What to Expect in the Late Stages of Alzheimer's Disease

Some of the Brain Changes as Alzheimer's Progresses to the Late Stages
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In the earlier stages of Alzheimer's disease, the disease affects cognitive processes (e.g., thinking, memory, orientation, judgment) and behavior more than physical functioning. However, in late-stage Alzheimer's disease, the disease begins to considerably affect parts of the brain that control bodily systems, such as motor coordination, bowel, and bladder function, and even breathing. The late stage of Alzheimer's usually requires rigorous, around-the-clock care, and it can last from several weeks to several years.

Symptoms of Late-Stage Alzheimer's Disease

The symptoms of late-stage Alzheimer's disease often include:

  • Increased susceptibility to infections, including skin infections
  • Difficulty walking and moving, eventually resulting in the person becoming chair-bound or bed-bound
  • Loss of the ability to communicate through words
  • Groaning, grunting, moaning
  • Difficulty swallowing and eating
  • Weight loss
  • Total incontinence of bowel and bladder, requiring full-time assistance with toileting and hygiene
  • Increased sleeping
  • Eventual inability to sit up or hold up one's head
  • Loss of facial expressions, including the ability to smile
  • Seizures

Individuals with Alzheimer's disease often die of a medical complication, such as pneumonia or the flu. However, Alzheimer's itself can be fatal; even if there are no other complications, these late-stage symptoms can lead to death when patients can no longer be fed or breathe safely.

Coping With Late-State Alzheimer's Disease

You will need to decide whether you can manage your loved one's condition at home or whether their needs require them to be in a skilled care facility or hospice. You may be able to use home care services, palliative care, and home hospice care to provide needed equipment, assistance, therapy, and appropriate medications.

Also look into respite care so you are able to get help and some time to care for yourself.

These are some of the care needs that will need to be addressed:

  • Difficulty moving: A physical therapist can show you how to transfer the person safely, change his position in bed, and do range-of-motion exercises to prevent stiffness and pressure sores. You will also need to learn skills to keep from hurting yourself when you move your loved one. You may need equipment such as a transfer belt or a lift.
  • Comfort: Use wedge-shaped cushions and a special mattress that can help prevent pressure sores and move the person every two hours.
  • Feeding: Serve meals in a quiet environment. Finger foods and protein milkshakes are often good options. Encourage self-feeding, offering food and drink slowly and alternating bites of food with something to drink. Encourage fluids. You may have to thicken liquids as the person develops problems swallowing. Contact the doctor if there is significant weight loss.
  • Toileting: Set a toileting schedule. Limit liquids before bedtime and use disposable adult briefs and bed pads as a backup.
  • Preventing infections: Keep the person's mouth and teeth clean, including the gums and tongue. Treat any small cuts immediately and get medical help for any deep cuts. Check for pressure sores and get assistance. Be sure that all caregivers, as well as the person with Alzheimer's, get the flu vaccine each year and a pneumococcal vaccine every five years.
  • Keep the personal connection: Comfort your loved one with a gentle touch. Speak soothingly. Keep him stimulated with music, videos, looking out the window or going into the garden, reading to him, and reminiscing. Encourage interaction with others.

Sources:

Alzheimer's Association. Late-stage care: Providing care and comfort during the late stage of Alzheimer's disease. Chicago, IL: Author. 2017.

Coping With Late-Stage Alzheimer's Disease. National Institute on Aging. https://www.nia.nih.gov/health/coping-late-stage-alzheimers-disease.

What Are the Signs of Alzheimer's Disease? National Institute on Aging. https://www.nia.nih.gov/health/what-are-signs-alzheimers-disease.

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