How Might Dementia Affect People Towards The End Of Life
Dementia is progressive, which means it gets worse over time. In the last year of life, its likely to have a big impact on the persons abilities including memory, communication and everyday activities. The speed at which someone will get worse will depend on the type of dementia they have and who they are as an individual.
The symptoms of later stage dementia include the following:
A person with later stage dementia often deteriorates slowly over many months. They gradually become more frail, and will need more help with everyday activities such as eating, dressing, washing and using the toilet. People may experience weight loss, as swallowing and chewing become more difficult.
A person with later-stage dementia may also have symptoms that suggest they are close to death, but continue to live with these symptoms for many months. This can make it difficult for the person and their family to plan for the end of life. It also makes it difficult for those supporting them professionally.
For more information on supporting someone with later stage dementia see Alzheimers Society factsheet, The later stages of dementia .
Caring For Someone With Dementia Towards The End Of Life
Please be aware – this information is for healthcare professionals. We also have information for the public.
You can use our My Learning form to reflect on how this page has helped with your continuing professional development.
People with dementia may experience problems with thinking, memory, behaviour and mobility. It can be difficult to recognise when someone with dementia is nearing the end of their life. You can support the person by communicating with them and helping them with any symptoms they have. If possible, its a good idea to plan the persons care in advance to help understand what they want from their care.
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Prescription Drugs That Make You Sick
Armon B. Neel, Jr., PharmD
Armon B. Neel, Jr., PharmD, a certified geriatric pharmacist, adjunct instructor in clinical pharmacy at Mercer University College of Pharmacy and Health Sciences in Atlanta and founder of the Georgia-based MedicationXpert, LLC, a private practice focused on pharmaceutical care for outpatients and institutional geriatric patients. Dr. Neel is also coauthor of Are Your Prescriptions Killing You? How to Prevent Dangerous Interactions, Avoid Deadly Side Effects, and Be Healthier with Fewer Drugs . www.MedicationXpert.com
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When your doctor pulls out his/her prescription pad, you probably assume that your health problem will soon be improving. Sure, there may be a side effect or twoperhaps an occasional upset stomach or a mild headache. But overall you will be better off, right?
Not necessarily. While its true that many drugs can help relieve symptoms and sometimes even cure certain medical conditions, a number of popular medications actually cause diseasenot simply side effectswhile treating the original problem.
Older adults are at greatest risk for this problem because the body becomes increasingly less efficient at metabolizing drugs with age. But no one is exempt from the risk. To protect yourselfor a loved one
This class of drugs includes adalimumab , certolizumab, etanercept , golimumab and infliximab .
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A Person With Dementia Can Feel Confused When They Get Something Wrong They May Feel Annoyed And Angry They Might Feel Upset With Other People Too They May Not Know They Are Upset And Can’t Descibe Why They Feel Like That
Everyone feels confused sometimes. Its the feeling you get when things dont make sense, or you dont know what you should be doing.
If someone seems angry with you, it can feel horrible. Remember that its not your fault, and its not their fault. It happens because the persons brain is not well. They may not be able to control how they feel any more. They may not know they are upsetting you.
People with dementia can still have nice feelings too. They can feel happy, safe and calm. Some people with dementia may seem like their usual self a lot of the time and you may only notice small changes every now and then.
Some people with dementia may not have as many good days. Those days when they do feel more like their old self can be very special.
Everyone with dementia is different. Dont be afraid to ask questions. If the person you know has not been ill for very long, they may be able to tell you what dementia feels like for them. A person who has had dementia for longer may not be able to tell you how they feel. But you can often see when they are feeling happy, safe and calm.
When Are Medicines For Dementia Usually Prescribed
Your GP will usually refer you to a doctor who specialises in treating dementia, to confirm that you have dementia. The specialist will then decide if you should have treatment. This decision to start treatment and which treatment to start depends on various things. These include what has caused your dementia, what your symptoms are and how severe your dementia is. Dementia is usually classed as being mild, moderate or severe. See also the separate leaflet called Memory Loss and Dementia.
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Dementia Drugs And Heart Problems: What Does The Latest Research Say
The effect of dementia drugs on the health of a persons heart and blood vessels appears to be generally quite positive.
A recent review of studies found that people who took cholinesterase inhibitors had a 37 per cent lower risk of having a heart attack or stroke.
The research study found that these people were also less likely to die from a heart-related problem.
However, the review also found an increased risk of a relatively rare problem called bradycardia.
How Should I Take These Medicines
It is usual to start with a low dose. This is then increased over a period of weeks to a target treatment dose. The dose is increased slowly because when you first start taking these medicines you may develop some unpleasant side-effects – for example, diarrhoea, feeling sick and being sick .
Most people who develop side-effects find that after a period of time these go away. If you are tolerating a low dose well, your doctor will increase your dose, if needed. How often the dose is increased depends upon which medicine you are taking. For example, if you are taking galantamine, the dose is increased every four weeks. If you are taking rivastigmine tablets, the dose is increased every two weeks.
See the leaflet that came with your medicine for more information.
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What Are The Symptoms
Each person is unique and will experience dementia in their own way. The different types of dementia tend to affect people differently, especially in the early stages.
A person with dementia will often have cognitive symptoms . They will often have problems with some of the following:
- Day-to-day memory difficulty recalling events that happened recently.
- Repetition repeating the same question or conversation frequently in a short space of time.
- Concentrating, planning or organising difficulties making decisions, solving problems or carrying out a sequence of tasks .
- Language difficulties following a conversation or finding the right word for something.
- Visuospatial skills – problems judging distances and seeing objects in three dimensions.
- Orientation – losing track of the day or date, or becoming confused about where they are.
Some people have other symptoms including movement problems, hallucinations or behaviour changes.
Stage : Age Associated Memory Impairment
This stage features occasional lapses of memory most frequently seen in:
- Forgetting where one has placed an object
- Forgetting names that were once very familiar
Oftentimes, this mild decline in memory is merely normal age-related cognitive decline, but it can also be one of the earliest signs of degenerative dementia. At this stage, signs are still virtually undetectable through clinical testing. Concern for early onset of dementia should arise with respect to other symptoms.
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What Are The Signs And Symptoms Of Dementia
Because dementia is a general term, its symptoms can vary widely from person to person. People with dementia have problems with:
- Reasoning, judgment, and problem solving
- Visual perception beyond typical age-related changes in vision
Signs that may point to dementia include:
- Getting lost in a familiar neighborhood
- Using unusual words to refer to familiar objects
- Forgetting the name of a close family member or friend
- Forgetting old memories
- Not being able to complete tasks independently
Health Problems In The Later Stages
There are a number of common factors during the later stages of dementia that can affect a persons health.
The later stages of dementia
These include problems with movement, the side effects of medication and illness or discomfort and pain. The person may also develop health problems related to age, such as arthritis and rheumatism.
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What Are The Most Common Types Of Dementia
- Alzheimers disease. This is the most common cause of dementia, accounting for 60 to 80 percent of cases. It is caused by specific changes in the brain. The trademark symptom is trouble remembering recent events, such as a conversation that occurred minutes or hours ago, while difficulty remembering more distant memories occurs later in the disease. Other concerns like difficulty with walking or talking or personality changes also come later. Family history is the most important risk factor. Having a first-degree relative with Alzheimers disease increases the risk of developing it by 10 to 30 percent.
- Vascular dementia. About 10 percent of dementia cases are linked to strokes or other issues with blood flow to the brain. Diabetes, high blood pressure and high cholesterol are also risk factors. Symptoms vary depending on the area and size of the brain impacted. The disease progresses in a step-wise fashion, meaning symptoms will suddenly get worse as the individual gets more strokes or mini-strokes.
- Lewy body dementia. In addition to more typical symptoms like memory loss, people with this form of dementia may have movement or balance problems like stiffness or trembling. Many people also experience changes in alertness including daytime sleepiness, confusion or staring spells. They may also have trouble sleeping at night or may experience visual hallucinations .
What Increases The Risk For Dementia
- AgeThe strongest known risk factor for dementia is increasing age, with most cases affecting those of 65 years and older
- Family historyThose who have parents or siblings with dementia are more likely to develop dementia themselves.
- Race/ethnicityOlder African Americans are twice more likely to have dementia than whites. Hispanics 1.5 times more likely to have dementia than whites.
- Poor heart healthHigh blood pressure, high cholesterol, and smoking increase the risk of dementia if not treated properly.
- Traumatic brain injuryHead injuries can increase the risk of dementia, especially if they are severe or occur repeatedly.
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Support For People With Dementia And Carers
UCL covid-19 decision aid – a tool to support carers of people living with dementia to make difficult decisions during covid-19
Alzheimers Society end of life care information for patients and families
Alzheimers Society information and fact sheets on all aspects of dementia including what is dementia, types of dementia and living well with dementia
Alzheimer Scotland specialist services for patients and carers
Dementia UK expert one-on-one advice and support to families living with dementia via Admiral Nurses
Pain In The Later Stages
A person still feels pain in the later stages of dementia even though they may not be able to verbally communicate it. The person may be unable to tell you they are in pain, and as a result they may start to behave in ways that are unusual. Its important to consider pain as a cause and make sure that it is properly managed.
Many people in the later stages arent given enough pain medication and may be left in pain that could otherwise be treated. Common causes of pain in people with dementia include urinary tract and other infections, constipation and other conditions . If you think the person may be in pain, speak to a GP about medication and non-drug approaches that may help.
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Knowing The Stages Of Dementia Helps You Plan
Even if the stages arent exact and symptoms can still be unpredictable, being able to plan ahead is essential.
The truth is that Alzheimers and dementia care is expensive and time-consuming. Being financially prepared for increasing care needs is a necessity.
On an emotional level, having an idea of what symptoms to expect helps you find ways to cope with challenging behaviors.
It also gives you a chance to mentally prepare yourself for the inevitable changes in your older adult.
Watch For Signs The Person Is In Pain
Always remember that the person with Alzheimer’s may not be able to tell you when he or she is in pain. Watch the person’s face to see if it looks like he or she is in pain or feeling ill. Also, notice sudden changes in behavior such as increased yelling or striking out. If you are unsure what to do, call the doctor for help.
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How Long Do Metformin Side Effects Last
In most cases of type 2 diabetes, it is observed that metformin does not show its effects immediately. Usually, it takes four or five days to experience the full benefits of the medicine. The period may vary from person to person because the dose of the medication also has a significant role in it.
If you are taking metformin for the first time, then it is casual to feel sick. Metformin shows mild side effects in the individuals taking medicine for the first time. The symptoms are mild and can be tolerated easily. But, in case the condition gets severe, this could be an alarming sign, and the person should not ignore it.
How Is Dementia Treated
Treatment of dementia depends on the underlying cause. Neurodegenerative dementias, like Alzheimers disease, have no cure, though there are medications that can help protect the brain or manage symptoms such as anxiety or behavior changes. Research to develop more treatment options is ongoing.
Leading a healthy lifestyle, including regular exercise, healthy eating, and maintaining social contacts, decreases chances of developing chronic diseases and may reduce number of people with dementia.
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How Well Do Dementia Treatments Work
It is thought that about half the people treated with a cholinesterase inhibitor will see an improvement in symptoms which affect thinking and memory. Whether they help with other symptoms such as aggression and agitation has still not been confirmed. The improvement in symptoms is usually only seen for about 6-12 months.
For memantine, some studies have shown that it can slow down the progression of symptoms in some cases.
What Do We Mean By ‘dementia Drugs’
Dementia is the broad term used to describe a number of different conditions affecting the brain.
There is currently no cure for the diseases that cause dementia.
However, some drugs can help to relieve or control symptoms for people living with Alzheimers disease, dementia with Lewy bodies or Parkinsons disease dementia.
Unfortunately, there are currently no drugs that can improve the cognitive symptoms of vascular dementia or frontotemporal dementia.
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Can Scabies Make You Feel Ill
i was told by the doctor that It COULD be scabies and I duly put the cream all over twice. I hope to see a dermotologist as my husband doesnt think it is. However I keep feeling unwell and am not sure what to do. I also have some dry itchy patches on my legs which wont go away as well as a nasty sore place on my ring finger. But does anyone actually think scabies makes you ill.
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Dementia Symptoms: What Memory Loss Means
Some people think of memory loss superficially, as merely forgetting words or names. But itâs much more profound than that. Everything we do is premised on memory. When you walk into the kitchen to make dinner, your actions are almost unconscious. You grab food from the fridge, turn on the oven, take out plates and silverware â your memories are a foundation, and they give you a context for what youâre supposed to do in a given situation.
For a person with dementia, that context is ripped away. A woman with Alzheimerâs disease may walk into a kitchen and have no idea why they were there or what were supposed to be doing. They might still be able to make dinner â especially in the early stages of the disease â but itâs a struggle. Each step has to be reasoned out and thought through. Thatâs why people with dementia tend to act more slowly than they once did.
In the advanced stages of the disease, the actions of a person with dementia may seem irrational. But Beth Kallmyer, MSW, director of client services for the national office of the Alzheimer’s Association in Chicago, says that they often make a kind of warped logic.
âOur brains are built to reason,â says Kallmyer, âand even when the brain has been affected by a disease like Alzheimerâs, itâs still struggling to reason.â The problem is that as memories are lost, the brain just doesnât have enough information to interpret situations correctly.
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