Are There Any Treatments For Dementia
At this time there is no treatment for dementia. There is only medical care that can help manage symptoms and support people through their gradual decline.
The options for proper medical care with the diagnosis often include specialty caregivers, individual and family support groups, healthy diet and exercise, and frequent check-ins with your doctor.
Depending on which stage of dementia you or your loved one is in, the level of care required will vary. Someone in the earlier stages might need little to no care if symptoms are mild and not affecting daily life.
On the other hand, someone in the final stages of dementia will most certainly require 24/7 caregiving and constant supervision. If they dont have the proper care they need to avoid a risk factor such as choking or falling, it could lead to death.
What Happens In The Later Stages Of Dementia
- Progressive loss of memoryThis can be a particularly disturbing time for family and carers as the person with dementia may fail to recognise close family members.
- Increased loss of physical abilitiesMost people with dementia gradually lose their ability to walk, wash, dress and feed themselves. Other illnesses such as stroke or arthritis may also affect them. Eventually the person will be confined to a bed or a chair.
- Increased difficulty communicatingA person with dementia will have increasing difficulty in understanding what is said or what is going on around them. They may gradually lose their speech, or repeat a few words or cry out from time to time. But continuing to communicate with them is very important. Remember, although many abilities are lost as dementia progresses, some – such as the sense of touch and ability to respond to emotions – remain.
- Problems eatingIt is common for people in the later stages of dementia to lose a considerable amount of weight. People may forget how to eat or drink, or may not recognise the food they are given. Some people become unable to swallow properly. Providing nutrition supplements may need to be considered. If a person has swallowing difficulties, or is not consuming food or drink over a significant period of time and their health is affected, nutrition supplements may be considered for consumption other than by mouth.
What Are The Signs That Someone With Dementia Is Dying
It is difficult to know when a person with dementia is coming to the end of their life. However, there are some symptoms that may indicate the person is at the end of their life including:
- limited speech
- 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.
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Final Signs And What To Do
If it has been established that the person is now dying and they become restless, this is often referred to as terminal restlessness. It is important to recognise restlessness and report it to a doctor or nurse immediately. Restlessness could be due to pain or high temperature and needs to be relieved.
If you notice the person is restless and you think they are uncomfortable, you could try helping them move into a more comfortable position. If this does not help, seek advice as they may need pain relief. Likewise, if you notice the person is hot to touch then they may need to be cooled down by a fan or cool flannel on their forehead and given rectal paracetamol by the nurse. They may also need medication to relieve the restlessness if the above does not help.
As death approaches the persons breathing pattern can change. This is caused by the person going into unconsciousness. It is often called Cheyne-Stoke breathing. The person may have periods where they have regular breathing, then stop breathing for a few seconds. Breathing usually gets faster and there can be long gaps in between. The person who is dying is unaware of this but family members may find this quite distressing. It is important that you or another senior member of staff explain to the relatives that this is what is to be expected and that the person is unaware. It is natural.
General Care And Support
If you care for or know someone who is living with dementia, it can make you feel frustrated and helpless. Its important to have people around who take time to build empathy and trust, and help provide a safe and predictable environment. Your emotional and physical support will be a great help to the person when the world seems confusing and hostile.
In some cases, its helpful to make changes to a persons home environment to help them feel less disoriented . Visit Health Victorias website for some ideas on creating ‘dementia-friendly environments’.
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Why Are There Swallowing Problems
As dementia progresses it affects the area of the brain that controls swallowing. In advanced dementia the person may have a weak swallow or lose the ability to swallow safely. For example, they may cough or choke after swallowing food or drinks. See the Chewing and swallowing problems feature in the Eating well section.
Swallowing problems can also be caused by general weakness and frailty of the person, that is, their swallowing muscles become very weak. In addition, changes in sensation and sensory awareness means that some people will find the experience of eating feels very different and may, at times, feel unpleasant to them.
Other problems such as having a sore mouth or sensitive teeth can cause a person to take in less food or develop swallowing problems. You should bring these difficulties to the attention of a doctor, nurse or dentist as soon as possible to review.
Eating And Drinking At End Of Life
As dementia progresses, people often develop problems with eating and drinking, such as difficulty chewing their food and swallowing safely.
They may choke on food or saliva as it accidentally goes down their windpipe, and this can cause an infection in their lungs . To prevent this, their food may need to be blended to make it easier and safer to swallow, and drinks or other fluids can be thickened. A speech and language therapist or dietitian should be able to advise on how to do this.
It can be distressing to see that the person is no longer able to eat and drink normally. Try to remember that this is normal for a person approaching the end of their life and that they may not feel hungry if they are very unwell.
Talk to health professionals about how to provide the right food and liquids for the person, taking into consideration their cultural background and what they have said they wanted.
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Barriers For Good Palliative Care For People With Dementia
Despite increasing knowledge of optimal care and the recommendation for early integration of palliative care in the course of disease, accompanied by disease modifying treatment , a number of reasons for barriers of good palliative care for people with dementia were identified .
Diagnosing dementia in the early phases can be challenging and lengthy, leading to delays early access to palliative care . Dementia is often not acknowledged as terminal and life limiting disease and consequently end of life is not taken into consideration or adequately addressed . Another barrier is the difficulty in predicting the duration of the disease or its anticipated course in contrast to cancer. Although experts have determined the average length of the different stages and length of the disease, accurate individual predictions remain challenging. Notably, people with dementia have limited access to hospice and palliative care .
Regardless of all efforts there is still no consensus on palliative care in dementia . The applicability and appropriateness of palliative care for people with dementia was also one of the controversies in the development of the EAPC White Paper on optimal palliative care for dementia . There is a great need for robust study results on complex interventions at the end of life . The optimal timing to integrate palliative care or adapt care goals or simultaneous goals to modify disease and to provide comfort is still in discussion .
How To Test For Dementia
There is no single test that can determine a person is suffering from dementia. The doctor can diagnose different types of dementia such as Alzheimers based on their medical history.
This has to be done very carefully. In addition, the doctor may conduct laboratory tests, physical examinations, and changes in the way the patient thinks.
When all things are considered carefully, a doctor can be able to determine that a person is actually suffering from dementia with certainty. Determining the type of dementia can be hard, especially due to the fact that brain changes and symptoms that are associated with the different types of dementias sometimes overlap.
It is normal for the doctor to give a diagnosis of dementia without really specifying the type. In such a case, it is important for the patient to visit a specialist in this area like a psychologist or neurologist for a more specific diagnosis.
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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.
What Physical Needs Might A Person Have At End Of Life
The person is likely to become less physically able as their dementia progresses, and particularly as they approach the end of their life. This can be for several reasons, including other health conditions.
Dementia will also often affect the persons ability to eat, drink, move around and sense things properly. They may need a lot more help at mealtimes, when they get dressed, or when they go to the toilet.
There are steps that can be taken to help meet these needs and to make sure that the person is as comfortable as possible.
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Caring For A Person With Late
If you are caring at home for someone who is in the later stages of dementia the Aged Care Assessment Team can help with advice and referrals for all aspects of care. You can contact your nearest ACAT by calling the number listed in the Age Page of your telephone directory. Your doctor or hospital can also help you to contact your local ACAT.
What Affects Life Expectancy In Dementia
The life expectancy of someone living with dementia depends on many factors. The type of dementia, the severity of dementia at the time of diagnosis, and the individual’s age, sex, and their general health and wellbeing can all impact on the time they can live with the disease. The key things that affect life expectancy include:
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Caring For Those With Dementia
Researcher Murna Downs, PhD, says most people don’t recognize that dementia is a disease people live with, and not just a death sentence.
Downs’ research focuses on quality-of-life issues among dementia patients.
“People with dementia live a long time, and we now know that there is a lot of awareness,” she says. “People assume that if someone doesn’t know where they are they have no other capacity for thinking and feeling. But people with dementia continue to think and to laugh and to feel the rain on their faces, and to try to make sense of their world.”
She adds that patients are often isolated because family members or other caregivers fail to recognize their need for interaction and stimulation.
“The therapeutic potential of human contact cannot be underestimated,” she says. “You would never put a small child in a chair and let them sit there all day with nothing to do. Children need stimulation and human contact and so do people with dementia.”
SOURCES: Xie, J. BMJ Online First, Jan. 11, 2008. Carol Brayne,professor, lecturer in epidemiology, department of public health and primarycare, Institute of Public Health, University of Cambridge, England. MurnaDowns, PhD, professor in dementia studies, Bradford Dementia Group, Universityof Bradford, England Ferri, C.P. Lancet, 2005 vol 366: pp2112-2117.
Scales For Rating Dementia
Rather than simply using early stage,middle-stage, and late-stage dementia as descriptors, there are scales that provide a more comprehensive description. These scales help better understand the different stages of Alzheimers disease based on how well a person thinks and functions . These scales are the Global Deterioration Scale for Assessment of Primary Degenerative Dementia, the Functional Assessment Staging Test, and the Clinical Dementia Rating.
Did You Know?
Global Deterioration Scale / Reisberg Scale
The most commonly used scale is often referred to simply as GDS, or by its more formal name, the Reisberg Scale . The GDS divides into seven stages based on the amount of cognitive decline. This test is most relevant for people who have Alzheimers disease because some other types of dementia do not always include memory loss.
Someone in stages 1-3 does not typically exhibit enough symptoms for a dementia diagnosis. By the time a diagnosis has been made, a dementia patient is typically in stage 4 or beyond. Stage 4 is considered early dementia, stages 5 and 6 are considered middle dementia, and stage 7 is considered late dementia.
|Global Deterioration Scale / Reisberg Scale|
Clinical Dementia Rating
|Clinical Dementia Rating Scale|
|Average duration is 1 year to 2.5 years.|
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Setting And Study Population
This prospective observational follow-up study was part of a study to validate methods of measurement of quality of care and quality of dying with dementia in long-term care facilities in the Netherlands . From January 2008 to February 2009 two elderly care physicians in two LTCFs included patients if they met the following inclusion criteria: residing in a LTCF for30 days, a physicians diagnosis of dementia and expected to die within the next 7 days. The expectancy of a patient to die within 7 days is based on an estimation made by the treating physician and the nurses caring for the patient, and is often related to the fact that a patient has stopped eating and drinking .
The Medical Ethics review Committee of VU University Medical Center Amsterdam approved the study. Families were asked for permission for study participation by the coordinating physician who also observed the patients. Neither of the observing elderly care physicians were part of the research group.
Average Dementia Survival: 45 Years
Study of Dementia Patients Shows Women Live Slightly Longer Than Men
Jan. 10, 2008 — The average survival time for people diagnosed with dementia is about four and a half years, new research shows. Those diagnosed before age 70 typically live for a decade or longer.
In an effort to learn more about survival characteristics among patients with Alzheimer’s disease or other dementias, researchers from the U.K.’s University of Cambridge followed 13,000 people who were aged 65 and older for 14 years.
During the follow-up, 438 of the study participants developed dementia and 356 of these people died.
Overall, women lived slightly longer than men after a diagnosis of dementia — around 4.6 years vs. 4.1 years. And frailer patients died sooner than healthier ones.
But being married, living at home, and even degree of mental decline were not found to have a big impact on survival.
The research is published in the Jan. 11 issue of the journal BMJ Online First.
“When we took everything into account, the big predictors of how long people survive remain sex, age, and functional ability,” University of Cambridge professor of epidemiology Carol Brayne tells WebMD. “Functional ability was a much better marker of how close someone was to death than cognitive decline.”
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