Where To Care For A Person In The Last Stages Of Dementia
When your loved one moves into the last stages of Dementia, you have a number of options for his or her care. The best time to decide about where they should spend the last months of their life should occur during the earlier stages when the patient can still participate in the decision. Moving dementia patients in the later stages can have significant challenges for both patients and caregivers. Dementia patients can receive support in the following settings:
Traditional home Your lovedone can continue to live in his or her own home as long as they receiveappropriate care services and the proper medical equipment is available for use
Assisted living The same asabove but in a building where the patient has a private appointment, and memorycare and other services are provided
Nursing home Onky appropriateif the patient has other accompanying health issues
Those experiencing late-stage Dementia often have more frequent hospital stays, but staying for a long time in a hospital setting is generally unfeasible. When dementia patients have entered the terminal phase of their lives, their caregivers can elect to obtain hospice services, either in the home or at a stand-alone hospice facility, to keep their loved ones as comfortable as possible.
How To Identify The 7 Stages Of Dementia
Dementia is a general term that encompasses different types of disorders, including Alzheimers disease, dementia with Lewy Bodies, frontotemporal dementia and others. While each type of dementia progresses differently, there are two general diagnostic models used to describe the progression of dementia: the three-stage model and the seven-stage model. With the latter, the decline of a patient is separated into more specific stages than the earlier. The seven-stage model is based off of the Global Deterioration Scale, an assessment tool created by Dr. Barry Reisberg to assist friends, family and caregivers with recognizing the clinical signs of the disease.
Prior to assessment, caregivers look at different behaviors demonstrated by the individual. Not only is memory assessed, but the persons judgment, sense of direction, personal care and daily activities are considered as well. Based on the severity of the dementia, a care plan can be devised by a physician and the individuals caregivers. In the earlier stages of dementia, an individual will still have independence and be able to perform many activities without assistance. When entering the later stages of dementia, the individual will need around-the-clock assistance for most daily activities.
The following is a summary of the seven stages of dementia, according to the model created by Dr. Reisberg:
The 7 Stages Of Alzheimers: What You Can Do As A Patient In The Second Stage
- Support your wellbeing by challenging your brain with different types of learning, such as learning a new instrument or language. Stick to a regular exercise program. Devise ways to help you remember things
- Assess your risk by understanding the difference between Alzheimers and normal aging. In addition, take a baseline cognitive test
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Mild Impairment Or Decline
The symptoms of Alzheimers are less clear during stage 3. While the entire stage lasts about seven years, the symptoms will slowly become clearer over a period of two to four 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.
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.
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Caregiving In The Early Stages
Although most of your loved ones immediate medical needs can be managed on their own in the early stages, you may need to assist with tasks associated with memory or problem-solving. You may need to remind them of their doctors appointments and to set up the next appointment, along with taking their medications on time and getting refills as needed. You may need to assist them in managing their finances and keeping up with social and work obligations. At times, they may also need help remembering places, people, words, and names. In the early stages, you will want to encourage them to:
- Maintain their independence
- Establish a routine to delay the disease from worsening
Stage : Very Severe Cognitive Declinesevere Dementia
At this stage, AD persons require continuous assistance with basic activities of daily life for survival. Six consecutive functional substages can be identified over the course of this final seventh stage. Early in this stage, speech has become so circumscribed, as to be limited to approximately a half-dozen intelligible words or fewer . As this stage progresses, speech becomes even more limited to, at most, a single intelligible word . Once intelligible speech is lost, the ability to ambulate independently , is invariably lost. However, ambulatory ability may be compromised at the end of the sixth stage and in the early portion of the seventh stage by concomitant physical disability, poor care, medication side-effects or other factors. Conversely, superb care provided in the early seventh stage, and particularly in stage 7b, can postpone the onset of loss of ambulation. However, under ordinary circumstances, stage 7a has a mean duration of approximately 1 year, and stage 7b has a mean duration of approximately 1.5 years.
In persons with AD who remain alive, stage 7c lasts approximately 1 year, after which persons with AD lose the ability not only to ambulate independently but also to sit up independently , At this point in the evolution, the person will fall over when seated unless there are armrests to assist in sitting up in the chair.
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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.
What Are The Symptoms
Each person is unique and will experience dementia in their own way. The different types of dementia tend to affect people differently, especially in the early stages.
A person with dementia will often have cognitive symptoms . They will often have problems with some of the following:
- Day-to-day memory difficulty recalling events that happened recently.
- Repetition repeating the same question or conversation frequently in a short space of time.
- Concentrating, planning or organising difficulties making decisions, solving problems or carrying out a sequence of tasks .
- Language difficulties following a conversation or finding the right word for something.
- Visuospatial skills – problems judging distances and seeing objects in three dimensions.
- Orientation – losing track of the day or date, or becoming confused about where they are.
Some people have other symptoms including movement problems, hallucinations or behaviour changes.
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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.
Stage Two: Very Mild Cognitive Decline
Stage two may bring subtle changes in the individual, such as mild forgetfulness. These instances may include forgetting names or having trouble locating familiar objects. In the second stage of dementia, its difficult or impossible to notice these minor symptoms, and a diagnosis is not yet able to be reached.
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The Seven Stages Of Dementia
One of the most difficult things to hear about dementia is that, in most cases, dementia is irreversible and incurable. However, with an early diagnosis and proper care, the progression of some forms of dementia can be managed and slowed down. The cognitive decline that accompanies dementia conditions does not happen all at once – the progression of dementia can be divided into seven distinct, identifiable stages.
Learning about the stages of dementia can help with identifying signs and symptoms early on, as well as assisting sufferers and caretakers in knowing what to expect in further stages. The earlier dementia is diagnosed, the sooner treatment can start.
Support For People With Dementia And Carers
UCL covid-19 decision aid – a tool to support carers of people living with dementia to make difficult decisions during covid-19
Alzheimers Society end of life care information for patients and families
Alzheimers Society information and fact sheets on all aspects of dementia including what is dementia, types of dementia and living well with dementia
Alzheimer Scotland specialist services for patients and carers
Dementia UK expert one-on-one advice and support to families living with dementia via Admiral Nurses
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The Later Stages Of Dementia
It is important to remember that not everyone living with dementia will want to know what is ahead of them. However, if youre caring for someone living with dementia, it is useful to know about the later stages of the disease so you can make decisions about future care options.
In the later stages of dementia, symptoms such as poor memory, confusion and other forms of cognitive impairment are joined by more physical symptoms.
Dementia is an illness of progressive cell damage. It starts in the parts of the brain that deal with memory and slowly moves to parts of the brain that control other functions. Sadly, this will eventually cause major organs to stop working. Below you can find a summary of some of the things you can expect when caring for someone in the later stages of dementia.
Our advice page on looking after someone with dementia might also be helpful.
How Long Do The Dementia Stages Last
Knowing the stages of dementia is a great way to figure out future treatment plans, but you are probably wondering how long you have with your loved one before they start forgetting things like your name. While everyone is different and everyone progresses at different speeds, we do have a general idea of how long certain stages in dementia will last.
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How Can Healthcare Professionals Help At This Stage
Healthcare professionals can explain these changes so you understand what is happening.
Healthcare professionals can also take steps to reduce the persons pain or distress, often using medication.
If the person cant swallow, then medication can be provided through patches on the skin, small injections or syringe pumps that provide a steady flow of medication through a small needle under the persons skin. Speak to a GP or another health professional about this.
What Are The Final Stages Of Dementia
As seniors progress to late stage dementia, full-time care may become necessary, whether you choose memory care or professional dementia care at home. The symptoms of the final stages of Alzheimers include behavioral and personality changes, inability to perform ADLs, and severe cognitive decline.
Dementia stage 6: severe cognitive decline
Stage 6 marks a need for caregiver help to perform basic daily activities such as dressing, eating, using the toilet, and other self-care. Seniors with late stage dementia may have difficulty regulating sleep, interacting with others, or behaving appropriately in public settings.
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Changes In Mood Emotions And Perceptions
Changes in mood remain in the later stages of dementia. Depression and apathy are particularly common.
Delusions and hallucinations are most common in the late stage of dementia. They are not always distressing but they can explain some changes in behaviour because the persons perception of reality is altered.
People with later stage dementia often respond more to senses than words. They may like listening to songs or enjoy textures. For example, they may like the feel of different types of material.
What Are The 7 Stages Of Dementia
Dementia does not affect every person in the same way. It presents itself differently in each individual and progresses at different rates. Some people will stay in a state of mild decline for an extended period, while others may develop multiple symptoms quickly. Understanding the seven stages of dementia can make these transitions a little easier for your loved one and you as their caregiver.
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How We Classify The Stages Of Dementia
Most doctors divide dementia into seven different stages. Each of these stages has a different level of severity. It ranges from no dementia to late-stage dementia. To provide clarity, weve grouped these stages under their different classifications.
Weve also done our best to help you answer common questions, like how long does each stage of dementia last. There are no guarantees that youll see a clear-cut transition between the stages. But they provide helpful guidelines to keep an eye out for.
Physical Difficulties In The Later Stages Of Dementia
The physical changes of late-stage dementia are partly why the person is likely to need much more support with daily living. At this stage they may:
- walk more slowly, with a shuffle and less steadily eventually they may spend more time in a chair or in bed
- be at increased risk of falls
- need a lot of help with eating and so lose weight
- have difficulty swallowing
- be incontinent losing control of their bladder and bowels.
The persons reduced mobility, in particular, raises their chances of blood clots and infections. These can be very serious or even fatal so it is vital that the person is supported to be as mobile as they can.
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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.
Stage : Severe Cognitive Decline
Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may:
- Lose most awareness of recent experiences and events as well as of their surroundings
- Recollect their personal history imperfectly, although they generally recall their own name
- Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces
- Need help getting dressed properly without supervision, may make such errors as pajamas over clothes or shoes on wrong feet
- Experience disruption of their normal sleep/waking cycle
- Need help with handling details of toileting
- Have increasing episodes of urinary or fecal incontinence
- Experience significant personality changes and behavioral symptoms, including: suspiciousness and delusions hallucinations or compulsive, repetitive behaviors such as hand-wringing or tissue shredding
- Tend to wander and become lost
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Caring For Dementia Patients
Many individuals in the earlier stagesof Dementia are able to maintain some of their own care. However, as Dementiaprogresses, you must make changes in the daily routine of your loved one. Forsome, transitioning to senior independent living is the answer. Thistype of care allows you or your loved one to live as independently as possibleyet get help with cooking and cleaning as well as bathing and other personalgrooming tasks.
Senior independent living is appropriate for those in the early stages of Dementia, as well as for some in the earlier middle stages. In the early stages, a caregiver can help with appointment reminders, names of people, developing a daily to-do list, and coping strategies to help the patient live as independently as possible. You should also develop a long-term care plan at this point.
During middle-stage dementia, patients need more help. At first, your loved one may only need a cue or a prompt, but eventually, hands-on assistance and additional services will be required during senior home care. As patients progress toward late-stage Dementia, they start losing the ability to communicate appropriately, become unable to drive, and eventually must have constant supervision as leaving the patient alone will be unsafe.