Dementia Symptoms And Treatment How Palliative Care Can Help
People with dementia begin to not recognize hunger and thirst, and lose the ability to feed themselves and the ability to eat. Families and caregivers often must face heartbreaking decisions when a person can no longer eat. They may have to decide whether to use artificial feeding. Unfortunately, medical research shows that this feeding method does not actually works to prolong life. Feeding through a tube to the stomach or through a vein might even cause more lung infections and pneumonia.
Dementia is sometimes hard to see because it progresses slowly. This is another challenge for caregivers. It is even harder because family members can get used to the slowly worsening new normal. Caregivers begin to do more and more without even realizing it, and they become exhausted.
Statistics show that people who are taking care of loved ones with dementia have a much higher risk of getting sick themselves. They may die earlier compared to those who are not caregivers. Again, heres where palliative care is so important. The team can help with in-depth communication and support for the family caregivers.
The palliative care team will see to it that a patient gets care in a skilled nursing facility if home care is no longer possible. Palliative care specialists will also help patients and families deal with the complex health care system. The goal is always quality of life.
But Is My Loved One Suffering
As a caregiver, the most important concern is that the person with dementia is not suffering. Once we understand that this is a normal part of the disease, it makes it easier to see why the person does not need as much to eat or drink. In most cases, they will not show any sign of being hungry or thirsty, but if they do show interest, have an assessment done and get recommendations on what type of alternatives you can give to keep them comfortable.
How Long Can An Elderly Person Live Without Food
An elderly person can live approximately three weeks without food, according to Dina Spector for Business Insider. However, there are additional factors to consider when determining how long a person can survive without food. These factors include age, weight and hydration levels.
There is a bit of precedent established to determine how long an elderly person can live without food. For instance, Mahatma Gandhi, a renowned civil rights activist, lived for 21 days without food, according to Scientific American. Gandhi did, however, take occasional sips of water while he was undertaking this fasting period. Twenty-one days without food is not considered the longest period. Irish prisoners, as a sign of revolt against British military forces, survived a duration somewhere between 46 and 73 days without food consumption.
While a person needs food to survive, Canadian Virtual Hospice states that fluid intake is the more important basic need that is essential for survival. A persons body has the capability of adjusting its metabolism to account for a decrease in food intake. However, a lack of necessary fluids, specifically water, leads to abnormal kidney function. Other body organs suffer from the dehydration as well, resulting in immune system failure and eventually death.
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Food And Drink Representing An Individuals Identity And Agency
For participants, the ability to eat and drink represented quality of life, sense of identity and agency. At the time of interviews, eating and drinking was one means of staying healthy and so represented something that they could control. Many hoped that if they controlled their diets at the early stage, it would prevent further decline . For some, weight loss was not a problem because they had always tried to lose weight and preferred to be slimmer. Some preferred to prepare food for themselves, and sometimes for others. Food preparation helped maintain their freedom to choose ingredients, flavours, nutrients and calories. These were suggested as a way to ensure that their identity and agency remained respected. Although most participants perceived that having meals with others generally helped encourage eating and drinking, some expressed unease. They acknowledged tending to avoid eating with other people because of difficulties with swallowing and using utensils, while a few reported food preference changes that might be noticed . Some participants felt that others might be excluding them gently because of their difficulties with eating and drinking.
How Can You Recognise When A Person Is Dying
Recognising when a person with advanced dementia is dying may not always be easy as they may have many general signs and symptoms of dying already. For example, some common signs and symptoms seen in people dying are:
- profound weakness
- needing assistance with all care
- disorientation to time or place
- agitated or restless
- difficulty concentrating.
People with advanced dementia may show some of these signs and symptoms for months or even years making it hard to tell if the person is approaching death. However, if these symptoms become much worse over a period of two to three weeks, or even days or hours, it is important that a doctor or nurse sees the person. If the doctor or nurse thinks that the person is deteriorating or nearing the end of life and it would be in the persons best interest to be cared for in their own home, a care home or hospice then discuss this information with the persons family. They should also be given an explanation of why the deterioration is happening and the care that is going to be given. When death is expected it is usally not of benefit for the purpose with dementia to be sent to hospital: the death is more likely to be traumatic, unsupported and complicated by other medical events .
When the dying process is established, the person may experience further changes:
- losing consciousness
- no longer able to swallow
- terminal restlessness
- changes to breathing pattern and circulation .
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What Does Best Practice Look Like Introducing The Priorities For Care Of The Dying Person
There are five priorities:
- Recognise: The possibility that a person may die within the next few days or hours is recognised and communicated clearly, decisions made and actions taken in accordance with the persons needs and wishes, and these are regularly reviewed and decisions revised accordingly. Always consider reversible causes, for example, infection, dehydration, hypercalcaemia.
- Communicate: Sensitive communication takes place between staff and the dying person, and those identified as important to them.
- Involve: The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants.
- Support: The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible.
- Plan & Do: An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, coordinated and delivered with compassion.
Why Does Water Intake Affect This
Youre much more likely to survive starvation for weeks and possibly months if youre able to consume a healthy amount of water. Your body has much more in its reserves to replace food than fluid. Your kidney function will diminish within a few days without proper hydration.
According to one article, those on their deathbeds can survive between 10 and 14 days without food and water. Some longer periods of survival have been noted, but are less common. Keep in mind that people who are bedridden arent using much energy. A person who is healthy and mobile would likely perish much sooner.
One study that looked at hunger strikes suggested that a person needs to drink at least 1.5 liters of water a day to survive starvation for a longer period of time. The study also suggested adding a half teaspoon of salt a day to the water to help with kidney function.
Living without access to food and water can have detrimental effects on your body. Your bodys many systems will begin to deteriorate despite your bodys ability to continue for days and weeks without food and water.
Some of the side effects of starvation include:
- faintness
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What Can Carers Do In The Final Stages
In the final stages of dementia the person may not be able to recognise or communicate with their family. Many, if not most, families find this a very painful stage. Although the relationship seems very nearly over, carers may find it difficult to mourn fully because the person is still alive.
And yet, there are things you can suggest that may help.
Encourage gentle touch when other forms of communication seem difficult. Holding the persons hand, sitting with an arm around them, or even gentle hand massage, may be comforting for both the person with dementia and their loved one.
Do Tube Feedings Prevent Aspiration Pneumonia
While it’s possible that a tube feeding may reduce the chance of food or liquid going into the lungs and developing a pneumonia, this can still occur due to saliva going down the wrong way. Dementia eventually affects the ability to eat and swallow. It is not uncommon to see someone with a tube feeding still develop an aspiration pneumonia.
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Getting Prepared For A Death
Care staff need to know the persons wishes for their death: where they would prefer to be when they die, who should be present, how pain might be treated, and so on. A persons spiritual and cultural needs are important throughout their life, but may take on a particular significance at the end of their life. We can only support a person nearing death properly if we know this information and have recorded it accurately so they have the best possible, and personalised, end-of-life care
Ensuring that a person is as physically comfortable as possible when they are dying also takes preparation. Is a hospital-style bed available, for example, if it is needed? Is a suitable mattress to hand? How can dignity best be maintained if all personal care is provided at a persons bedside? Does the persons room need to be altered in any way, for example fitting new lighting?
Relatives also need to be prepared. For family, having a good relationship with care staff may be a critical part of the lead-in to this dying phase. You also need to know family members wishes at this time. For example, do they want to be present for the death if possible?
How Opioids Can Help At The End
Research shows that certain symptoms and difficulties are common in people with very advanced dementia . These include:
- Aspiration and other swallowing difficulties
- Pneumonia
- Shortness of breath
- Pain
Most people know that opioid medications such as morphine are effective pain-killers. For this reason, they are often used to treat pain at the end-of-life.
But people sometimes dont know that opioids have also been shown to help relieve shortness of breath. So in hospice, a drug like morphine can be used to provide relief from two common end-of-life symptoms: pain, and/or shortness of breath.
Now, opioids do have some downsides. We dont usually worry much about addiction in people who are terminally ill. But opioids do cause other problems and side-effects, such as constipation.
One of the biggest concerns about opioids is that they can slow a persons breathing rate. This is a problem because if a persons breathing gets too slow, they end up with too much carbon dioxide and not enough oxygen in the blood, and this can cause death.
Now, people on hospice are expected to die. But that doesnt mean we want to be rushing things along with medications they are supposed to die of their illness, not because we overly medicate them.
The American College of Physicians covers the use of opioids at the end of life here: Evidence-Based Interventions to Improve the Palliative Care of Pain, Dyspnea, and Depression at the End of Life: A Clinical Practice Guideline.
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What Is Palliative Care For Dementia
Palliative care is specialized medical care for people facing serious illnesses like dementia. The goal is to improve quality of life for both you and your family.
Palliative care is provided by a specially trained team of doctors, nurses and social workers who work together with your other doctors to give you an extra layer of support. You can have palliative care at any age and at any stage of the illness. You can also have it together with all other treatments.
Palliative care is as much about helping the family as it is about treating the person with dementia. The team is a very valuable resource for the caregivers. Family caregivers often face terrible stress on a 24/7 basis because a person with dementia may also gradually experience the loss of hand-eye coordination, motor skills and the ability to dress and bathe.
How Long Is A Life For A Hospice Patient When They Stop Eating And Drinking
When someone stops taking fluids and is bedridden , they may live for a few days or as long as a couple of weeks. People lose their sense of hunger and thirst during the normal dying process.
According to the National Institute for Health Care Excellence , someone considered to be two to three days from death should have their hydration monitored daily to determine whether they require fluids via a drip with the risks of assisted hydration and drinking water explained.
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What Are Hospices Final Stages
The following are signs and tips for approaching the end of life:
- Coolness. Of the touch, the hands, arms, feet and legs may become increasingly cool.
- Confusion. The patient may become unaware of time or place and may become unable to recognize those around them.
- Sleeping.
- Fluid and food consumption decreases.
Acknowledge Potential Anh Complications
End-of-life patients who are fed through artificial means can suffer from gagging, tube complications , discomfort, aspiration pneumonia, pressure sores, bloating and a sense of drowning or feeling trapped.
Moreover, studies have shown that artificial nutrition has very little impact on survival for hospice patients. For example, studies show that dementia patients who are tube-fed have no different life expectancy than those who are slow hand-fed.
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Be Aware Of Their Eating And Drinking
The person may have lost their appetite or have difficulties swallowing safely. In the last days, the person may stop eating or drinking. This can be very distressing to watch, but it is normal for people approaching the end of life.
You should offer the person food and drink for as long as it is safe and they show an interest. Its important to keep the persons mouth comfortable provide sips of fluids and keep lips moist and clean.
What Do Elderly People Think About Life And Death
As we get older, death seems to be nearer than when we are younger. In as much as anyone can die regardless of age, for an older person, it seems like it is more likely to happen, especially when dealing with different health conditions that the body does not handle as it used to in the younger years.
For older persons, death does not always spell sorrow and terror, as is the case with younger people. Many of the older people are contented with what the short-term future has for them. You may think that people may get anxious as they become older, but this is not the case. Older people do not have much sadness and anxiety, especially related to death. They are actually more positive about life and death.
As we grow older, our perspective shifts. This is when you realize that things are not as they always seem. Most people fear death because they feel that they will lose the things that they have been working so hard to get over the years. However, for older people, this attachment to things acquired is not really pronounced. This is how some of the fear of death actually melts away.
When you look around you and you realize that there are things that are a part of you that will outlive you actually help in a major way. This could be the legacy we have in children or gardens planted. There are yet others who place value on their country, their religion, or families that live on even after they are gone.
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Does Food Intake Affect This
You dont just get hydration from water and other beverages alone. Food consumption contributes to 20 percent of your total water intake per day.
Some people may get even more water from their food if they eat a significant amount of fruits and vegetables, which contain a high amount of water. People in countries like include many more of these foods in their daily diets, resulting in more water intake through foods.
Fruits and vegetables with the highest amount of water include:
- cantaloupe
How Long Can An Average Person Survive In The Absence Of Water
The body requires a large amount of water to perform numerous vital functions, such as maintaining an internal temperature balance and keeping cells alive.
As a general rule, a person can survive for approximately three days without water. However, certain factors, such as the amount of water required by an individual body and how it uses it, can affect this.
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Loss Of Appetite And Dementia
- Check with the doctor to make sure that there are no treatable causes for loss of appetite, such as acute illness or depression.
- Offer meals at regular times each day.
- Allow the person to eat when hungry.
- Encourage physical activity.
- Provide balanced meals to avoid constipation.
- Offer ice-cream or milkshakes.
- Try to prepare familiar foods in familiar ways, especially foods that are favourites.
- Encourage the person to eat all or most of one food before moving on to the next some people can become confused when tastes and textures change.
- Try to make meal times simple, relaxed and calm. Be sure to allow enough time for a meal helping the person to eat can take up to an hour.
- Consult a doctor if the person with dementia experiences significant weight loss .
- Check with the doctor about vitamin supplements.
- Carers should also make sure their own diet is varied, nutritious and enjoyable.