Stage : Moderate Cognitive Declinemild Dementia
The diagnosis of Alzheimers disease can be made with considerable accuracy in this stage. The most common functioning deficit in these persons is a decreased ability to manage instrumental activities of daily life, which may hinder their ability to live independently. For the stage 4 person, this may become evident in the form of difficulties in paying rent and other bills, not being able to write out checks with the correct date or amount without assistance the inability to market for personal items and groceries or order from a menu in a restaurant. Persons who previously prepared meals for family members and/or guests begin to manifest decreased performance in these skills.
Symptoms of memory loss also become evident in this stage. For example, seemingly major recent events, such as a holiday or visit with a relative may not be remembered. Obvious mistakes in remembering the day of the week, month or season of the year may occur.
Persons at this stage can still generally recall their correct current address they can usually correctly remember the weather conditions outside. Significant current events, including the name of a prominent head of state, will likely be recalled easily. Despite the obvious deficits in cognition, persons at this stage can still potentially survive independently in community settings.
How Long Will A Person With Dementia Live For
Dementia is a life-limiting condition, but it is very difficult to know how long someone with dementia will live for. This depends on many factors.
If the person also has another life-limiting condition , it may be clearer how long they may live for and how they will die.
A person may die from another condition at any stage of having dementia. Because of this, they may die before their dementia symptoms become very advanced.
A person in the later stages of dementia may get worse slowly over many months. During this time they will usually:
- become more frail
- have more frequent falls or infections
- have problems eating, drinking and swallowing
- be more likely to need urgent medical care
- become less mobile
- sleep more
- talk less often.
A person in the later stages of dementia is likely to have a weak immune system. This means they have a higher risk of getting infections, which in some cases can last for a long time. One of the most common causes of death for people with dementia is pneumonia caused by an infection.
A person in the later stages of dementia may have symptoms that suggest that they are close to death, but can sometimes live with these symptoms for many months. This uncertainty makes it very difficult to plan and put things in place for the end of someones life.
Stage : Very Severe Decline
Many basic abilities in a person with Alzheimer’s, such as eating, walking, and sitting up, fade during this period. You can stay involved by feeding your loved one with soft, easy-to-swallow food, helping them use a spoon, and making sure they drink. This is important, as many people at this stage can no longer tell when they’re thirsty.
In this stage, people with Alzheimer’s disease need a lot of help from caregivers. Many families find that, as much as they may want to, they can no longer take care of their loved one at home. If thatâs you, look into facilities such as nursing homes that provide professional care day and night.
When someone nears the end of their life, hospice may be a good option. That doesn’t necessarily mean moving them to another location. Hospice care can happen anywhere. Itâs a team approach that focuses on comfort, pain management and other medical needs, emotional concerns, and spiritual support for the person and their family.
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Supporting Dementia Caregivers At The End Of Life
Caring for people with Alzheimers or another dementia at the end of life can be demanding and stressful for the family caregiver. Depression and fatigue are common problems for caregivers because many feel they are always on call. Family caregivers may have to cut back on work hours or leave work altogether because of their caregiving responsibilities.
It is not uncommon for those who took care of a person with advanced dementia to feel a sense of relief when death happens. It is important to realize such feelings are normal. Hospice care experts can provide support to family caregivers near the end of life as well as help with their grief.
If you are a caregiver, ask for help when you need it and learn about respite care.
Stage : Very Mild Changes
You still might not notice anything amiss in your loved one’s behavior, but they may be picking up on small differences, things that even a doctor doesn’t catch. This could include forgetting words or misplacing objects.
At this stage, subtle symptoms of Alzheimer’s don’t interfere with their ability to work or live independently.
Keep in mind that these symptoms might not be Alzheimer’s at all, but simply normal changes from aging.
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Late Stages Care: Hospitalization
Studies have shown that hospitalization and other aggressive treatments such as artificial feeding have low rates of success among persons with dementia and can have undesired outcomes that can hasten functional and cognitive decline and even death. Hospitalization of elders who are not even diagnosed with dementia can cause or increase confusion and incontinence, loss of appetite and vulnerability to falls and fractures.
Another risk of hospitalization is exposure to infectious diseases. Individuals with dementia are particularly susceptible to infections due to their reduced immune response, swallowing difficulties, immobility and their inability to make their needs known. Because many of the patients in hospitals have infections, there is greater risk of catching serious infections in hospitals than in the general community, especially among the elder and immune-compromised. In fact, studies have shown better long term outcomes with treating pneumonia and other infections at home or in a care facility rather than in a hospital. For these reasons, some people include a do not hospitalize clause in their advance directives.
Some people include a Do Not Resuscitate clause in their advance directives. For those people who do not want aggressive treatment to prolong life through artificial means, Do Not Resuscitate orders advocate a respectful and dignified death and allows the family meaningful time with their loved one at the end of the persons life.
How Does Dementia Reduce Life Expectancy
Dementia reduces life expectancy in two ways.
First, some of the diseases that are closely linked to Alzheimers disease and vascular dementia, such as diabetes and cardiovascular disease can mean a lower life expectancy. For example, vascular dementia is closely linked to heart disease and stroke. A person with vascular dementia is at risk of dying at any stage of dementia, from one of these.
The other way that dementia reduces life expectancy is through the effects of severe disease.
These all make them much more likely to develop other medical problems that can lead to death, such as infections or cardiovascular problems .
This is why the later stage of dementia is often the shortest.
A person with dementia can also die at any stage from another condition not closely related to their dementia. Cancer and lung disease are common examples.
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When Should I Ask For Support
Supporting people with dementia at the end of their life requires a team approach. Often, there will be many people involved in the persons care at the end of their life. Good communication and information sharing helps to ensure the person receives the care they need.
If youre unsure about anything or have any concerns seek advice from a colleague, manager or another health care professional.
There may be certain professionals who can advise on specific issues. These may include a GP, district nurses, social workers, other care staff and specialists.
What Are The Signs Of End
It is important for caregivers to know when an individual with dementia is close to the end of their life, because it helps ensure they receive the right amount of care at the right time. It can be difficult to know exactly when this time is due to the variable nature of dementias progression, but understanding common end-of-life symptoms of seniors with dementia can help. Below is a timeline of signs of dying in elderly people with dementia:
Final Six Months
- A diagnosis of another condition such as cancer, congestive heart failure or COPD
- An increase in hospital visits or admissions
Final Two-to-Three Months
- Speech limited to six words or less per day
- Difficulty in swallowing or choking on liquids or food
- Unable to walk or sit upright without assistance
- Incontinence
- Hands, feet, arms and legs may be increasingly cold to the touch
- Inability to swallow
- Terminal agitation or restlessness
- An increasing amount of time asleep or drifting into unconsciousness
- Changes in breathing, including shallow breaths or periods without breathing for several seconds or up to a minute
Patients with dementia are eligible to receive hospice care if they have a diagnosis of six months or less to live if the disease progresses in a typical fashion. Once a patient begins experiencing any of the above symptoms, it is time to speak with a hospice professional about how they can help provide added care and support.
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Check Their Advance Care Plan
You should find out if the person has an advance care plan. This document may record their preferences about the care theyd like to receive, including what they want to happen, what they do not want to happen and who they want to speak on their behalf. It may include an advance statement or an advance decision. We have information on planning ahead for patients and their families, which you might find useful.
End Stage Of Dementia
The end stage of dementia is the most difficult stage for those suffering from the disease, and also for family members, caregivers, and healthcare professionals. Victims lose what is left of their intellectual and physical capabilities and become completely dependent on others. The model is still shifting in considering end stage dementia an end of life condition experts are pushing this model in order to advocate for better pain and distress management for those suffering at their end.
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Recognizing Pain Or Illness
Promoting quality of life means keeping those in the late stage of Alzheimer’s disease comfortable. However, persons in this stage of the disease have difficulty communicating their pain. Here are some ways to recognize pain:
Look for physical signs that can indicate illnessSigns such as pale or flushed skin tone dry, pale gums mouth sores vomiting feverish skin or swelling of any part of the body.
Pay attention to nonverbal signs and body languageSigns such as wincing, moving about in discomfort, etc.
Be alert for changes in behaviorAnxiety, agitation, shouting and sleep disturbances can all indicate pain.
Consult your physician to determine the cause of the person’s pain and what can be done about it.
Resist The Urge To Reorient
Do not correct a patient if they get confused. For example, they might mistake their son for their husband. When this happens, play along. You are unlikely to win an argument with an Alzheimers patient and pointing out their mistake will only embarrass them. Rather, humor them and either change the subject or distract them with an activity.
This is especially true if they ask about someone who has died. The truth is going to be hard on them. Alzheimers patients can still grieve, but they cannot move on. After a few minutes they will forget and ask again. If you persist in telling them the truth, you will force them to relive their grief at its most painful. For this reason, it is better to tell them everything is fine.
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What Are Final Stage Care Options For Alzheimers
Caring for someone with Alzheimers can be a monumental task. Home care may not be sufficient even with additional assistance.
Some areas that need utmost care include foods and fluids, bowel and bladder function, skin and body health, infections and pneumonia, and pain and illness.
Here are some things to keep in mind:
What To Do About Swallowing Problems
As Alzheimer’s disease progresses to later stages, the person may no longer be able to chew and swallow easily. This is a serious problem. Difficulty with swallowing may lead to choking or cause food or liquid to go into the lungs, which is known as aspiration. This can causepneumonia, which can lead to death.
The following suggestions may help with swallowing:
- Make sure to cut food into small pieces and that it is soft enough for the person to eat.
- Grind or blend food to make it easier to eat.
- Offer soft foods, such as yogurt, applesauce, mashed avocado, sweet potatoes, and bananas.
- Don’t use a straw, which may cause more swallowing problems. Instead, have the person drink small sips from a cup.
- Offer drinks of different temperatures warm, cold, and room temperatureto see which might be easiest for the person to drink.
- Don’t hurry the person. He or she needs time to chew and swallow each mouthful before taking another bite.
- Encourage the person to feed themselves as much as possible during meals. If the person needs support, try using overhand, underhand, or direct hand feeding approaches.
- Don’t feed a person who is drowsy or lying down. He or she should be in an upright, seated position during the meal and for at least 20 minutes after the meal.
- Say “swallow” to remind him or her to swallow.
- Find out if the person’s pills can be crushed or taken in another form.
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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.
Mild Alzheimers Or Moderate Decline
Stage 4 lasts about 2 years and marks the beginning of diagnosable Alzheimers disease. You or your loved one will have more trouble with complex but everyday tasks. Mood changes such as withdrawal and denial are more evident. Decreased emotional response is also frequent, especially in challenging situations.
New symptoms of decline that appear in stage 4 may include:
- losing memory of personal history
- trouble with handling finances and bills
- inability to count backward from 100 by 7s
A clinician will also look for a decline in areas mentioned in stage 3, but there will often have been no change since then.
Caregiver support: Itll still be possible for someone to recall weather conditions, important events, and addresses. But they may ask for help with other tasks such as writing checks, ordering food, and buying groceries.
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Stage : Normal Outward Behavior
Alzheimerâs disease usually starts silently, with brain changes that begin years before anyone notices a problem. When your loved one is in this early phase, they won’t have any symptoms that you can spot. Only a PET scan, an imaging test that shows how the brain is working, can reveal whether they have Alzheimer’s.
As they move into the next six stages, your friend or relative with Alzheimer’s will see more and more changes in their thinking and reasoning.