How Dementia Affects Communication
As Alzheimers disease and other related dementias destroy brain cells, a significant symptom, known as aphasia, is losing the ability to speak and to understand speech. Aphasia worsens as the disease progresses. It becomes harder to remember the right words and process what others are saying. Difficulty speaking is one of the first noticeable symptoms in people with dementia, particularly those with Fronto Temporal dementia.
Dementia takes years to advance over stages, the symptoms worsening in each subsequent stage. In early stages, someone can carry on normal conversations but will simply forget a word or use the wrong words. Resuming a conversation after an interruption becomes difficult. These communication hiccups happen all the time to most people, but dementia affects the brain so that language problems become more noticeable. Someone with Alzheimers, for instance, wont remember phrases, or be able to learn new phrases. Slang and common expressions become hard or even impossible to remember. Someone with dementia may start confusing the meaning of words, like saying I want worms for dinner instead of asking for a favorite meal, or calling a computer the picture. It is also more difficult for people with dementia to hold multiple ideas in their heads at once, so they may jump from topic to topic without completing a coherent sentence.
Inappropriate Behavior And Loss Of Empathy
If someone who is usually sweet, considerate, and polite starts to say insulting or inappropriate things and shows no awareness of their inappropriateness or concern or regret about what theyve said they could be exhibiting an early sign of dementia. In the early stages of some types of dementia, symptoms can include losing the ability to read social cues and, therefore, the ability to understand why its not acceptable to say hurtful things.
Repetition In Alzheimer’s Patients
Alzheimer’s caregivers can feel like they are losing their own minds to dementia, as they must keep answering the same questions repeatedly. But patients who repeat themselves just want to be reassured, Rubinstein explains. One way to cut down on anxious questioning is to be strategic about discussing schedules. Don’t announce plans days or weeks in advance. Instead, just arrange the details and tell your loved one on the morning of a medical appointment or other event. Apologize if necessary for the “short notice.”
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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.
How You Can Help
- It is important to note that people with dementia can have problems with walking that are not associated with dementia. Exhaustion and pain can limit how far a person can walk. Sometimes that pain can reflect an unattended problem in foot care or muscle fatigue.
- The person you care for may also require a mobility aid, such as a walking cane or a wheelchair in order to feel secure. Sometimes just being physically present can provide your loved one with the confidence and security to walk.
- Consider a physiotherapist: They can help with anything from exercises to strengthen muscles to walking aids.
It is not easy to care for someone with mobility constraints! Unfortunately, this issue is usually compounded with others, including constipation, blood clots, and pressure sores.
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When The Care Home Nurses Led Her To The Piano She Stared At It Blankly Put Her Hands On The Keys And Stopped And Then Stared Off Into Space Disinterested In The Thing That Had Given Her So Much Joy Her Whole Life
They say the disease takes a big downward step and then stabilizes, but that those periods of stability get shorter and shorter. That was the case in February. When we would come visit, her face would light up Hi, Poepie, she would say to me, even when she had lost all her other words. But one day in late February, my sister found her sitting alone in her room, staring vacantly and unresponsive. Nothing my sister did elicited a response. It was the first wakeup call of many for us. The next day, it was back to normal. My mother was her oldalbeit post-Alzheimersself, smiling and responding with yes, no, nods and shakes of the head.
Dental Skin And Foot Problems
Dental, skin, and foot problems may take place in early and moderate stages of Alzheimer’s disease, but most often happen during late-stage Alzheimer’s disease.
Dental problems. As Alzheimer’s disease symptoms worsen, people will need help taking care of their teeth or dentures. Brushing and flossing help to maintain oral health and reduce bacteria in the mouth, which may decrease the risk of pneumonia.
Make sure the person’s teeth and teeth surfaces are gently brushed at least twice a day with fluoride toothpaste. The last brushing session should take place after the evening meal or after any medication is given at night. You may find that using a child’s size toothbrush is easier for the person.It is also best to floss once per day, if possible. If this is distressing to the person, an interdental brush, which is a small brush designed to clean between the teeth. Try to check the person’s mouth for any problems such as:
- Food “pocketed” in the cheek or on the roof of the mouth
Be sure to take the person for regular dental checkups for as long as possible. Some people need medicine to calm them before they can see the dentist. Calling the dentist beforehand to discuss potential sensitivities may also be helpful.
Skin problems. Once the person stops walking or stays in one position too long, he or she may get skin or pressure sores. To prevent them, you can:
To check for pressure sores:
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Pneumonia Fever Eating Problems Common
Pneumonia, fever, and an eating problem were the most common complications in the final months of life, and 41% of patients had at least one aggressive treatment including hospitalization, a visit to the ER, intravenous treatment, or a feeding tube.
âThere is a lack of recognition that dementia is a terminal illness and this has a big impact on the quality of care patients receive,â Mitchell says. âWe found that a high percentage of patients had distressing symptoms toward the end of life.â
More than 5 million Americans suffer from Alzheimerâs dementia, and this figure is expected to triple over the next four decades as baby boomers reach old age. Alzheimerâs is the most common cause of dementia.
In the late stages of the disease, patients are often bedridden and can no longer communicate their needs, recognize close family members, or perform basic functions like feeding themselves and going to the bathroom.
In an editorial published with the study, geriatrician and dementia researcher Greg A. Sachs, MD, of the Indiana University Center for Aging Research, recalls his maternal grandmotherâs struggle with advanced Alzheimerâs disease.
Her final months in a nursing home included repeated courses of antibiotics for infections and restraints to control her agitation. Her condition so distressed Sachsâ mother that she stopped taking her children when she visited.
When The Person With Alzheimers Can’t Move
During the later stages of Alzheimers disease, a person may lose the ability to move and spend much of his or her time in a bed or chair. This lack of movement can cause problems such as pressure sores or bedsores, and stiffness of the arms, hands, and legs.
If the person with Alzheimers cannot move around on his or her own, contact a home health aide, physical therapist, or nurse for help. These professionals can show you how to move the person safely, such as changing positions in bed or in a chair.
A physical therapist can also show you how to move the person’s body joints using range-of-motion exercises. During these exercises, you hold the person’s arms or legs, one at a time, and move and bend it several times a day. Movement prevents stiffness of the arms, hands, and legs. It also prevents pressure sores or bedsores.
To make the person more comfortable:
To keep from hurting yourself when moving someone with Alzheimer’s disease:
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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.
A Person With Dementia Doesnt Always Fit Into One Stage
Dementia affects each person in a unique way and changes different parts of the brain at different points in the disease progression.
Plus, different types of dementia tend to have different symptoms.
For example, someone with frontotemporal dementia may first show extreme behavior and personality changes. But someone with Alzheimers disease would first experience short-term memory loss and struggle with everyday tasks.
Researchers and doctors still dont know enough about how these diseases work to predict exactly what will happen.
Another common occurrence is for someone in the middle stages of dementia to suddenly have a clear moment, hour, or day and seem like theyre back to their pre-dementia abilities. They could be sharp for a little while and later, go back to having obvious cognitive impairment.
When this happens, some families may feel like their older adult is faking their symptoms or just isnt trying hard enough.
Its important to know that this isnt true, its truly the dementia thats causing their declining abilities as well as those strange moments of clarity theyre truly not doing it on purpose.
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Which Skills Are Lost
This dependency on others is commonly interpreted as signifying that not only do people with advanced dementia have nothing to contribute to the social world, but that they have actually lost the desire to communicate and participate in social interactions. This stage of dementia has even been referred to as a social death .
These are serious claims and can lead to a damaging marginalisation of people with advanced dementia. Would we make similar claims about people who have difficulty in communicating due to learning disability, stroke or deafblindness? Would we make these claims about healthy babies who are yet to talk, walk or communicate in a way that we easily understand? The answer to these questions is undoubtedly no, but sadly this alienation of people with advanced dementia is commonplace in our society.
Signs Of Dying In The Elderly With Dementia
Dementia is a general term for a chronic or persistent decline in mental processes including memory loss, impaired reasoning, and personality changes. Alzheimers disease is the most common form of dementia, accounting for 60-80% of all cases of dementia. It is also the 6th leading cause of death in the United States, and over 5 million Americans are currently living with Alzheimers disease.
Alzheimers disease and most progressive dementias do not have a cure. While the disease inevitably worsens over time, that timeline can vary greatly from one patient to the next.
Caring for a loved one can be challenging and stressful, as the individuals personality changes and cognitive function declines. They may even stop recognizing their nearest and dearest friends and relatives. As dementia progresses, the individual will require more and more care. As a family caregiver, its important to be able to recognize the signs of dying in elderly with dementia. Hospice can help by offering care wherever the individual resides, providing physical, emotional and spiritual care to the patient and support their family.
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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.
Late Stage Alzheimers Care
The needs of Alzheimers patients change considerably during the final stages of the disease. Their physical and mental decline accelerates, leaving them dependent on their caregivers. Patients have to be monitored round the clock, with family members watching their own health to guard against burnout and exhaustion.
But regardless of the difficulties, there will still be bright and welcome moments. Even in late stage Alzheimers, it is possible to express your feelings and create happy memories to hold onto after the disease has reached its end.
Jose Escobar is the Hospice Executive for Parentis Health. He works with patients and families across Southern California, providing support and education, in order to alleviate the pain and suffering of chronic and terminal illness.
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What To Do About Swallowing Problems
As Alzheimer’s disease progresses to later stages, the person may no longer be able to chew and swallow easily. This is a serious problem. Difficulty with swallowing may lead to choking or cause food or liquid to go into the lungs, which is known as aspiration. This can cause pneumonia, which can lead to death.
The following suggestions may help with swallowing:
- Make sure to cut food into small pieces and that it is soft enough for the person to eat.
- Grind or blend food to make it easier to eat.
- Offer soft foods, such as yogurt, applesauce, mashed avocado, sweet potatoes, and bananas.
- Don’t use a straw, which may cause more swallowing problems. Instead, have the person drink small sips from a cup.
- Offer drinks of different temperatures warm, cold, and room temperatureto see which might be easiest for the person to drink.
- Don’t hurry the person. He or she needs time to chew and swallow each mouthful before taking another bite.
- Encourage the person to feed themselves as much as possible during meals. If the person needs support, try using overhand, underhand, or direct hand feeding approaches.
- Don’t feed a person who is drowsy or lying down. He or she should be in an upright, seated position during the meal and for at least 20 minutes after the meal.
- Say “swallow” to remind him or her to swallow.
- Find out if the person’s pills can be crushed or taken in another form.
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And then one day, the spell broke. She was hungry and thirsty, and drank and even ate and chewed, slowly, but with relish. And we gave her as much as we dared without causing her to choke. The doctor told us we would have many more months with her if she kept eating. It was a relief to hear this, and we had a few good daysso good that I planned to go back home, my sister made plans to head back to work, and my father planned to visit friends in France. We would keep in touch and be ready to come back as soon as things got worse again.
But worse came the following day. The doctor called saying my mother had developed a lung infection. She must have choked on something on one of the good days, some water, some food had entered her lungs and triggered a lung infection.
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Tips For Managing Dementia End
Because individuals with advanced dementia will often have difficulty communicating, it is important that caregivers keep a close eye on their loved one for signs of pain or discomfort. These signs may include moaning or yelling, restlessness or an inability to sleep, grimacing, or sweating. This may also signal that its time to call hospice or a palliative care team to help with the pain management.
If an individual with end-stage dementia is having trouble sitting up without assistance, hospice can provide a hospital bed or other equipment to lift their head.
Perhaps the hardest thing for families is when a loved one with dementia is no longer able to eat or swallow. Because an individual with dementia is unable to understand the benefits of feeding tubes or IV drips, they will often be incredibly distressed and attempt to remove them, causing added pain and risk of infection. Instead, focusing on keeping the individual comfortable. Supporting them with mouth care to prevent their mouth from becoming dry will allow them to make their final transition in peace.