How To Keep Elders With Dementia Safe During Winter, Amid Rising Pollution Levels

As winter descends across India, it paints a familiar yet contrasting picture: dense fog and biting cold in the North, and mild, pleasant coolness in the South. For most of us, these changes are simply seasonal adjustments. But for older adults, especially those living with dementia, this transition can be deeply unsettling. The drop in temperature, shorter daylight hours, and increasing air pollution all combine to create an environment that can affect both physical and emotional well-being.

We work closely with elders who have dementia and other cognitive conditions, the change in seasons brings renewed focus on personalised care. Our teams adapt daily routines, adjust the living environment, and pay close attention to the subtle cues that indicate comfort or distress. Having cared for hundreds of elders over the years, we've learned that winter demands not just physical warmth, but heightened empathy and proactive engagement.

The Foundation: Warmth, Comfort and Vigilance

One of the most significant challenges we see during this time is that elders with dementia often cannot sense or express discomfort. They may not realise that they are cold or may resist wearing warm clothes. That's why anticipatory care, or acting before discomfort arises, becomes essential.

Dressing elders in layers that can be easily adjusted: a soft inner vest, a comfortable cotton shirt, and a warm sweater or cardigan. Accessories such as socks, slippers with grips, and cozy shawls add much-needed warmth. Our caregivers ensure that all rooms are free from drafts and maintain consistent indoor temperatures so that our elders are at ease. Equally important is hydration.

Many elders drink less water in winter, increasing the risk of dehydration, which can lead to confusion and lethargy. Warm soups, herbal teas, and lukewarm water are encouraged throughout the day. Small steps like these go a long way in maintaining both comfort and cognitive stability.

The Unseen Threat: Air Pollution

Every winter, cities across India experience dangerously high levels of air pollution. The heavy blanket of smog, often invisible indoors, is not just a respiratory hazard, it is also detrimental to brain health. Studies have shown that prolonged exposure to high levels of particulate matter can worsen cognitive decline and accelerate the progression of dementia.

In Delhi and other northern cities, where we operate, we closely monitor the Air Quality Index (AQI) every day. When the air quality is "poor" or "severe," we keep windows and doors closed, especially in the early morning and late evening when pollution peaks. Contrary to common belief, "fresh air" is not always safe during winter.

Where possible, we use HEPA air purifiers to maintain cleaner indoor air. These devices help create a safe zone for elders; a small but vital buffer against an otherwise harsh environment. Families caring for loved ones at home can consider this a worthwhile investment. For elders who enjoy walks, we recommend shifting outdoor activities to the afternoon when pollution levels are relatively lower.

Preventing Falls and Wandering

Cold weather often brings damp floors, slippery surfaces, and dimly lit spaces, all of which increase the risk of falls. For someone living with dementia, these risks are amplified due to changes in depth perception and spatial awareness.

Taking extra precautions can be beneficial: non-slip mats in bathrooms, sturdy footwear, and sufficient lighting in all walkways and corners. We encourage families to do the same at home, assuming every surface could be slippery is the safest approach.

Winter also increases the dangers of wandering behaviour among those with dementia. A person may step out intending to "go to the office" or "visit a relative," following a memory rather than an intention. Caregivers are trained to redirect such behaviour gently, by acknowledging the emotion behind the action rather than correcting the action.

Letting in the Light

The long, dark evenings of winter can heighten confusion and anxiety. This is especially true for those who experience sundowning, where agitation increases as daylight fades. One of the simplest yet most effective interventions is to maximise natural light exposure during the day.

Each morning,j we open curtains wide and encourage our elders to spend time in sunny courtyards or balconies, provided air quality allows. Even ten minutes of sunlight helps regulate circadian rhythms, improving both mood and sleep. As evening approaches, we ensure every corner is well-lit. Warm, gentle lighting makes spaces feel safer and prevents the confusion that shadows can cause.

The Power of Familiar Routines and Meaningful Engagement

For a person with dementia, routine acts as an anchor in a world that can often feel unpredictable. Predictability brings comfort. We maintain a steady schedule for meals, rest, and activities, allowing elders to know what comes next, an important reassurance when memory is fading.

Engagement, too, plays a crucial role. It doesn't have to be elaborate; simple, purposeful tasks can be deeply meaningful. Folding laundry, sorting grains, watering plants, or listening to old songs. These small activities create moments of calm and connection. We've seen elders light up when hearing a familiar bhajan or recognising a face in a family photo. These experiences awaken emotion and identity even when words are lost.

Music, in particular, is a powerful bridge. It can calm agitation, spark joy, and evoke memories that outlast language. Incorporating any kind of music therapy into engagement programs throughout the year, but especially during winter can help prevent isolation and low mood can from setting in.

A Season for Tender Care

Winter, especially in India's polluted cities, is a testing time for both elders and caregivers. But it also reminds us of the profound impact of attentive, empathetic care. The essence of dementia care lies not just in managing physical health but in preserving dignity, comfort, and emotional warmth.

Through vigilance, compassion, and a little extra patience, we can help our loved ones and every elder in our care so that they stay safe, serene, and connected through the winter months.

(By Neha Sinha, Dementia Specialist and Clinical Psychologist, Co-founder & CEO, Epoch Elder Care)

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