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What Are The End Stages Of Alzheimer’s

How Can Healthcare Professionals Help At This Stage

Dementia: End Stage of Life

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.

Making End Of Life Decisions

When individuals with Alzheimer’s disease approach the end of life, caregivers and their families must make difficult decisions regarding their care. Ultimately, any end-of-life decisions made on the individuals’ behalf should respect their values and wishes and maintain their comfort and dignity.

Honoring the Person’s WishesIndividuals with Alzheimer’s disease have the legal right to limit, withdraw, or refuse medical or life-sustaining treatments. These decisions are usually expressed through advance directives legal documents that indicate the type of medical care a person wants to receive once he or she can no longer make or express these decisions due to incapacity.

Two common forms of advance directives are a Health Care Proxy and a durable power of attorney.

Ideally, advance directive documents should have been completed while the person with Alzheimer’s still had the mental capacity to make decisions. If there are no advance directives in place, a family must be prepared to make decisions consistent with what they believe the person’s wishes would have been in combination with his or her best interests. Typically, residential care facilities and hospitals have ethics committees that can facilitate the decision-making process if there is a conflict between family members or with health care providers.

To help ensure care decisions are guided by your loved one’s advance directives, inform others about them and be active in all medical decision making.

How Long Does The Final Stage Of Dementia Last

We wish we could give you a firm answer. The final stages of dementia can last anywhere from a few weeks to a few years.

The intensive end-of-life care required to mitigate the symptoms of end-stage dementia, when provided by professional care staff, can allow caregivers space and emotional energy to spend quality time with your loved one.

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Getting Prepared For A Death

Care staff need to know the persons wishes for their death: where they would prefer to be when they die, who should be present, how pain might be treated, and so on. A persons spiritual and cultural needs are important throughout their life, but may take on a particular significance at the end of their life. We can only support a person nearing death properly if we know this information and have recorded it accurately so they have the best possible, and personalised, end-of-life care

Ensuring that a person is as physically comfortable as possible when they are dying also takes preparation. Is a hospital-style bed available, for example, if it is needed? Is a suitable mattress to hand? How can dignity best be maintained if all personal care is provided at a persons bedside? Does the persons room need to be altered in any way, for example fitting new lighting?

Relatives also need to be prepared. For family, having a good relationship with care staff may be a critical part of the lead-in to this dying phase. You also need to know family members wishes at this time. For example, do they want to be present for the death if possible?

Recognise And Meet Spiritual And Cultural Needs

Progression of Alzheimers Disease

Care providers also need to be attentive to meeting a persons spiritual or cultural needs at the end of life. For one person, this may involve making sure they have contact with a religious leader in the last days or hours of their life, while another may want their favourite composers music to be played quietly but continuously throughout the period. This information should be recorded clearly, and should not come as a surprise to care staff who will know the person their life history, preferences and nature well. You should also discuss these aspects with the persons family or friends.

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Late Stage Alzheimers: What To Expect

Alzheimers disease affects every aspect of personality and behavior. Patients become forgetful. They struggle to talk, lose control of their emotions, and neglect basic tasks. By the time they enter late stage Alzheimers, they will no longer be able to function on their own. Whereas before they retained some limited autonomy, now patients depend entirely on their family. Motor skills become fatally compromised, placing even greater demands on caregivers. While there will still be moments of happiness, families must be prepared for the hard choices they face in order to ensure their loved ones physical and emotional wellbeing.

How Can Carers Family And Close Friends Of Person At End Of Life Get Support

Most people find it difficult to come to terms with the person with dementia approaching the end of life. Many carers say theyve already started grieving while the person is alive and as the dementia has progressed. This may be because of the dementia progressing over a long period of time, and the changes that they are seeing in the person.

You should tell health and social care professionals about your own wishes, including the need to say goodbye to the person and whether you want to be with them at the end of their life, if this is possible. You may have your own spiritual and cultural needs and as a carer, its important that you are supported to express these and have them met.

Talk to hospital or community nurses or nursing home staff about how they can support you, including whether any spiritual or faith-based support is available. You may also find it helpful to turn to a religious leader or representative for support during this time, for example a rabbi, imam, priest or chaplain.

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Stage : Mild Cognitive Impairment

Persons at this stage manifest deficits which are subtle, but which are noted by persons who are closely associated with the person with mild cognitive impairment. The subtle deficits may become manifest in diverse ways. For example, a person with mild cognitive impairment may noticeably repeat queries. The capacity to perform executive functions also becomes compromised. Commonly, for persons who are still working in complex occupational settings, job performance may decline. For those required to master new job skills, such as a computer or other machinery, decrements in these capacities may become evident.

MCI persons who are not employed, but who plan complex social events, such as dinner parties, may manifest declines in their ability to organize such events. This may be an early stage of Alzheimers, however, it is important for the person to seek medical help as soon as possible, to determine if a broad variety of medical conditions may be causing or contributing to the persons difficulties. Blood tests and an MRI of the brain should be obtained to assist in determining if the individual has MCI due to Alzheimers and whether there are other causes or contributing conditions to the persons cognitive decline.

Some MCI persons may manifest concentration deficits. Many persons with these symptoms begin to experience anxiety, which may be overtly evident.

Stages Of Alzheimer’s Everyone Should Know

Journey Through Alzheimers: Late Stages

We’ve all been touched by memory loss, whether it affects us personally or someone we love. However, most people with memory loss do not have a specific diagnosis. The thing is, there is a lot we can do if we are empowered with information. I trained in both psychiatry and neurology because all aspects of how we experience memory loss are important. This includes feeling depressed or anxious, all the way to how we diagnose specifically what kind of memory loss we are experiencing, and what to do about it. In my experience, the more specific I can be with someone about what is going on with their memory, the better. Nobody likes feeling uncertain about something, and memory loss is scary. Once we are given specific information, we can act and do something about it. Autonomy and choice are central to being human. Therefore, it’s important to understand how Alzheimer’s affects the brain, what signs to look for, and what options one has to minimize the damage of the disease.Dr. Reza Hosseini Ghomi is a practicing neuropsychiatrist, focused on neurodegenerative disorders and is serving as Chief Medical Officer at BrainCheck.

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Stages Of Alzheimer Disease

The stages of Alzheimer disease usually follow a progressive pattern. But each person moves through the disease stages in his or her own way. Knowing these stages helps healthcare providers and family members make decisions about how to care for someone who has Alzheimer disease.

Preclinical stage. Changes in the brain begin years before a person shows any signs of the disease. This time period is called preclinical Alzheimer disease and it can last for years.

Mild, early stage. Symptoms at this stage include mild forgetfulness. This may seem like the mild forgetfulness that often comes with aging. But it may also include problems with concentration.

A person may still live independently at this stage, but may have problems:

  • Remembering a name

  • Staying organized

  • Managing money

The person may be aware of memory lapses and their friends, family or neighbors may also notice these difficulties.

Moderate, middle stage. This is typically the longest stage, usually lasting many years. At this stage, symptoms include:

  • Increasing trouble remembering events

  • Problems learning new things

  • Trouble with planning complicated events, like a dinner

  • Trouble remembering their own name, but not details about their own life, such as address and phone number

  • Problems with reading, writing, and working with numbers

As the disease progresses, the person may:

Physical changes may occur as well. Some people have sleep problems. Wandering away from home is often a concern.

Stage : Mild Dementia

At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:

  • Difficulty remembering things about one’s personal history
  • Disorientation
  • Difficulty recognizing faces and people

In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.

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How Can A Person In Pain At End Of Life Be Supported

Its important to look for possible causes of discomfort related to the persons situation or surroundings. For example:

  • are they hungry or thirsty?
  • are they too hot or too cold?
  • could they want to use the toilet?
  • is their environment calm and supportive?
  • could they be anxious or upset for other reasons?

Doctors treating pain may start with paracetamol, which often works well. If this doesnt relieve the pain then they may try stronger painkillers.

However, these tend to have side effects, such as disorientation, dizziness, drowsiness, slowed breathing or constipation particularly at higher doses. This is why doctors start with lower doses and then increase them as the person needs more pain relief.

Some people may take regular strong painkillers for conditions such as cancer. If they start to show signs of pain, the dose or type of their painkillers may need to be reviewed. The doctor may either increase the dose or switch the person to a different drug. Doctors will also try to treat any medical conditions that might be causing pain, such as constipation or infections.

There are sometimes ways to make a person comfortable that may also relieve their pain. These can include very gentle exercise, massage and warm packs placed over the area that hurts.

Changes In Mood And Emotions

End

Having a brain disease that changes your perception of the world around you often causes dramatic changes in mood and emotion.

Everyone is different, and everyone exhibits different symptoms, meaning there is no definitive list of what to expect however, were here to offer guidance about some of the most common end-stage dementia symptoms.

Patients who are experiencing dementia’s last stage symptoms may experience:

  • Anger and frustration

  • Mood disorders such as depression and anxiety

  • Self-awareness that their faculties are lessening

If you think you are experiencing any signs of dementia and live alone, now would be the time to discuss moving in with a loved one or into an assisted living facility that best suits your needs.

If you are reading this and have a loved one who is already in an assisted living facility, transitioning from assisted living to memory care may be the option that works best for all.

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Stage : Moderately Severe Dementia

When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:

  • Delusional behavior

Hospice Care Offered To Alzheimers Patients

Hospice care is intended for individuals with a life expectancy of six months or less, so patients with Alzheimers disease or other forms of advanced dementia must meet the criteria to qualify for care. It can be hard to assess when the end of life will occur since the disease progresses at different rates for each patient, so families should begin the conversation about hospice care with a doctor when the patient begins to enter the later stages of Alzheimers disease.

Families caring for a loved one with advanced dementia who has a life expectancy of six months or more may benefit from palliative care even if the person doesnt yet qualify for hospice services. Palliative care works in conjunction with treatment directed by a health care provider, so the patient can continue to treat Alzheimers or other concurrent diseases while receiving support services.

Respite care is another option for family members caring for an Alzheimers patient. This type of care is intended to give a short break to family caregivers. In some cases, coverage for hospice care, palliative care and respite care may be covered by Medicaid, Medicare or private insurance, so check with your provider to see if coverage is available.

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Challenges Of Caring For Dementia Patients At Home

As Alzheimers disease progresses into late-stage dementia, more hands-on care becomes required to help the patient maintain the best possible quality of life. Someone in the final stages of dementia may not understand whats happening, making it challenging for a family caregiver to provide support. Personality changes can cause family stress as the patient becomes unable to recognize familiar faces.

Feeding changes can cause weight loss or nutritional impairment in Alzheimers patients, and it can be difficult to get a family member with dementia to eat. The patient will experience difficulty swallowing but will not be able to communicate the difficulties, resulting in pocketing food, coughing, choking or aspiration.

Patients with a co-occurring condition, such as cardiovascular disease, COPD, diabetes or renal failure, may present even more challenges for caregivers. Your hospice care team can coordinate with your loved ones regular health care provider to find strategies to alleviate symptoms of these illnesses in addition to dementia symptoms.

Mild Alzheimers Or Moderate Decline

Later stage dementia: Bruce and Jan’s story

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 such as withdrawal and denial are more evident. Decreased emotional response is also frequent, especially in challenging situations.

New symptoms 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 there will often have been 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 such as writing checks, ordering food, and buying groceries.

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How Might I Feel When The Person Is Nearing The End Of Their Life

Knowing when someone will die is unpredictable. When the time comes, your experience and feelings will be unique to you. It may feel very intense, quiet or overwhelming.

Caring for someone at the end of their life can be a rewarding experience and a time of great closeness. Carers who have supported the person through dying and death often value this as an important memory.

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 is not 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 cannot 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.

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What To Do About Incontinence

Incontinence means a person can’t control his or her bladder and/or bowels. This may happen at any stage of Alzheimer’s disease, but it is more often a problem in the later stages. Signs of this problem are leaking urine, problems emptying the bladder, and soiled underwear and bed sheets. Be sure to let the doctor know if this happens. He or she may be able to treat the cause of the problem.

Accidents happen. Try to be understanding when they occur. Stay calm and reassure the person if he or she is upset. Incontinence supplies, such as adult disposable briefs or underwear, bed protectors, and waterproof mattress covers, may be helpful. Learn more about dealing with incontinence.

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