Who Can Diagnose Dementia
Visiting a primary care doctor is often the first step for people who are experiencing changes in thinking, movement, or behavior. However, neurologists doctors who specialize in disorders of the brain and nervous system are often consulted to diagnose dementia. Geriatric psychiatrists, neuropsychologists, and geriatricians may also be able to diagnose dementia. Your doctor can help you find a specialist.
If a specialist cannot be found in your community, contact the nearest medical school neurology department for a referral. A medical school hospital also may have a dementia clinic that provides expert evaluation. You can also visit the Alzheimers Disease Research Centers directory to see if there is an NIA-funded center near you. These centers can help with obtaining a diagnosis and medical management of conditions.
Social Worker And Chaplain:
- Help patients and families explore their feelings and relationships
- Participate in life review, including the search for meaning and contributions
- Conduct life closure, including forgiving and facing regrets, being able to say goodbye, and coming to terms with the acceptance of ongoing losses and death
Physical Changes At End Of Life
People in the final months of dementia will experience increased mental and physical deterioration and will need care for 24 hours per day. It is always best if care can be provided with a palliative care approach in the person’s home or long-term care home as transfers to a hospital may cause great distress for the person.
The progressive nature of dementia means symptoms will ultimately worsen over time. How quickly this occurs varies from person to person. In the final weeks before death, the person goes through changes as the body gradually shuts down. As they lose their capacity for recognizable speech, nonverbal communication through the senses of touch, smell, vision and hearing will become increasingly important.
Some of the physical changes which often occur in the later stages of dementia include:
- Profound memory loss and loss of ability to communicate with words
- Loss of mobility, inability to sit up
- Difficulty swallowing foods and liquids
- Poor blood circulation
- Impaired bladder and bowel function
- Prone to infection
Please note that some of the above changes may occur months/weeks prior to the end-of-life stage.
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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.
Increased Difficulty Controlling Pain
It is important to provide pain medications as prescribed by your loved ones health care team. Be sure to contact their doctor if the prescribed dosage does not seem effective or if side effects become troublesome. Alternative pain management methods, such as massage, music therapy and relaxation techniques, may be used in conjunction with pharmaceuticals to minimize anxiety and discomfort.
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How Can You Recognise When A Person Is Dying
Recognising when a person with advanced dementia is dying may not always be easy as they may have many general signs and symptoms of dying already. For example, some common signs and symptoms seen in people dying are:
- profound weakness
- needing assistance with all care
- disorientation to time or place
- agitated or restless
- difficulty concentrating.
People with advanced dementia may show some of these signs and symptoms for months or even years making it hard to tell if the person is approaching death. However, if these symptoms become much worse over a period of two to three weeks, or even days or hours, it is important that a doctor or nurse sees the person. If the doctor or nurse thinks that the person is deteriorating or nearing the end of life and it would be in the persons best interest to be cared for in their own home, a care home or hospice then discuss this information with the persons family. They should also be given an explanation of why the deterioration is happening and the care that is going to be given. When death is expected it is usally not of benefit for the purpose with dementia to be sent to hospital: the death is more likely to be traumatic, unsupported and complicated by other medical events .
When the dying process is established, the person may experience further changes:
- losing consciousness
- no longer able to swallow
- terminal restlessness
- changes to breathing pattern and circulation .
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
- 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.
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Cognition And Severity Of Dementia Before Dying
About half of the participants had very severe cognitive impairment. The mean BANS-S score was 19 .
Table 1 Baseline characteristics of the study population and course of mortality
The physicians also reported that no treatment was stopped or withheld to induce death.
Five participants had an indwelling urinary catheter and two received oxygen. All participants received mouth care, and 19 treatments for the prevention of pressure ulcers were conducted.
How Can I Communicate With A Person With Dementia At End Of Life
There are ways to keep communicating with a person with dementia at end of ilfe.
For example, the person may be able to show their needs or feelings using their body or facial expressions. They may still sense what is going on around them and be able to respond with basic gestures, such as smiling or hand squeezing. They may also become distressed if they hear harsh noises or commotion.
Tips for communicating with the person with dementia at the end of life Tips for communicating with the person with dementia at the end of life.
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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.
Link Between Clinical Signs Of Dying And Impending Death
A direct relationship exists between the number of clinical signs of dying and death:
- Persons with two clinical signs of dying had a 40% chance of dying
- Persons with eight clinical signs of dying had more than an 80% chance of dying
Therefore, the more clinical signs of death that are present necessitates a care plan update including necessary discipline visits.
The likelihood of death increases with the number of present end-of-life signs.
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Making Decisions About End Of Life Care Making Decisions About End Of Life Care
There will be important decisions to make as the person nears the end of life, including whether they should be resuscitated if they have a heart attack, and any religious practices they want observed. Advance care planning can help to ensure that a person’s wishes are known and respected.
Communication At End Of Life
In the later stages of dementia, the person is likely to have problems with communication.
They may have sight or hearing problems, and there may eventually come a time when the person can hardly communicate at all as they usually would. This can make it harder to know if they are uncomfortable or in pain, for example.
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What Are The Symptoms Of Dementia
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.
Changes In Muscle Function
Sudden, involuntary muscle movements called myoclonic jerks and the loss of reflexes in the legs and arms are additional signs that death is near. Myoclonus is not painful, but the abrupt onset of these uncontrollable muscle spasms can be distressing. Medication may be given to minimize jerking or twitching at the end of life and improve sleep quality.
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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.
Initial Causes Signs A Dementia Patient Is Dying
There are several different causes of memory loss. Some cause this condition in the young, while others may be more gradual. If you notice that your memory is weakening, its important to consult a medical professional. Whether the cause is mental illness, age, or a combination of factors, its important to seek treatment as soon as possible. People with extensive memory loss may have social difficulties and anxiety, which can lead to depression. They may be afraid they are letting their loved ones down, which can lead to anxiety and depression. Signs a Dementia Patient Is Dying
Fortunately, there are many causes of memory loss, and many of them are treatable. However, if you are experiencing serious memory problems, you may need medical treatment. If you have been undergoing any type of medication, you should consult with your doctor. Some people have other underlying conditions that may be causing their loss of memory. Alcohol abuse, sleep deprivation, or other mental health conditions can cause memory problems. You should seek out a medical professional if you suspect youre suffering from any of these conditions.
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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.
What Does Best Practice Look Like Introducing The Priorities For Care Of The Dying Person
There are five priorities:
- Recognise: The possibility that a person may die within the next few days or hours is recognised and communicated clearly, decisions made and actions taken in accordance with the persons needs and wishes, and these are regularly reviewed and decisions revised accordingly. Always consider reversible causes, for example, infection, dehydration, hypercalcaemia.
- Communicate: Sensitive communication takes place between staff and the dying person, and those identified as important to them.
- Involve: The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants.
- Support: The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible.
- Plan & Do: An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, coordinated and delivered with compassion.
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Importance Of Palliative Care
The overall goals of palliative and end-of-life care are to improve the quality of living and dying for people with dementia and their family. A palliative approach to care is not only beneficial at the end of life but often for months in advance. Palliative care can start much earlier and be provided at the same time as potentially curative treatments. A person may continue to receive any necessary medications. These include medications to manage chronic conditions such as diabetes or high blood pressure, as well as those that prevent pain and discomfort.
The Canadian Virtual Hospice defines palliative care as âan approach to care that focuses on comfort and quality of life for those affected by progressive, life threatening illness. The goal of palliative care is to control pain and other symptoms, support emotional, spiritual and cultural needs and maximize functioning.â In the past, a palliative care approach was most commonly offered to individuals in the final stages of dying from cancer. But there is now a consensus among experts that a palliative approach to care for people in advanced dementia is considered the best practice and that the care should be individualized to meet the needs, values and preferences of the person and their family.
âItâs important for staff to be informed about the âlittle thingsâ that will help keep the person comfortable.ââ Barbara Dylla, a former caregiver in Montreal.
What Happens In The Final Stage Of Dementia
In dementia, death may be sudden and unexpected or it may be slow and painful, showing a continual decline. The death will be expected if its accompanied by other health conditions such as an infection or serious malnutrition.
Bodily injury can also hasten death. A dementia patient who falls and breaks a hip could have limited days ahead.
In the very end stages, you may see profound weakness, reduced awareness of what is happening, disorientation, agitation, difficulty concentrating, or even the appearance they are speaking with someone from another world. Theres a progressive loss of memory.
Breathing changes to periods where its normal but then they stop breathing for a few seconds. There may be a faster breathing rate and there may be gaps in between breaths.
Accompanying these breathing changes may be pale and clammy skin. This may be because the circulation slows down the closer you get to death.
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