Behavioral And Cognitive Symptoms Of Dementia
Michelle Niedens, L.S.C.S.W., in The Neuropsychiatric Symptoms of Alzheimers, states that 80% of individuals with dementia will experience neuropsychiatric symptoms.
Personality changes such as anxiety, depression or irritability are common in the early stages of the disease. Later, agitation, physical or verbal outbursts, pacing and restlessness are more common.
Behavioral symptoms have been identified as the most challenging and distressing for caregivers and family members. They are oftentimes the determining factor in deciding to move a family member with Alzheimers into a structured living environment.
Cognitive symptoms start out mild in the early stages of Alzheimers and gradually worsen as each stage progresses. In the late stages of Alzheimers, the person with the disease is no longer able to form new memories or access old ones. Language abilities become worse until the person is no longer able to communicate. Judgment and reasoning skills continue to diminish and eventually, the person with dementia loses the ability to reason altogether.
Provide Physical Comfort And Care
Assess the person to ensure they are not in discomfort or restless, and offer the kind of care described in the above section . Reduce any interventions to only what is necessary, for example change the persons position every few hours or when they need changing.
Give regular mouth care. This can be done hourly to prevent the persons mouth from becoming dry. Apply Vaseline to keep lips moist.
Give eye care, for example use a soft piece of wet clean gauze to prevent the persons eyes from looking sticky.
What Can Hospice Do For The Family Of A Patient With Dementia
Family members may have to make difficult healthcare and financial decisions, act as caregivers and provide emotional support to others. If the decision is made to stop medical support, families often experience strong emotions and feel overwhelmed.
Hospice offers comprehensive services for families of patients with dementia:
Caregiver education and training The family caregiver is vital in helping hospice professionals care for the patient. As the patient gets weaker, symptoms increase and communication becomes more difficult. We relieve families concerns by educating them on how best to care for their loved one.
Help with difficult decisions Hospice helps families make tough choices that impact the patients condition and quality of lifefor example, whether to give antibiotics for a recurring infection.
A VITAS nurse by phone 24/7 Even the most experienced caregivers will have questions and concerns. With Telecare®, they dont have to wonder, worry or wait for an answer. As the heartbeat of VITAS after hours, Telecare® provides trained hospice clinicians around the clock to answer questions or dispatch a member of the team to the bedside.
Emotional and spiritual assistance Hospice meets the needs of loved ones along with those of the patient.
Respite care Caring for a loved one with an end-stage illness can cause tremendous stress. Hospice offers up to five days of inpatient care for the patient in order to give the caregiver a break.
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Dying From Dementia With Late
The death of your loved one can be a hard concept to wrap your head around and accept. But knowing what to expect can help you when your loved one has late-stage dementia. It might help to understand what’s coming in the future so you can prepare emotionally and practically.
This article explains how dementia progresses and what happens during late-stage dementia.
Tips For Providing Compassionate Care
Although learning about what happens during the final stage of Alzheimers disease can feel upsetting, knowing what to expect empowers you and your loved one to make decisions while you can. If your loved one hasnt reached this stage yet, now is the ideal time to talk about long-term plans for his or her care. For instance, your loved one may do best at home with a professional caregiver. If your loved one is already in this stage, your role now is to focus on helping him or her stay comfortable despite the symptoms. By putting together a team of caregivers who can help with meals, dressing, and providing calm opportunities to socialize, you can help your loved one move through the final stages of Alzheimers with the understanding that he or she is loved.
Alzheimers can be challenging for seniors to manage without assistance, and it can be just as challenging for families who dont have experience in providing Alzheimers care. TorontoHome Care Assistance provides Alzheimers care seniors and their families can depend on. Our proprietary Cognitive Therapeutics Method was designed to help seniors with Alzheimers and other memory-related conditions live happier and healthier lives. Home Care Assistance will work with you to customize a care plan thats just right for your loved ones needs. Call us today at 488-8777 to discuss how we can give you the peace of mind that comes from knowing your loved one is being cared for with professionalism and compassion.
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How Can I Support Someone With Dementia Towards The End Of Life
Knowing the person will make it easier to provide person-centred care that is focused on what they need and want. It can help to know about their likes, dislikes and their wishes for how they want to be cared for. If the person isnt able to tell you about themselves, speak to their family, friends or other people who know them well.
Its a good idea to find out if the person has a copy of This is me , a document that records information about themselves. If you cant speak to the person, ask those close to them if they have a copy. They may have these details recorded in their care plan.
There are many ways to support someone with dementia at the end of life.
What Are The Average Life Expectancy Figures For The Most Common Types Of Dementia
The average life expectancy figures for the most common types of dementia are as follows:
- Alzheimers disease around eight to 10 years. Life expectancy is less if the person is diagnosed in their 80s or 90s. A few people with Alzheimers live for longer, sometimes for 15 or even 20 years.
- Vascular dementia around five years. This is lower than the average for Alzheimers mostly because someone with vascular dementia is more likely to die from a stroke or heart attack than from the dementia itself.
- Dementia with Lewy bodies about six years. This is slightly less than the average for Alzheimers disease. The physical symptoms of DLB increase a persons risk of falls and infections.
- Frontotemporal dementia about six to eight years. If a person has FTD mixed with motor neurone disease a movement disorder, their dementia tends to progress much quicker. Life expectancy for people who have both conditions is on average about two to three years after diagnosis.
To find out about the support available to someone at the end of their life, and to their carers, family and friends, see our End of life care information.
You can also call Alzheimers Society on 0333 150 3456 for personalised advice and support on living well with dementia, at any stage.
Dementia Connect support line
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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
- 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.
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.
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How Long Does It Take To Die From Dementia
Dementia is not a part of a persons normal aging process. Some individuals aged 85 and above suffer from it. Meanwhile, some live to their 90s without experiencing any signs of dementia.
Its still best to get a check early than be late and reach the last stages of the disease without proper care. But if your loved one has already reached the final stages of dementia, where the symptoms become severe, you should expect that the patient will require help with everything.
Patients in their last stage of dementia will:
- Become weaker and need help with sitting and walking
- Mostly become bedridden as days go by
- Have problems with drinking, eating, and swallowing foods and medications
- Develop an inability to recognize family members and friends
- Often be doing time-shifting or looking for someone who has already passed away
- Struggle to speak clearly and get more sleep
- Lose their facial expressions and emotions
- Get sick quickly, have accidents, and need urgent medical care
- Have a weak immune system and become prone to ailments such as pneumonia
Alzheimers Late Stage Progression
Sleep will overtake more of their day as the disease progresses. At this point you will need to begin to reposition them while they are sleeping. They will lose the ability to reposition themselves in bed or a chair. If they lay or sit for long periods of time their skin will break down. This will lead to what most people refer to as bed sores. I recommend repositioning them every 2-3 hours to maintain blood flow to those areas.
Often in the Alzheimers late stage caregivers are at home alone with their family member. This should not be your situation! You need what is referred to as respite time. You need to take time away several times a week. If you don’t you will wear down and become sick. Most caregivers feel guilty about leaving their family member at home and going out for social activities. This is a very important part of your life that you should make time for. Failure to take time out for yourself can lead to caregiver burnout.
End stage dementia patients usually qualify for Hospice benefits under medicaid, medicare, and private insurances. Hospice can provide care to patients in the home or long term care facility. Hospice can help with direct patient care, medication management, and emotional support for the caregiver. Please check with the hospice providers in your area to determine if you are eligible for these benefits!
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Care In The Later Stages Of Dementia
There are medicines used in the early stages of dementia that manage some of the behavioural symptoms. In the later stages some of these medicines can do more harm than good causing severe side effects that can increase confusion and frailty. It also becomes harder to diagnose and manage some of the normal illnesses that older people get such as Urinary Tract Infections . UTIs can exaggerate some symptoms of dementia and increase confusion sometimes know as delirium.
Pain is also something that can be present in the later stages of dementia, but can be harder to diagnose if the person isnt able to communicate it. For all of these reasons, its important to stay vigilant when looking after someone with dementia, and to talk to the GP if you are worried about anything.
There are dementia living aids and products that can help you to care for someone living with dementia. Something like a simple dementia clock or personal alarm can make the world of difference to your life and the live of the person you care for.
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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.
What Are Signs Of The Dying Process For End
At the end of their illness, some of the signs that they are transitioning may include:
Raspy breathing/rattle in the chest
In and out of awareness of surroundings
It is not unusual for a loved one to be unaware of these symptoms. Medical professionals can help ensure that dementia patients are as physically comfortable as possible in the last days and weeks of their life.
Handling the emotional distress that sometimes comes when dealing with dementia may even involve assistance outside of a physician or their team. A clergy member, or other cultural spiritual leader may be able to provide support to both you, and your loved ones, as the end-stages continue.
Skilled Nursing Facility Care
Medicare will also pay for up to 100 days in a skilled nursing facility. The first 20 days are fully covered, but for days 21 through 100, a $105 daily co-payment is required. This co-payment may be covered by Medigap insurance. The patient must have been hospitalized for at least 3 days prior to entering the skilled nursing facility, and generally, must be admitted to the facility within 30 days after leaving the hospital.
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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 like withdrawal and denial are more evident. Decreased emotional response is also frequent, especially in challenging situations.
New signs 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 theres often 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 like writing checks, ordering food, and buying groceries.
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.
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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.|
Mild Impairment Or Decline
The symptoms of Alzheimers are less clear during stage 3. While the entire stage lasts about 7 years, the symptoms will slowly become clearer over a period of 2 to 4 years. Only people close to someone in this stage may notice the signs. Work quality will decline, and they may have trouble learning new skills.
Other examples of stage 3 signs include:
- getting lost even when traveling a familiar route
- finding it hard to remember the right words or names
- being unable to remember what you just read
- not remembering new names or people
- misplacing or losing a valuable object
Your doctor or clinician may also have to conduct a more intense interview than usual to discover cases of memory loss.
Caregiver support: At this stage, someone with Alzheimers may need counseling, especially if they have complex job responsibilities. They may experience mild to moderate anxiety and denial.