Very Mild Impairment Or Common Forgetfulness
Alzheimers disease mainly affects older adults over the age of 65. At this age, its common to have slight functional difficulties such as forgetfulness.
But for people with stage 2 Alzheimers, this decline will happen more quickly than it will for similarly aged people without Alzheimers. For example, a person may forget familiar words, a family members name, or where they placed something.
Caregiver support: Symptoms at stage 2 wont interfere with work or social activities. Memory troubles are still very mild and may not be apparent to friends and family.
Problems With Eating And Drinking
Changes in eating and drinking patterns are also considered to be part of end-stage dementia signs.
Most people will lose their appetite, which makes them eat less. As a result, most people with dementia will lose weight in an unhealthy manner.
Losing weight may have an effect on a persons IMMUNE system, making it harder for the body to fight off other diseases.
Many people will have a problem with eating and drinking because they develop mouth sores or have problems swallowing.
Swallowing issues arise when a persons reflexes and muscles cease to function correctly.
How To Ensure The Person Eats Well
In the later stages of Alzheimers disease, many people lose interest in food and caregivers may notice changes in how or when they eat. They may not be aware of mealtimes, know when they’ve had enough food, or remember to cook. If they are not eating enough different kinds of foods, they may not be getting the nutrients they need to stay healthy.
Here are some suggestions to help a person with late-stage Alzheimer’s eat better. Remember that these are just tipstry different things and see what works best for the person:
- Serve bigger portions at breakfast because it’s the first meal of the day.
- Offer several smaller meals throughout the day.
- Serve meals at the same time each day.
- Make the eating area quiet. Turn off the TV or radio.
- Control between-meal snacks. Lock the refrigerator door and food cabinets if necessary.
- If the person has dentures, make sure they fit. Loose dentures or dentures with bumps or cracks may cause choking or pain, making it harder to eat. Remove poorly fitting dentures until the person can get some that fit.
- Let the person’s doctor know if they lose a lot of weight, for example, if he or she loses 10 pounds in a month.
You can also try different ways of preparing the person’s plate. For example:
If the person needs help eating, you might try to:
When choosing foods to eat and liquids to drink, these suggestions might help:
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What Are The Signs That Someone With Dementia Is Near Death
It is difficult to know when a person with dementia is near death. However, there are some symptoms that may indicate the person is at the end of their life including:
- needing help with everyday activities
- eating less and swallowing difficulties
- incontinence and becoming bed bound.
When these are combined with frailty, recurrent infections and/or pressure ulcers, the person is likely to be nearing the end of their life. If the person has another life limiting condition , their condition is likely to worsen in a more predictable way.
When a person gets to within a few days or hours of dying, further changes are common. These include:
- deteriorating more quickly
- irregular breathing
- cold hands and feet.
These are part of the dying process, and its important to be aware of them so that you can help family and friends understand what is happening.
When a person with dementia is at the end of life its important to support the person to be as comfortable as possible until they die
For more information, see our page, Signs that someone is in their last days or hours.
Making End Of Life Decisions
When individuals with Alzheimer’s disease approach the end of life, caregivers and their families must make difficult decisions regarding their care. Ultimately, any end-of-life decisions made on the individuals’ behalf should respect their values and wishes and maintain their comfort and dignity.
Honoring the Person’s WishesIndividuals with Alzheimer’s disease have the legal right to limit, withdraw, or refuse medical or life-sustaining treatments. These decisions are usually expressed through advance directives legal documents that indicate the type of medical care a person wants to receive once he or she can no longer make or express these decisions due to incapacity.
Two common forms of advance directives are a Health Care Proxy and a durable power of attorney.
Ideally, advance directive documents should have been completed while the person with Alzheimer’s still had the mental capacity to make decisions. If there are no advance directives in place, a family must be prepared to make decisions consistent with what they believe the person’s wishes would have been in combination with his or her best interests. Typically, residential care facilities and hospitals have ethics committees that can facilitate the decision-making process if there is a conflict between family members or with health care providers.
To help ensure care decisions are guided by your loved one’s advance directives, inform others about them and be active in all medical decision making.
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Place Of Care In The Last Phase Of Life
In developing palliative care for people with advanced dementia, it is important to consider circumstances of care such as place of care or where the person dies. The majority of people with early stage dementia live at home with family members caring for them. Approximately one third of people with dementia are cared for in nursing homes . A survey identified dementia in 68% of nursing home residents with only slightly more than half having recorded diagnosis and with more than half suffering from advanced dementia . People in the advanced stages of dementia spend most of their time in nursing homes . The likelihood of nursing home admission increases with age and severity of behavioural symptoms high burden of family carers is also associated with nursing home admission . People with migration background are less often cared for in nursing homes .
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.
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How Dementia Causes Death
A person in the late stage of dementia is at risk for many medical complications. Because they might not be able to move, they’re at especially high risk for certain conditions.
They could get a urinary tract infection or pneumonia . They can also experience skin breakdown, pressure ulcers , or blood clots.
Trouble swallowing, eating, and drinking leads to weight loss, dehydration, and malnutrition. This further increases their risk of infection.
In the end, most people with late-stage dementia die from underlying dementia or a related complication.
For example:
- A person may die from an infection like aspiration pneumonia. If someone has trouble swallowing, food or liquids may go down the wrong tube. Instead of going into the esophagus or stomach, it’s breathed into the airways or lungs. This leads to a type of pneumonia called aspiration pneumonia.
- Dementia increases the risk of death from a blood clot in the lung because they are bedbound and not mobile.
It’s important to know that late-stage dementia is a terminal illness and can lead to death. In these cases, the death certificate may list dementia as the cause of death.
Section I: Cancer Diagnoses
Note: Certain cancers with poor prognoses may be hospice eligible without fulfilling the other criteria in this section.
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What To Do About Body Jerking
Sudden twitching or jerking, known as myoclonus, is another condition that sometimes happens with Alzheimer’s. The person’s arms, legs, or whole body may jerk. This can look like a seizure, but the person doesn’t pass out. Tell the doctor right away if you see these signs. The doctor may prescribe one or more medicines to help reduce symptoms.
Read about this topic in Spanish. Lea sobre este tema en español.
Stage : Severe Decline
As Alzheimer’s progresses, your loved one might recognize faces but forget names. They might also mistake a person for someone else, for instance, think their wife is their mother. Delusions might set in, such as thinking they need to go to work even though they no longer have a job.
You might need to help them go to the bathroom.
It might be hard to talk, but you can still connect with them through the senses. Many people with Alzheimer’s love hearing music, being read to, or looking over old photos.
At this stage, your loved one might struggle to:
- Feed themselves
- Changes in their sleeping patterns
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Moderate Dementia Or Moderately Severe Decline
Stage 5 lasts about 1 1/2 years and requires a lot of support. Those who dont have enough support often experience feelings of anger and suspicion.
People in this stage will remember their own names and close family members, but major events, weather conditions, or their current address can be difficult to recall. Theyll also show some confusion regarding time or place and have difficulty counting backward.
Caregiver support: People will need assistance with daily tasks and can no longer live independently. Personal hygiene and eating wont be an issue yet, but they may have trouble picking the right clothing for the weather or taking care of finances.
Stage : Very Severe Cognitive Decline
This severe late stage of AD is the sad time when a patients speech becomes unrecognizable, urinary and bowel incontinence set in, eating unassisted is difficult, if not impossible, and swallowing can be impaired . Seniors in the advanced stage usually need assistance and support with walking, sitting, standing up and transfers. If a patient is able to stand up at this stage, it is likely that they are very unsteady on their feet. They should be closely monitored as falls can be a dangerous complication. A dementia patients needs become so great in these later stages that it is vital for caregivers to seek out assistance, either in the form of in-home care, a memory care facility or even hospice care.
Family caregivers often become frantic when their loved ones refuse to eat later on in the disease. There is little we can do to ameliorate their symptoms, so we resort to providing food as a way of offering comfort and showing we care. However, this can be risky as the patient becomes frailer. Dysphagia can easily result in aspiration of food particles and saliva into the lungs, which may develop into pneumoniaa dangerous and often deadly infection. As neurological damage progresses, patients may not know what to do with food that is put in their mouths or be able to coordinate the complex movements involved in chewing and swallowing. Those at the end of life may refuse to eat altogether because their organs are shutting down and can no longer process food.
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Provide Support For Family And Friends
Keep any family or friends informed about what is happening in a gentle, sensitive and supportive way. This will help reassure them that the person is getting the care they need. You could consider signposting them to appropriate services, such as an Admiral Nurse or local Alzheimers Society. It can also help to give them an opportunity to talk about what is happening.
Tips For Managing Dementia End
Because individuals with advanced dementia will often have difficulty communicating, it is important that caregivers keep a close eye on their loved one for signs of pain or discomfort. These signs may include moaning or yelling, restlessness or an inability to sleep, grimacing, or sweating. This may also signal that its time to call hospice or a palliative care team to help with the pain management.
If an individual with end-stage dementia is having trouble sitting up without assistance, hospice can provide a hospital bed or other equipment to lift their head.
Perhaps the hardest thing for families is when a loved one with dementia is no longer able to eat or swallow. Because an individual with dementia is unable to understand the benefits of feeding tubes or IV drips, they will often be incredibly distressed and attempt to remove them, causing added pain and risk of infection. Instead, focusing on keeping the individual comfortable. Supporting them with mouth care to prevent their mouth from becoming dry will allow them to make their final transition in peace.
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Coping With Alzheimer’s Progression
The progression of Alzheimers disease is a mind-bender to deal with. Each stage puts new demands and strains on the patient and their informal and professional caregivers. Education can help immensely throughout this process, so it is important for family members to learn as much as they can about this condition, ask questions of medical professionals and seek out advice and support from other caregivers who have had first-hand experience with Alzheimers. Caring for someone with AD takes a super-human effort, and embarking on this journey alone should not be an option. This is a difficult disease where community support can make all the difference. Be sure to get help for your loved one and get help for yourself.
Common Types Of Dementia
Most people who have dementia experience problems with cognitive skills, depression, indifference, and a lack of interest in doing things.
People with Lewy body dementia and Alzheimer’s disease may have similar early symptoms. Memory loss is common in both conditions, for example. Lewy body dementia also commonly causes fluctuations in arousal, hallucinations, sleep problems, and difficulty walking.
In contrast, people in the early stages of frontotemporal dementia usually don’t have memory problems. Instead, they might have obvious changes in personality and behavior.
Vascular dementia, which occurs as a result of having many strokes throughout the brain, can cause problems understanding concepts, emotional and personality changes, and memory problems. This type of dementia may accompany other types, making the decline more severe.
And chronic traumatic encephalopathy , which occurs after repeated head trauma, often begins to cause symptoms years after the traumatic brain injuries, with a significant progression of mood changes, personality changes, and a decline in memory and cognitive skills.
With Lewy body dementia, frontotemporal dementia, vascular dementia, and CTE, the memory problems may respond to cues/reminders, while in Alzheimer’s there is often a forgetting of recent events altogether.
In the final stage of all types of dementia, a person goes through a major decline in everyday functioning.
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Signs Of The Dying Process
As someones condition gets worse and they are within a few days or hours of dying, further changes are common. The person may:
- deteriorate more quickly than before
- lose consciousness
- develop an irregular breathing pattern
- have a chesty or rattly sound to their breathing
- have cold hands and feet.
These changes are part of the dying process when the person is often unaware of what is happening.
Palliative Care In Advanced Dementia
- 1Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- 2Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf , Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- 3Clinical Trials Center , Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- 4Center for Health Services Research, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Maintaining Bladder And Bowel Function
A person with Alzheimer’s may experience incontinence due to such factors as a urinary tract infection or fecal impaction. After consulting with a physician to rule out any medical problems, try the following suggestions for helping the person maintain bladder and bowel function:
Set a toileting schedule and monitor the frequency of bowel movementsKeep a written record of when the person goes to the bathroom and when and how much he or she eats and drinks. This will help you determine the person’s natural toileting routine. The person need not have a bowel movement every day. However, if he or she goes three days without a bowel movement, the person may be constipated. Speak to your physician about adding natural laxatives to the person’s diet, such as prunes, or fiber-rich foods, like bran or whole grain breads.
Eliminate caffeinated drinksBeverages with caffeine, such as coffee, cola, and tea, act as diuretics and can stimulate urination.
Limit liquids at least two hours before bedtimeBut be sure to provide adequate hydration throughout the day.
Use absorbent and protective productsUse adult briefs and bed pads at night for extra protection.
Stage : Severe Cognitive Decline
This moderately severe mid-stage is where forgetfulness becomes the least problematic symptom. Instead, significant personality changes and troublesome dementia behaviors begin to take center stage. That sweet person you used to know may suddenly become combative, volatile and possibly violent at times. The Alzheimers Association says that at this stage, people lose most awareness of recent experiences as well as their surroundings.
Individuals in this stage can be very inventive when trying to outwit their caregivers. They are also prone to wandering, so providing constant supervision to keep them safe is an ongoing challenge. Astonishingly, patients may find ways to undo several complicated locks on doors or start a supposedly disabled car. Family members sometimes install an alarm system that is meant to alert homeowners if someone is breaking in but instead use it to keep track of whether their loved one is trying to elope.
Patients in this stage often do not remember their own histories and can forget the names of people they love . They need help dressing and toileting. Normal sleep/wake cycles may give way to wandering and agitation all night long. Lack of sleep further compounds memory, mood and emotional symptoms, creating an exhausting positive feedback loop. Unfortunately, this means that family caregivers sleep habits and patience suffer as well.
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