By Debra Kain

The joys, charms, chaos and confusion of family life during the holidays can be very positive or highly stressful, with older family members who are frail or ill particularly susceptible to negative consequences if emotional, mental or physical health needs are not taken into account.

Specialists in senior medicine at the University of California, San Diego (UCSD) School of Medicine offer some simple tips to help ensure that elderly family members with underlying health issues enjoy the season.

1. Holidays provoke memories, which can be especially powerful in the later years of life.  “Leading authorities have observed that memory and ‘life review’ are important parts of the aging process,” said Barry Lebowitz, Ph.D., deputy director of UCSD’s Stein Institute for Research on Aging.  “Older people whose memories are impaired may have difficulty remembering recent events, but they are often able to share stories and observations from the past.  These shared memories are important for the young as well –children enjoy hearing about how it was ‘when your parents were your age…”.  He suggests using picture albums, family videos and music, even theme songs from old radio or TV programs, to help stimulate this sharing process.
2. Plan ahead.  If an older family member tires easily or is vulnerable to over-stimulation, limit the activities or length of time he or she is included.  Try to budget in a nap time, if necessary. Consider designating a “quiet room” where the older individual can take a break from the noise and confusion of a large family gathering, in order to avoid the irritability or exhaustion that may result from over-stimulation.  “Assign someone to be the day’s companion to the older person, to make sure the individual is comfortable,” said Daniel Sewell, M.D., director of the Senior Behavior Health Unit at the UCSD Medical Center, adding that such guidelines are good for young children as well as adults with mental impairments.
3. If a holiday get-together is in the home of a person with memory impairment or behavioral problems, don’t rearrange the furniture.  This could be a source of confusion and anxiety.  If the gathering is in a new place, remove slippery throw rugs and other items that could present barriers to an individual who has difficulty walking.
4. Avoid comments that might inadvertently embarrass someone who might be experiencing short-term memory problems.  For example, if an older individual forgets a recent conversation, refrain from saying “don’t you remember?”
5. In addition to memories, older individuals need something to anticipate. Add something new to the holiday celebration, or volunteer time as a family to help others.  Enjoy activities that are free, such as taking a drive to look at holiday decorations, or a walk through the mall to window-shop.
6. Involve everyone in the holiday meal preparation, breaking down tasks to include the youngest and oldest family members.  “Older adults with physical limitations can still be included in kitchen activities by asking them to do a simple, helpful task, like greasing cooking pans, peeling vegetables, folding napkins or arranging flowers,” said Sewell.
7. Social connectedness is especially important at holiday times.  “Reaching out to older relatives and friends who are alone is something all of us should do,” said Lebowitz. “Loneliness is a difficult emotion for anyone.  Recent research with older people has documented that loneliness is associated with major depression and with suicidal thoughts and impulses.”
8. “Holiday blues” are feelings of profound sadness that can be provoked by all the activities of the holiday season.  Seasonal blues can have a particular impact in the lives of older people, according to Lebowitz.  “In some people, the ‘holiday blues’ represent the exacerbation of an ongoing depressive illness,” he said. “Depression is a dangerous and life-threatening illness in older people. Tragically, suicide rates increase with age, specifically for older men. Depression is not a normal part of aging and should never be ignored or written off.”*
9. Seasonal affective disorder (SAD) or winter depression is a similar illness that can be provoked by reductions in sunlight during the short days of winter.  It is important for people confined indoors, especially those at risk for winter depression, to make time for activities that will increase exposure to daylight, according to Lebowitz.
10. Physicians remind family members to adhere to the regular schedule of a senior’s medications in the hustle and bustle of the holiday.  Also pay attention to alcohol consumption during holiday parties and family gatherings, since alcohol can provoke inappropriate behavior or interfere with medications, according to Sewell.

“Older family members with special needs can get lost in the shuffle and chaos of happy family gatherings.  So, with all the hustle and bustle of the season, just remember to be sensitive and loving. And plan ahead,” Sewell said.

*According to experts at UCSD’s Stein Institute for Research on Aging, signs of depression – which are not always associated with sadness – include apathy, withdrawal, isolation, failure to thrive and agitation.  Some other clues that older adults may be depressed are unexplained weight loss or pain, headache, fatigue or insomnia, or a higher than usual use of medical services