Signs Of Death In Elderly With Dementia: End Stage
Dementia is a term used to describe the persistent or chronic decline in ones mental processes and this include personality changes, impaired reasoning, and memory loss. The most common form is Alzheimers disease and it accounts for over 70 percent of all the dementia cases.
It is one of the greatest causes of death in the United States with over five million people living with the disease in the country alone. One of the age groups affected by dementia is the seniors. If you are a caregiver, it is important to know the signs of death in elderly with dementia.
Most progressive dementias and Alzheimers disease do not have any cure. The diseases get worse with the passage of time, but the timeline can be very different from one person to the next.
Caring for persons with the diseases can be stressful and very challenging, especially when their personality begins to change and their cognitive function starts to decline. It is possible that the individual will not even recognize the people who are closest and dearest to them.
As the disease progresses, the person needs more and more support from the caregiver and the family. If the person is elderly, the caregiver needs to know about all the signs that the patient may be dying.
You may need to put the patient on hospice so as that he or she can get the appropriate care during such moments. This offers the family and the patient spiritual, physical, and emotional care.
Suggestions For Managing Feeding Difficulties:
Ensure mealtimes are relaxed and as unhurried as possible.
Choose a calming setting with minimal noise or distractions.
Try not to become stressed at the mealtime if difficulties are encountered. A person with dementia can sense stress, making the situation worse.
If the person is confused at mealtime and not able to initiate feeding, use gentle reminders or prompts of how to use certain items. If this fails then load the fork / spoon for the person and gently guide the persons hand to mouth.
Talk about the different foods you are offering so they can identify what they are eating.
Avoid mixing foods together as the person may dislike one particular ingredient and end up refusing all of the meal.
Finger foods are foods that can be easily picked up and eaten with the hands and are sometimes preferred to meals that require a knife and fork. They allow a person eat independently and at their own pace.
Examples of finger foods:
- Crackers with butter or soft cheese
- Baby boiled potato
What Happens In The Last Stage Of Dementia
A patient could spend between approximately one and three years in the last severe stage of Alzheimers. Approximately 1.8 million US adults are in the final stages of dementia at the time of writing.
As the disease progresses, a patient can do less. They become increasingly dependent on others for assistance.
Eating and swallowing become more difficult during this stage. Sometimes patients wont eat because they arent hungry or theyre simply confused.
Around the clock hospice care is usually administered to such patients.
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Types Of Medication For Difficult Behaviors In Dementia
Most medications used to treat difficult behaviors fall into one of the following categories:
1.Antipsychotics. These are medications originally developed to treat schizophrenia and other illnesses featuring psychosis symptoms.
Commonly used drugs: Antipsychotics often used in older adults include:
- For a longer list of antipsychotics drugs, see this NIH page.
Usual effects: Most antipsychotics are sedating, and will calm agitation or aggression through these sedating effects. Antipsychotics may also reduce true psychosis symptoms, such as delusions, hallucinations, or paranoid beliefs, but its rare for them to completely correct these in people with dementia.
Risks of use: The risks of antipsychotics are related to how high the dose is, and include:
- Increased risk of falls
- Increased risk of stroke and of death this has been estimated as an increased absolute risk of 1-4%
- A risk of side-effects known as extrapyramidal symptoms, which include stiffness and tremor similar to Parkinsons disease, as well as a variety of other muscle coordination problems
- People with Lewy-body dementia or a history of Parkinsonism may be especially sensitive to antipsychotic side-effects in such people, quetiapine is considered the safest choice
2. Benzodiazepines. This is a category of medication that relaxes people fairly quickly. So these drugs are used for anxiety, for panic attacks, for sedation, and to treat insomnia. They can easily become habit-forming.
Tips For Dealing With Aggressive Behavior In Dementia
1. Be prepared with realistic expectationsReminding yourself that challenging behavior and aggressive outbursts are normal symptoms of dementia helps you respond in a calm and supportive way.
Knowing that these episodes are a common part of the disease reduces your shock and surprise when it does happen and may also make it a little easier to not take the behavior personally.
2. Try to identify the immediate cause or triggerThink about what happened just before the aggressive outburst started. Something like fear, frustration, or pain might have triggered it.
For example, your older adult might start yelling at empty areas of the room and telling people to get out. Looking around, you might notice that the room is starting to get darker because its early evening. The dim light causes shadowing in the corners of the room, making it seem like there are people in the corner.
After identifying that potential trigger, turn on the lights to get rid of the shadowy corners. That will hopefully help you older adult calm down. And, in the future youll know to turn on the lights before the room gets too dim.
In another example, you could have unintentionally approached your older adult from behind and startled them. In a sensitive moment, that could make them feel attacked and so they lash out in what they perceive as self-defense.
3. Rule out pain as the cause of the behaviorPain and physical discomfort can trigger aggressive behavior in someone with dementia.
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When You Need Themand When You Dont
Most people in the last stage of Alzheimers disease have difficulty eating and drinking. At this time, families may wonder if their family member needs a feeding tube.
Families want to do everything possible for someone who is ill. But they often get little information about feeding tubes. And they may feel pressure from doctors or nursing home staff, because feeding is simpler with a feeding tube.
But feeding tubes sometimes do more harm than good. Heres why:
Feeding tubes usually arent helpful for severe Alzheimers disease.
People with severe Alzheimers disease can no longer communicate or do basic things. Chewing and swallowing is often hard. This can cause serious problems, such as weight loss, weakness, and pressure sores. Or food can get into the lungs, and cause pneumonia. So people often need help to eat.
In many cases, a decision is made to use a feeding tube. The tube may be put down the throat. Or it may be put through a small cut in the abdominal wall, into the stomach. The person is then given liquid nutrition through the tube.
But tube feeding is not better than careful hand feedingand it may be worse. It does not help people live longer, gain more weight, become stronger, or regain skills. And it may increase the risk of pneumonia and pressure sores. Hand feeding gives human contact and the pleasure of tasting favorite foods.
Feeding tubes can have risks.
Tube feeding has many risks.
Feeding tubes can cost a lot.
So when are feeding tubes a good idea?
Black Pepper Ginger And Long Pepper Mixture
You should not use other sweeteners instead of honey because all other sweeteners themselves cause excessive saliva formation in the mouth.
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What You Can Do For Your Loved One
As an individual with dementia declines, you can help them by providing a loving and supportive presence. Sit with them. Hold their hand. Play music they enjoy.
One of the greatest gifts you can give your loved one is helping to get their affairs in order. Ensure that financial and healthcare powers of attorney are put in place, so you can make decisions when your loved one is no longer able. Look into funeral arrangements before you need them, so you dont need to make important decisions in a time of crisis.
Talk to your loved ones physician about the possibility of palliative care support in the home and hospice care when your loved one is ready.
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.
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How You Can Help
Let the person help with everyday tasks, such as:
These can lead to increased confusion and make the symptoms of dementia worse.
Common food-related problems include:
- forgetting what food and drink they like
- refusing or spitting out food
- asking for strange food combinations
These behaviours can be due to a range of reasons, such as confusion, pain in the mouth caused by sore gums or ill-fitting dentures, or difficulty swallowing.
What Are Some Other Things I Should Know
A clinical study completed in Korea compared the swallowing problems of people with late stage Alzheimers with those having vascular dementia and found that those with Alzheimers had more trouble swallowing fluids, while those with vascular dementia struggled more with swallowing food. Also important is the finding that those with frontotemporal dementia has links to behaviour which affects the food relationship. Some individuals may eat compulsively, eat only sweets or will eat very quickly, shoving food into their mouths until they choke. Knowing these facts are important in discussions regarding how to proceed with caring for these different aspects of the diseases.
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Mouth Care For People With Dementia
The content below is reflective of our leaflet.
Maintaining good oral health is essential to the overall well-being of people living with dementia. Daily care can help stop problems like painful cavities and infections before they arise, and helps avoid pain when eating, drinking and communicating.
People living with dementia have a high rate of tooth decay and gum disease. This may be because as dementia progresses, they may find it difficult to perform their normal daily activities and require some support to keep up with their oral hygiene routine. Others may not be able to express that they have a toothache and leave problems untreated. Its important that people living with dementia receive the help they need to keep their teeth and gums clean and free of debris so that they can maintain their self-esteem and avoid pain and infections.
Stage : Age Associated Memory Impairment
This stage features occasional lapses of memory most frequently seen in:
- Forgetting where one has placed an object
- Forgetting names that were once very familiar
Oftentimes, this mild decline in memory is merely normal age-related cognitive decline, but it can also be one of the earliest signs of degenerative dementia. At this stage, signs are still virtually undetectable through clinical testing. Concern for early onset of dementia should arise with respect to other symptoms.
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Encouraging Oral Care If Someone Is Reluctant
A change in a care routine or the prospect of treatment may make some people feel confused or uncomfortable. Try to help this by:
- Giving the person short, clear instructions
- Demonstrating what to do, and gently guiding the person to take care of their mouth and teeth in stages
- Clearly and simply explaining what you are about to do, gesturing with a toothbrush and toothpaste if you are brushing the persons teeth
- Observing the person for signs of discomfort. The person may hold their face, grimace, struggle with ill-fitting dentures, have loose teeth, frequent bleeding or sensitivity to hot and cold food and drink. If you notice any of these signs, consult a dentist as soon as possible
What You Can Do About Medications And Difficult Dementia Behaviors
If your relative with dementia is not yet taking medications for behaviors, consider these tips:
- Start keeping a journal and learn to identify triggers of difficult behaviors. You will need to observe the person carefully. Your journaling will come in handy later if you start medications, as this will help you monitor for benefit and side-effects.
- Learn to redirect and de-escalate difficult dementia behaviors. Contact your local Alzheimers Association chapter or local Area Agency on Aging to find support near you. You can also learn a good approach in this article: 7 Steps to Managing Difficult Dementia Behaviors
- Ask your doctor to help assess for pain and/or constipation. Consider a trial of scheduled acetaminophen, and see if this helps.
- Consider the possibility of depression. Consider a trial of escitalopram or a related antidepressant, but realize any effect will take weeks to appear.
- For all medications for dementia behaviors:
- Monitor carefully for evidence of improvement and for signs of side-effects.
- Doses should be increased a little bit at a time.
- Especially for antipsychotics, the goal is to find the minimum necessary dose to keep behavior manageable.
If your relative with dementia is currently taking medications for behaviors, then you will have to consider at least the following two issues.
The other issue is to make sure you are aware of any risks or side-effects that the current medications may be causing.
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Remedies For Treating Excessive Salivation
The general ayurvedic rule for treating excess saliva is based on the dominance of KAPHA element in the body. In most of the cases, the problem occurs in the morning and during cold weather as compared to other times of day and warmer weather. Therefore, we require such remedies, which produce some heat in the body and removes excess saliva & KAPHA element from the body. Here are some natural home remedies for stopping excessive salivation.
Things For Carers To Think About Around Medication:
- Are there some situations where the person is more comfortable taking the medication, and others less so eg, in a particular setting or with the help of a particular person?
- Can you tell from the persons reaction that they dislike the taste, or that the drugs cause unpleasant side effects?
- Does the person have capacity to refuse to take their medication?
- Have you asked the GP about alternative forms of the medication?
- If you are tempted to try hiding medication in food, have you had this approved by a qualified medical professional first?
What Can Caregivers Do To Improve And Encourage Better Eating And Drinking Habits In Persons With Alzheimers Disease
Each person may be helped with different tactics, depending on the main reason they are not maintaining good nutrition. Here are some tips.
For loss of appetite:
- Offer a variety of different colored foods with pleasant aromas.
- Offer smaller portions, but more frequent foods, drinks, and snacks.
- Try a wide selection of different foods .
- Use herbs and spices, sauces, gravies, or broths to add flavor to foods.
- Serve food warm to keep its appeal.
- Ask the doctor about liquid diet supplements or medication to stimulate appetite.
For difficulty chewing or swallowing:
- Talk to a speech and language therapist if the person is having difficulty swallowing, as the individual may benefit from a swallowing evaluation. Also talk with a dietitian for tips to make sure that the person is getting enough nutrition.
- Offer soft, moist foods, such as scrambled eggs, oatmeal, yogurt, cottage cheese, mashed potatoes, applesauce, soups, baked fish, juices, milkshakes and smoothies.
- For other food types, grind the food or cut into small, bite-sized pieces.
- Make sure the person is sitting up straight, with head leaning slightly forward.
- Check the persons mouth after each meal to make sure all food has been swallowed.
- Learn the Heimlich maneuver in case choking leads to the persons airway becoming blocked. Call 911 for assistance if choking occurs.
For difficulty using hands to hold utensils and cups:
For the person who is agitated, angry or irritable:
For people who have vision problems:
Is Your Loved One Scratching All The Time
Many patients with Alzheimers disease can scratch at themselves until they are bloody. Sometimes it is an obsessive/compulsive behavior that is hard to stop. But many times, the scratching is caused by something in the environment. Below are some tips to consider to solve this problem:
To soothe her itching, use ointments to keep the scabs soft. Hard scabs encourage yet more scratching. Some Alzheimers patients will leave alone bandaids, so try covering scabs with them.
Keep in mind that many older people have fragile skin. You may not want to give her a bath every day, as this can dry the skin. Consider switching her to a quick shower, rather than a long bath . Dont bathe her more than three times per week. Also, keep her skin moisturized with non-allergenic lotion after every shower.
If problems persist, consider getting an appointment with a dermatologist.
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