Monday, November 26, 2012

Dementia and the Holidays

As fun as the coming holidays can be, they can be packed with hazards for people with dementia. It means caregivers and families need to be especially vigilant about the safety.

Many decorations look like food and may even smell like the real thing.  For instance, a Christmas tree decoration that looks like a gingerbread man may be even scented with gingerbread smell—making doubly appealing to try to eat.  Other small decorations can be choking hazards.  Artificial fruits, vegetables and nuts can look very real.

Candles that smell like pumpkin or apple pie can be a fire hazard if tipped over if a person reaches into it.  Poinsettia leaves, contrary to popular belief, are not poisonous—but they will make a resident nauseated if he or she eats them.

People with dementia need routines—the same activities, in the same place, at the same time.  Families should consider this carefully before deciding to take a loved one home for a holiday.  The excitement, the car ride, change in surroundings and many people talking can cause the confused person with dementia to become agitated or upset.

Here are some tips for family members planning to take a loved one home for a holiday.


  • Plan ahead.  Let the facility staff know several days ahead so they have time to obtain medications and clothes.
  • Allow extra time for everything, don’t rush the person.
  • Try to keep as much as possible to their daily routine.
  • Use ribbon instead of sharp hooks when hanging decorations.
  • Holly and mistletoe can be poisonous and berries pose a choking hazard.
  • Begin new traditions by letting another family be the host but try to go to a place familiar to your loved one.  
  • Assign tasks to other family members so you do not become overloaded and stressed, which in turn causes your loved one to be stressed.
  • Provide a nap before festivities. If you know the day will be long, you may want to attend only the most important part of the event.
  • Plan for a quiet place for your loved one to go to if he or she becomes overwhelmed.
  • Avoid alcohol.
  • Be aware of their diet and diet restrictions. Cut up food into small bites.
  • Let your loved one know who is coming to visit.
  • Have visitors and family call ahead to determine best time to visit.
  • Small groups of visitors or family is advisable. Have them wear name tags as this might help with recognition.
  • Reintroduce yourself as necessary. “Mary, my name is Betty.” And when she asks, “Are you my granddaughter?” say “yes” and shake her hand and act very comfortable about this introduction.
  • If your loved one begins talking about the past, try not to reorient him or tell him he is wrong.  Enter his reality and live his truth.  Ask about the past memory.
  • Reminisce about the past.
  • Play holiday music familiar to your loved one.
  • Read holiday cards aloud.
  • Stuff stockings, watch a holiday video, look at family slides or pictures or albums, read scriptures, etc.
The Kitchen
  • Monitor your loved one while in the kitchen.
  • Give your loved one task to help with baking or decorating. Try baking cookies, making pudding, folding napkins, polishing silver, etc.
  • Always check the microwave before turning on in case something was put in that is flammable.
  • Check all trash cans before throwing out garbage
  • Don’t leave your loved one in the car or in the front of the store.  If you can’t take them in with you, try to arrange for someone to stay with your loved one.
  • Shop during hours when stores are less crowded.
  • Dress your loved one in a bright yellow shirt which is easy to see if you become separated. Be sure they have a purse or wallet with identification.
  • Shop in smaller stores rather than the mall.
  • People with dementia should never travel alone.  Hire a personal care aid to travel if a family member is unable to accompany the resident.
  • Be aware of balconies and other hazards in hotels.
  • Travel may not be appropriate even with a companion if the person has:
  1. Consistent disorientation or agitation in familiar settings
  2. Wanting to go home when away from home on short visits
  3. Delusional, paranoid, aggressive or disinhibited behavior
  4. Problems managing continence
  5. Teary, anxious, withdrawn behavior in crowded, noisy settings
  6. Agitated or wandering behavior
Please visit our website to download additional resources for Caregivers.

Monday, November 19, 2012

Respect Counts More Than Money

Happiness in life may be related more to how much you are respected than how much money you have.

An article published in June in Psychological Science reports that in a series of four studies they tested the hypothesis that higher sociometric status might make a difference in overall happiness.  Sociometric status might be defined as respect and admiration in face-to-face groups such as among friends, in the neighborhood, or on an athletic team.

“We got interested in this idea because there is abundant evidence that higher socioeconomic status—higher income or wealth, higher education—does not boost subjective well-being (or happiness) much at all. Yet at the same time, many theories suggest that higher status should boost happiness,” said psychological scientist Cameron Anderson of the Haas School of Business at UC Berkeley.

“Having high standing in your local ladder leads to receiving more respect, having more influence, and being more integrated into the group’s social fabric,” said Anderson.

One possible explanation for the results is that people adapt. “One of the reasons why money doesn’t buy happiness is that people quickly adapt to the new level of income or wealth. Lottery winners, for example, are initially happy but then return to their original level of happiness quickly,” said Anderson.

Adaptation of this sort may not occur with local status. “It’s possible that being respected, having influence, and being socially integrated just never gets old,” Anderson said.

For more details visit and use the search word “respect.” 

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Monday, November 12, 2012

Patients Hesitate to Disagree

Patients don’t want to disagree with their doctors, even though they would like a say in treatment decisions, according to a survey published in the Archives of Internal Medicine, July 9, 2012.

When asked, more than 9 out of 10 people said they could visualize asking questions and discussing preferences with their doctors, and 80% said they had the ability to disagree.  But when it came down to it, only 14% of patients reported that they would actually challenge their doctor if he or she recommended a treatment that conflicted with their preferences.

Nearly half of those unwilling to disagree feared being labeled as “difficult”; 40% worried such actions would damage their relationship with the physician; and more than half thought disagreeing with their doctor might negatively affect their care.

The online research involved 1,340 adults who were told to imagine that they had heart disease.  They were then asked the extent to which they would like to be involved in their treatment decisions.  The treatments might include options such as medications, bypass surgery or angioplasty—which have similar long-term outcomes, said Dominick Frosch, from the Palo Alto Medical Foundation Research Institute and the University of California, Los Angeles.

Nearly 70% of the survey participants said they preferred making medical decisions together with their doctor, each contributing equally to decisions about treatment.

“We know when patients are surveyed directly they really want to participate in their medical decisions, but are very nervous about this idea of pushing back against doctor recommendations for fear of being labeled a ‘bad patient,’” said Dr. Michael Barry, president of the Informed Medical Decisions Foundation and a primary care doctor at Massachusetts General Hospital in Boston. 

Barry did not participate in the research but his foundation financed it. “I think getting over that culture—that there’s a right answer based as a clinician on your preferences—is what we’re facing. Clinicians are the experts in the options and the outcomes of the options, but patients are experts in what’s best for them.”

Despite current focus on patient-centered care, the authors found that these fears prevent shared decision making.  They noted that poor communication itself can cause inferior outcomes.   A study published in July, 2012 in the journal Perspectives on Psychological Science reinforced this with findings that patients’ feelings of autonomy, competence and relatedness were associated with better mental and physical health.

Frosch cited patients who won’t take their hypertension medication because they didn’t want it in the first place as an example of miscommunication that can lead to worse outcomes.  Frosch said that when it comes to doctors they need to “create a safe space for patients to be able to speak up and express their preferences.” 

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Tuesday, November 6, 2012

Hospice Impacts Spouses' Survival: Live Longer

Using hospice not only benefits patients, there is some evidence that it may help surviving widows and widowers live longer.

Some time ago researchers at Harvard Medical School and the University of Pennsylvania Department of Medicine examined death rates of surviving spouses of 195,553 elderly American couples.  The premise was that the 30,838 people who used hospice had “good deaths” that were less stressful for their spouses and would result in living longer.

The results of the matched retrospective cohort study suggest that the supportive end-of-life care provided by hospice has a beneficial impact on spouses.  “Hospice may attenuate the ordinarily increased mortality associated with becoming widowed,” concluded authors Nicholas Christakis and Theodore Iwashyna.  The results were statistically significant in both men and women.

After adjusting for variables, 5.4% of bereaved women died by 18 months after the death of their husbands when hospice was not used compared with 4.9% when hospice had been used.  Of the surviving husbands, 13.7% died within 18 months when their wives had not had hospice care compared with 13.2% when their wives died with hospice.

The support of hospice care appears to not only improve quality of life for patients, but reduces the stress on survivors to the extent that they live longer.   

For more information see Social Science & Medicine, 2003, vol. 57, issue 3, pages 465-475.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at