Encinitas resident Lana Tipton and her husband, Don, are staying at home this holiday season. They will not be traveling to visit family and friends, because even a short car trip has become disorienting for Don, who was diagnosed with Alzheimer's three years ago, and frustrating for her.

For most families, the holidays are special occasions to share. But for the 360,000 family members and caregivers who are affected by Alzheimer's in our San Diego community, it can also be a particularly stressful and challenging time of year.

"I recommend that families sit down beforehand and ask themselves what they are trying to do this holiday," said Lisa Snyder, a social worker who provides counseling, education and referral services at the Alzheimer's Disease Research Center at UC San Diego. "I really try to shy away from blanket recommendations, because each case is different. Look at your traditional habits and customs, and see what are the most meaningful and what can continue to work. And be realistic."

'The holidays are tough'

Last summer, the Tiptons drove to Lake Tahoe, where they have owned a vacation home for 30 years that has always been one of Don's favorite places.

"He was on oxygen and wondering when we were going home the whole time," Tipton recalled. "He even opened the car door when we were going 70 miles an hour on the freeway. You get so you don't put yourself in those situations anymore. They're not getting anything out of it, and you get so you don't want to expose yourself to the unknown."

On Christmas Day, Tipton said, she will plan a smaller celebration at home instead.

"The holidays are tough," she said. "We'll just have a few people over -- only people who know what's going on. And if the noise and the confusion is too much for him, he can go in his room and sit in his own chair."

Adjust expectations

First and foremost, say those who have extensive experience studying and working with Alzheimer's patients, it is wise for everyone to adjust expectations. And while families may not be able to keep all of the traditions they may have enjoyed in the past, neither should they think there is no cause for celebration.

Joy Glenner, who with her husband, George, founded the George G. Glenner Alzheimer's Family Centers in San Diego, said that the holiday season can be difficult not only for the one with Alzheimer's but for other family members who are mourning the way their loved ones used to be.

"If families come out to visit during the holidays," Glenner said, "tell them beforehand not to have high expectations. Don't ask (the Alzheimer's patient) a lot of questions. And don't plan activities that add to the confusion. They are often so insecure and easily confused, so just cut down on the events and the noise, and keep the time together short."

Kathy Randall, a social worker and member of the Alzheimer's Association speakers bureau, suggested sending an e-mail or letter to the family, or arranging a telephone conference call to discuss the upcoming celebrations. It is important, she said, to tell visitors that the behavior of the person with Alzheimer's may be unpredictable, or that they may confuse one family member with another.

"It's a good idea to tell them that they may not be able to attend midnight Mass, that he should have his plate first, or maybe you will have to cut up his meat, or that the meal will be earlier in the day," she said. Indeed, a smaller, less complicated celebration may be just the ticket.

Tailor the celebration

Catherine Lombardi, executive director at Somerford Place, an Alzheimer's assisted-living residence in Encinitas, said the holiday meal may be an opportunity to get more people to participate, especially those with Alzheimer's.

"You may be able to assign them tasks such as folding napkins, mixing the salad or setting the table," she said. "But it is important to take your cues from the loved one if they are getting confused, frustrated or overwhelmed."

The most important thing, the experts say, is to remember to tailor the celebrations to suit the family member's comfort levels and abilities.

"I recall one family who came to talk with me about their annual Thanksgiving celebration, which always consisted of the many members gathering at a restaurant," Lombardi wrote in the residence newsletter.

"Their mother, who had Alzheimer's disease, was more confused, anxious in large groups, and less interested in leaving her assisted living residence. These family members understood, but said others felt that their mother would be upset not to have the traditional annual restaurant meal. We did some brainstorming, and the family decided to let small groups come to visit her in her assisted living residence. One small group enjoyed lunch with her the day before Thanksgiving. Another came in the afternoon with a pumpkin pie they all could share. Others came for a short visit during the time she participated in activities.

"It wasn't the same, but their mother had so many wonderful moments because they modified their time with her. And they didn't completely give up their tradition. The rest of them did meet in their favorite restaurant, and they made certain that they shared stories about their mother during the meal."

Gift giving

Another part of the holiday tradition is gift giving, and the Alzheimer's experts offered these suggestions.

Randall and Lombardi suggested gift ideas for the person with Alzheimer's. Hats, scarves, clothing that is easy to get on and off (and watch for changes in sizing), and soft, warm slippers with a hard sole are on their wish lists. Also good are hobby items such as photo albums with large photos of the family; flowers or plants for their rooms; and edible gifts in resealable containers or pretty tins.

"At the top of the list is respite care for the caregivers," said Randall. "Caregivers need time for themselves, a few hours to get their hair done or go out to lunch. Sometimes it is hard to convince the husbands or wives of those with Alzheimer's to spend the money, so a gift certificate for 40 hours of day care would be great. This is a generation that doesn't spend money easily."

Taking her husband, Joe, to the center for day care has been a gift for Carlsbad resident Janice Sandiford, who cares for him at home. Sandiford was among the guests -- many of them spouses -- who were at the Glenner center in Encinitas to enjoy a Thanksgiving meal on Nov. 20. For many of the caregivers, the center's lunch was probably the only event they would attend for that holiday.

"It's a long, lonely road," she said of her husband's Alzheimer's. "He comes to the center five times a week, he's picked up in the van and dropped off, and I come on Wednesdays for the support group. Otherwise, I would flounder."

Besides respite care and support counseling for caregivers, Randall also suggests a gift certificate for family counseling with a professional geriatric care manager. Geriatric care managers, Randall said, help families assess their loved one's needs and recommend the most appropriate, available and cost-effective services in their situation and geographic area.

"A case manager can help them negotiate through the different levels of care and set up a road map when their mental capacity is compromised," she said.

A quiet celebration

At Somerford Place, the 56 residents will celebrate Christmas and Hanukkah quietly, with most of their families coming to the residence to visit for holiday events such as a family tree trimming party, holiday sing-along, and resident gift exchange.

"Families have to learn to live in the moment and find the simple meaning of the holiday season," said Randall. "And it's always good to have a Plan B."

Contact staff writer Ruth Marvin Webster at (760) 740-3527 or rwebster@nctimes.com.

Do's and Don'ts: Simple Holiday Strategies for Those With Alzheimer's

Don't:

- Compare the present with the past. If you aspire to a picture-perfect holiday, you are likely to be disappointed.

- Test your loved one's memory by asking, "Do you remember who this is?" Testing memory does not preserve it, and often demoralizes the person with Alzheimer's. Instead, introduce the family member to your loved one by name and state his or her relationship to your loved one. For example, say, "Bob, your nephew David wants to wish you happy holidays. Say hello to your nephew David."

Do:

- Celebrate in the most familiar setting. For many people with Alzheimer's, a change of environment -- even a visit home -- causes anxiety. Instead of creating that disruption, consider holding a small family celebration at the facility. Find out what holiday activities are planned for the residents, and consider participating with your loved one there.

- Schedule visits at your loved one's best time of day. People with Alzheimer's tire easily, particularly as they approach the late stage of the disease. Your loved one may appreciate morning and lunchtime visitors more than those in the afternoon and evening.

- Include the person with Alzheimer's in the activities of the day, if possible. An Alzheimer's patient may be able to help with meal preparation, such as peeling vegetables, stirring batter, tossing salad, folding napkins or setting the table.

- Tone down the decorations. Blinking lights and large decorative displays can cause disorientation. Avoid candles and decorations, such as artificial fruits, that could be mistaken for edible treats.

- Keep the visitor traffic to a minimum. Arrange for a few family members to drop in on different days. Even if your loved one isn't sure who is who, two or three familiar faces are likely to be welcome, while nine or 10 may be confusing.

- Host quiet, slow-paced gatherings. Television, conversation, and meal preparation all add to the noise and stimulation of an event. Keep things as quiet as possible, and encourage your loved one to rest during family get-togethers.

- Be aware that active, loud children may distress the person with Alzheimer's. Try to have some activities planned for the kids, ideally those that they can do with the Alzheimer's patient, such as making holiday decorations or decorating cookies. Watch for any signs of anxiety or distress from your loved one and intervene immediately by redirecting the children to another room or by taking the person with Alzheimer's for a walk, sitting together for a while in a quiet room or taking a short drive around the neighborhood.

- Delegate to family members and friends who have offered assistance. Let them help with cleaning, writing cards and shopping for gifts. Or ask if one of your children or a close friend could stay with your loved one while you go to a holiday party.

- Try to maintain routine as much as possible. If your loved one customarily takes a walk after eating lunch, try to maintain this activity and go with him or her.

- Develop new ways to mark the holiday season. For example, ask family and friends to come prepared to tell a favorite story from past holiday seasons involving the loved one with Alzheimer's. Reminiscing can be an important therapeutic tool that benefits those with Alzheimer's if not too stressful.

- Use the sights, sounds, smells of the holidays to stimulate your loved one's senses. Your loved one may be able to participate in the singing of well-learned holiday songs.

- Ask for help. Your stress increases the stress of your loved one with Alzheimer's. Delegate holiday responsibilities to family and friends.