and can be experienced at any age, but it tends to happen a little more frequently as we get older. This is because we typically have less cognitive reserve as we age. For example, when you’re in your 20s, not getting enough sleep may have a small impact on your brain health, but as you get older, lack of sleep can be enough to throw you off the next day. 

Additionally, certain memory lapses, such as forgetting the day of the week, can sometimes stem from a lack of routine rather than cognitive decline. When we retire, we often lose the structure that is naturally created for us through our work. This is why keeping a routine is very important for maintaining our brain health as we age. 

What are some other things older adults can do to maintain their health and slow their cognitive or physical decline? 

Sargent: Many of the actions that health care professionals recommend for keeping your body healthy are also important for your cognitive health. For instance, engaging in regular physical activity – even if it’s only 15 minutes a day – is greatly beneficial for your brain health. So is sticking to a healthy diet and avoiding highly processed foods, staying socially connected to the level of your comfort, and keeping your mind engaged in learning new things. Working with your health care provider to prevent or manage chronic diseases, like diabetes and hypertension, can also reduce your risk of cognitive decline. 

What advice do you have for someone who has concerns that their relative is experiencing cognitive decline? 

Sargent: If family members are worried about the brain health of a loved one, it’s important to establish a village of support around that person. Decide who in the family feels most comfortable opening up a conversation about their concerns for their health or offering to accompany them on their next medical visit to talk about the symptoms they’ve observed.

It’s also important to note that people do much better when they age in their own environment, and there are many resources people can use to promote independent living while providing peace of mind to families. This could mean setting up in-home care, working with volunteer programs, or tapping into faith-based organizations to help with picking up groceries, fixing up things around the home, or running other errands. There are also respite programs, like adult day centers, that can provide some relief from the stress and demands of caregiving. 

For families who have older relatives with dementia, how can you make sure those experiencing cognitive changes feel more comfortable during gatherings?

Rhodes: The first step is adjusting your expectations to be mindful of family members with different kinds of abilities. As you approach the holidays, reflect on what matters the most to you and your loved ones, what would make the season really meaningful, and which traditions may need to be let go or adapted to be more dementia-friendly.

For example, a person’s cognition can change quite drastically once it’s dark outside, so consider holding family gatherings earlier in the day. Changes in routine can be very stressful for older people with dementia, so think about how you can have fun during the holidays without making drastic changes to the time that person wakes up, takes medication, or goes to sleep. I would also be careful about drinking alcohol, as that can magnify the impact of dementia, even early dementia. Consider making alcohol-free drinks like mocktails or other options to limit alcohol consumption.

What are some strategies for making activities during family gathering more inclusive? 

Rhodes: You can definitely adapt holiday activities to involve older family members while also being mindful of any physical limitations or cognitive decline. For instance, if you are preparing a traditional family dish, ask your relative to give you directions as you cook or tell you stories about when they used to make this meal. 

While dementia usually impacts a person’s short-term memory first, their long-term memory will remain intact for longer. With that in mind, looking over family photo books or reminiscing in general can be an inclusive way to engage older adults with memory loss. However, if a loved one seems distressed by this activity, try something else.

What can caregivers do to also manage their own mental and emotional well-being during the holiday stress?

Rhodes: It’s never too early or too late to start taking steps to protect your brain health, especially if you are a caregiver. This role can be very isolating, and many caregivers feel like they aren’t getting enough physical activity or time away from their house. If you are feeling overwhelmed, I recommend tapping into your community for resources, guidance and support. 

Whether it’s over the holidays or any time of the year, if friends and family members ask how they can help you, it’s fine to ask for the gift of time. Maybe it’s running to get groceries, doing chores around the house, or picking up the kids from school. 

You can also get in touch with a local Area Agency on Aging, respite programs, or a geriatric care manager. If you are taking care of an older adult who can’t be left alone, they can provide resources or help you brainstorm strategies for how to create a safe environment when you’re away from the house for a few hours. 

There are many initiatives and organizations – both local and statewide – that are dedicated to supporting aging adults and their caregivers. For those based in Richmond, this includes the Virginia Department for Aging and Rehabilitative Services, the Virginia Memory Project, Virginia Navigator, Alter Dementia, the Span Center, Richmond Brain Health Initiative, and the Greater Richmond chapter of the Alzheimer’s Association.