Every patient is different. So, it is hard to predict how long the final stage of dementia will last. Most patients may survive for one to three years.
- Presence of serious illnesses. If the person has other conditions that decrease the lifespan, such as cancer or heart failure, it will be easier to predict.
- Death from other conditions. The affected person may die from a condition other than dementia.
- Worsening of condition. A person in the final stages of dementia may get worse slowly over many months. Adequate care related to nutrition, bowel and bladder care, and prevention of infections can help prolong their life.
What happens during the final stage of dementia?
The final stage of dementia is also called the end stage of dementia or the stage of very severe cognitive decline.
This stage affects the person in the following ways:
- Complete dependence on others to carry even basic activities, such as eating, drinking, walking, and sitting
- Loss of bladder and bowel control
- Loss of memory such as failing to remember the names of loved ones and mistaking one person for another
- The setting of severe confusion and anxiety
- Speech limited to single words or phrases and not complete sentences with no sense
- Having a limited understanding of what other people say to them
- Increased vulnerability to infections, especially pneumonia
The speed of progression through the stages of dementia differs amongst patients. Not all patients will experience the same problems at each stage.
How is dementia treated?
Treatment of dementia depends on its cause, such as:
- Dementia that has developed due to vitamin deficiency is reversible and can be treated with vitamin supplements.
- Other causes of dementia, such as depression, can be treated with medications and psychotherapy.
- Another cause, hypothyroidism (underactive thyroid), can be treated with synthetic thyroxine tablets.
No treatment can halt the progression of progressive dementia, such as Alzheimer’s. However, some medications may help improve the symptoms, such as memory loss and confusion, temporarily, including:
Some of the nondrug approaches adopted by family members and caregivers help improve the quality of life of patients with dementia, which include:
- Monitoring the patient’s comfort
- Being gentle in arguing or explaining certain facts
- Learning to cope with the patient’s agitation
- Diverting the patient’s attention
- Creating a calm atmosphere
- Creating a safe and secure environment (such as installing safety switches throughout the home)
- Helping the patient join a dementia support group
What should be your role as a caregiver in the end-stage of dementia?
During the final stage of dementia, the affected individual becomes completely dependent on the people around them to carry out basic activities.
If a person is a caregiver, they need to take care of the patient regarding certain important aspects, including:
The appetite of the affected individual may decrease in the final stages of dementia due to the inability to stay physically active. They may forget to eat food or drink fluids.
To help ensure that the person in the final stage of dementia receives adequate nutrition, try the following tips:
- Make sure the person is in an upright position: To aid swallowing and digestion, do not let the patient lie down immediately. Keep them upright for at least 30 minutes after they have finished eating.
- Make modifications in the consistency of food: Choose soft foods that can be chewed and swallowed easily. The patient may have difficulty swallowing liquids, such as water, milk, juice, and soup. Think of ways to thicken them, such as adding cornstarch or unflavored gelatin, or feeding them pudding or ice cream.
- Encourage self-feeding or assist the person with feeding: Put food on their spoon and give cues to help them bring food toward their mouth. Alternate small bites with fluids. The patient may need to be reminded to chew or swallow food properly before moving to the next bite.
- Monitor weight: Visit the doctor to have weight loss evaluated and find out if it is due to other illnesses or medications. The doctor may add supplements to help such patients deal with their weight loss.
Bowel and bladder function
The patient may eventually lose control of bladder and bowel function in the final stage of dementia.
To maintain bowel and bladder function, try the following tips:
- Set a toileting schedule: Note down the timings of the patient’s bladder and bowel emptying times and the type and amount of foods consumed during each day. This can help track their natural routine and plan their schedule.
- Limit liquids before bedtime: Adequate hydration is necessary but makes sure the patient does not drink anything two hours before bedtime. This may limit the number of times the patient pees at night. Adult disposable briefs and bed pads can help them at night.
- Treat constipation: If the patient goes without a bowel movement for three consecutive days, they may be constipated. Check if they get regular bowel movements by adding natural laxatives to their diets, such as prunes or fiber-rich foods. If this does not work, consult with their doctor.
Skin and bone health
A patient with end-stage Alzheimer’s disease can eventually become bedridden or chair-bound. This can result in skin breakdown, pressure sores, and freezing of joints (limb contractures).
To keep the skin healthy and bones functioning, try the following tips:
- Relieve body pressure: Change the patient’s position at least every two hours to relieve pressure and improve blood circulation.
- Keep the skin clean and dry: Be gentle and avoid friction when cleaning the body of the patient. Wash with mild soap and pat dry. Check daily for skin problems, such as rashes or sores.
- Treat cuts and scrapes immediately: Clean cuts with soap and warm water and apply an antibiotic ointment. In case of deep injuries, get professional medical help.
- Protect bony areas and joints: Use soft cushions, such as pillows or pads, to protect elbows, heels, hips, and other bony areas. To prevent limb contractures, assist them with exercises that allow movement of the joints. These exercises include carefully moving the arms and legs two to three times a day. The doctor can guide more on these kinds of exercises.
Good oral hygiene reduces the risk of bacteria in the mouth that can lead to infections, including pneumonia. Brush the patient’s teeth every time after the patient eats. If the patient wears dentures, remove them and clean them every night.
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Montine TJ. Dementia Pathology. Medscape. https://emedicine.medscape.com/article/2003174-overview
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