Youll Need Support For Yourself Too
The National Institute on Aging points out that caregivers can experience confusion, depression, anxiety, fatigue, and grief at times. Its a good idea to plan regular times for others to take over caregiving responsibilities so you can take care of your own needs and experience some respite and relief.
What Causes Alzheimers Disease
In recent years, scientists have made tremendous progress in better understanding Alzheimers and the momentum continues to grow. Still, scientists dont yet fully understand what causes Alzheimers disease in most people. In people with early-onset Alzheimers, a genetic mutation may be the cause. Late-onset Alzheimers arises from a complex series of brain changes that may occur over decades. The causes probably include a combination of genetic, environmental, and lifestyle factors. The importance of any one of these factors in increasing or decreasing the risk of developing Alzheimers may differ from person to person.
What To Expect At The End Of Life
The way people with Alzheimerâs disease die is different from person to person, but thereâs a basic pattern to the process. They slowly lose the ability to control basic body functions, such as eating, drinking, and toileting. After a while, their body shuts down.
They canât move much on their own. They donât want to eat or drink, and they lose weight. They often get seriously dehydrated. It can get hard for them to cough up fluid from their chest. In the last stages, many people with dementia get pneumonia.
Some other common signs that someone with Alzheimerâs disease is close to the end of their life include:
- They speak very few or no words.
- Theyâre not able to do very basic activities such as eat, move from a bed to a chair, or change their position in a bed or chair.
- They canât swallow well.
- They get sores because they sit or lie in the same position for too long. These are called bedsores or pressure ulcers.
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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’re unable to move, they’re 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.
- Another person may die 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.
How Alzheimer’s Causes Death
In late-stage Alzheimer’s disease, people become extremely confused and disoriented. The behavior of someone with late stage Alzheimer’s may become more agitated and restless, while other persons experience withdrawal and apathy. Sometimes, people with later stage dementia cry and call out. Eventually, they lose the ability to communicate, and they may not respond at all.
Additionally, people in the late stages are unable to care for themselves, becoming bedbound and completely dependent on others for their activities of daily living. Their ability to be continent of bowel and bladder declines.
Their appetite decreases as well, and eventually, they lose the ability to swallow, leading to poor nutrition and a high risk of aspiration. Aspiration, where a person’s food goes “down the wrong tube” when they swallow it, greatly increases the risk of pneumonia developing because they’re not able to fully cough and clear the food out of their esophagus and then it settles into their lungs.
Under these difficult conditions, it’s not hard to imagine how vulnerable people with late-stage dementia become, sometimes succumbing to infections, pressure sores, and pneumonia. One study found that half of all people with dementia admitted to a hospital for pneumonia or a hip fracture died within six months of leaving the hospital.
Other factors that impact the death rate in Alzheimer’s disease include advanced age, increased falls, and delirium.
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Health Environmental And Lifestyle Factors
Research suggests that a host of factors beyond genetics may play a role in the development and course of Alzheimers. There is a great deal of interest, for example, in the relationship between cognitive decline and vascular conditions such as heart disease, stroke, and high blood pressure, as well as conditions such as diabetes and obesity. Ongoing research will help us understand whether and how reducing risk factors for these conditions may also reduce the risk of Alzheimers.
A nutritious diet, physical activity, social engagement, and mentally stimulating pursuits have all been associated with helping people stay healthy as they age. These factors might also help reduce the risk of cognitive decline and Alzheimers. Researchers are testing some of these possibilities in clinical trials.
Is Alzheimers A Terminal Illness
This question has a fair amount of subtlety. I have treated it at greater length HERE. But, suffice it to say that there are broad and narrow conceptions for what a âterminal illnessâ is.
On the broad conception, a terminal illness is merely one that reduces your life expectancy and that you will you will have at the time of your death. Alzheimerâs surely fits this general description.
On the narrow definition, a terminal illness is one that you are expected to die from very soon â maybe within twelve or twenty-four months. A person recently diagnosed with mild-cognitive impairment or early-stage Alzheimerâs may have eight to ten years to live. So, on this narrow definition, âAlzheimerâsâ â by itself â may not be a terminal illness. However, we could say that late-stage Alzheimerâs could plausibly be construed as a terminal illness. Because, by the time a person enters Alzheimerâs advanced, end, or late stage, it may well be that their life expectancy has been reduced to one or two years.
For a more in-depth discussion of this issue, click HERE.
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Whats The Best Way To Care For Someone Whos In Late Stages Of Dementia
The ideal time to plan for late stage care is when the person with dementia can still participate in the decision-making process. However, even if the person with dementia and caregivers communicated clearly while the disease was in early stages, things can change. Symptoms can progress more or less quickly and resources may dwindle.
Here are a few things to keep in mind if you are caring for someone in late stage dementia:
Brain Changes Associated With Alzheimer’s Disease
A healthy adult brain has about 100 billion neurons, each with long, branching extensions. These extensions enable individual neurons to form connections with other neurons. At such connections, called synapses, information flows in tiny bursts of chemicals that are released by one neuron and detected by another neuron. The brain contains about 100 trillion synapses. They allow signals to travel rapidly through the brain’s neuronal circuits, creating the cellular basis of memories, thoughts, sensations, emotions, movements and skills.
The accumulation of the protein fragment beta-amyloid outside neurons and the accumulation of an abnormal form of the protein tau inside neurons are two of several brain changes associated with Alzheimer’s.
Plaques and smaller accumulations of beta-amyloid called oligomers may contribute to the damage and death of neurons by interfering with neuron-to-neuron communication at synapses. Tau tangles block the transport of nutrients and other essential molecules inside neurons. Although the complete sequence of events is unclear, beta-amyloid may begin accumulating before abnormal tau, and increasing beta-amyloid accumulation is associated with subsequent increases in tau.,
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Variables Impacting Life Expectancy Calculations
Gender. Men dont live as long with Alzheimers as women. A study of more than 500 people diagnosed with Alzheimers disease between 1987 and 1996 found that women with Alzheimers live, on average, 20% longer than men. Age. Someone diagnosed at 65 lives an average of about eight years, while someone over 90 who gets a diagnosis typically lives about three-and-a-half more years. Strength of Symptoms at Diagnosis. If someone is showing especially severe dementia-related problems at the time of diagnosis, this usually leads to an earlier death. Someone who wanders, is prone to falling, and experiences urinary incontinence , will typically not live as long. A lower mini-mental state examination score at the time of diagnosis will also not live as long. Other Health Problems. A person with a history of heart problems or asthma or diabetes, for example, will not live as long as someone without those underlying issues.
Why Do Dementia Patients Stop Talking
There are many signs that can tell you death is near for a dementia payment. Even though you may be prepared for the end, it is never easy. The ten signs that death is near include:
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Stage : Mild Cognitive Impairment
Clear cognitive problems begin to manifest in stage 3. A few signs of stage 3 dementia include:
- Getting lost easily
- Noticeably poor performance at work
- Forgetting the names of family members and close friends
- Difficulty retaining information read in a book or passage
- Losing or misplacing important objects
- Difficulty concentrating
Patients often start to experience mild to moderate anxiety as these symptoms increasingly interfere with day to day life. Patients who may be in this stage of dementia are encouraged to have a clinical interview with a clinician for proper diagnosis.
Support For Families And Alzheimer’s Disease Caregivers
Caring for a person with Alzheimers can have significant physical, emotional, and financial costs. The demands of day-to-day care, changes in family roles, and decisions about placement in a care facility can be difficult. NIA supports efforts to evaluate programs, strategies, approaches, and other research to improve the quality of care and life for those living with dementia and their caregivers.
Becoming well-informed about the disease is one important long-term strategy. Programs that teach families about the various stages of Alzheimers and about ways to deal with difficult behaviors and other caregiving challenges can help.
Good coping skills, a strong support network, and respite care are other things that may help caregivers handle the stress of caring for a loved one with Alzheimers. For example, staying physically active provides physical and emotional benefits.
Some caregivers have found that joining a support group is a critical lifeline. These support groups enable caregivers to find respite, express concerns, share experiences, get tips, and receive emotional comfort. Many organizations sponsor in-person and online support groups, including groups for people with early-stage Alzheimers and their families.
Read about this topic in Spanish. Lea sobre este tema en español.
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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.
Medications To Treat The Underlying Alzheimer’s Disease Process
Aducanumab is the first disease-modifying therapy approved by the FDA to treat Alzheimers disease. The medication helps to reduce amyloid deposits in the brain and may help slow the progression of Alzheimers, although it has not yet been shown to affect clinical outcomes such as progression of cognitive decline or dementia. A doctor or specialist will likely perform tests, such as a PET scan or analysis of cerebrospinal fluid, to look for evidence of amyloid plaques and help decide if the treatment is right for the patient.
Aducanumab was approved through the FDAs Accelerated Approval Program. This process requires an additional study after approval to confirm the anticipated clinical benefit. If the follow-up trial fails to verify clinical benefit, the FDA may withdraw approval of the drug. Results of the phase 4 clinical trial for aducanumab are expected to be available by early 2030.
Several other disease-modifying medications are being tested in people with mild cognitive impairment or early Alzheimers as potential treatments.
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What Are The Complications Of Dementia
A common question people have when they hear that a loved one has dementia is, How can you die from dementia?
Though dementia itself may not be the final cause of death, the complications of dementia, like infections, cardiovascular diseases, malnutrition, and falls can be fatal.
Dementia often progresses through a variety of different signs and symptoms:
- Memory Difficulties and Loss: Memory issues are often the first signs of dementia, and they can be an ongoing problem with most patients.
- Disorientation: People with Alzheimers can become confused in familiar situations or surroundings, such as at home.
- Language Problems: This may be an issue with frontotemporal dementia, one of the less common forms.
- Problems Completing Complex Tasks: Problems following a set of instructions, such as brush your teeth, may signify that dementia is affecting higher-level brain functions.
- Wandering: People with dementia may wander and become lost or disoriented, even in familiar places.
- Physical Difficulties: Dementia may cause physical changes, such as weight loss or dehydration, affecting overall health. In late stage dementia, eating and walking can become difficult.
- Delusions and Hallucinations: People with delusions may become anxious or agitated. This problem can be worse at night.
Through all these stages, its important to have the right support in your corner. Dementia patients often end up requiring24-hour in-home care to support them through the decline.
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.
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What Are The Warning Signs That Life Is Nearing An End
When an elderly person with dementia is almost bearing their end, it can be very traumatic especially for the loved ones. It is important to have an idea of what signs one needs to expect when the end comes as this can give you some sort of comfort.
When you think of a condition such as Alzheimers disease, a person can live for over 10 years with it. It is possible to make the person happy over those years. Since we are not immortals, at some point life does come to an end when you have dementia and it is something that one needs to be prepared for especially if they are caregivers.
Handling the final stage of dementia is much easier, especially when you are aware of the things that you should expect. It is important to give the person the kind of care that will award him or her dignified and peaceful death.
Usually, when a person is about to reach the end, the dementia symptoms usually get worse and this can be quite upsetting. Some of the things that you may notice include:
- Limited mobility so they may have to be bed bound
- Limited speech or no speech at all
- Double incontinence
- Difficulties swallowing and eating
It is important to note that the above symptoms do not really mean that the person will just die. There are people who can have such symptoms for quite some time. You should also remember that about two-thirds of dementia patients succumb to other ailments such as pneumonia.
Some of the other signs that can indicate that death is indeed close include:
Stage : Moderately Severe Dementia
When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:
- Delusional behavior
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