How do you know that a person is the last stages of Alzheimer's?
When a person with dementia reaches the advanced stage of Alzheimer’s disease, he or she usually displays the following physical and cognitive signs:
- Unable to walk even with assistance
- Requires total care with bathing, dressing, and grooming
- Verbal skills are limited; the person may just be able to say a few words but is unable to have meaningful communication
- May not recognize familiar faces
- Incontinent of bowel and bladder
- Poor appetite, needs cueing at meals or needs to be fed
It's important to remember that each person is an individual and may not experience all of these symptoms. These are the most frequent signs that a person is in the last or advanced stage of a dementing illness.
I don't notice the changes as much as people that don't see my mother everyday. I'm with my mother 24/7 and she has lived with me for the past 5 years. I know she has gotten worse. Today I looked at some pictures I had taken of her 3 years ago and I couldn't believe the difference not only in her weight loss but also in her facial expressions. I look at her now and it's like she has a certain stare that goes right through you. Her doctor said that she is in the late stage of alzheimers. She needs help with eating, bathing,grooming, and her incontinonce but she is probably healthier than I am. But she has needed all this help for the last 4 years. So to say she is in the last stage has me wondering also how doctors can catagorize what stage the patient is in. Do they really know or just guessing?
I think the stages are just guidelines for the medical staff to use and to give the family an idea of what might happen. In the last stage of Alzheimers I have found that the patient eats less and less. Their mouth starts to clamp down. Medication and nutrition starts to be a problem. They sometimes live on supplements such as Ensure. The question of a peg tube will be brought up as well as IV therapy for dehydration. Hopefully your love one has advanced directives. As they lose weight they become more unresponsive. Hospice many times will be called in to help the patient pass on with dignity and respect and give support to the family.
The official descriptions that the end is near are based on a collection of averages. Most discussed are how the average person with Alzheimer's will wind down. But each one is unique. Doctors often don't document what caused the actual death very often. They just put down what is expected. Usually things like low sodium, low potassium, congestive heart failure, kidney failure, systemic organ failure etc and add Alzheimer related to the report. So gathering reliable information is almost impossible. It depends on what type of care the person is getting. It depends on what areas of the brain are effected. The human body has an uncanny ability to fight death. I wish there was an easy answer I could give you. There isn't one.
Doctors know a lot less than they want you to know. Very few spend more that a few minutes with an Alzheimer's patient. All they see are little snapshots of the disease. They base their knowledge on poorly sourced information. Hearsay from other doctors and most have little time or dedicate little time to keep up with cutting edge research. Most seldom or never read medical journal publications to keep up on the latest findings. Often when they tell you something new they heard it from another patient telling them what they discovered. Doctors are also protective of what they know and often don't share amongst themselves. This is true of other diseases also.
As the disease progresses most or all memory related abilities degrade and they become totally reliable on someone to do everything for them. They may constantly stare. This may not indicate anything. They sort of trance out. Almost like a day dream state but deeper. They may not respond to talking or normal noises. You can look right in their eyes and be a foot or two in front of their face. You can talk to them and they seem not to respond. They often drift in and out of this trance like state. They may also come out of it if there is an unusual sound. I found that my mother, would at times, not respond if I talked to her. But if I snapped my fingers she would come out of it. As if she was somewhere else or was sleeping with her eyes open. At times it seemed like a young child when they sit in front of a television and get so involved with what they are watching they enter a trance like state. My friends father didn't respond to sound like the finger snapping. But wave your hand quickly about a foot in front of his face and he would snap out of it. I would often wonder if they were having an out of body experience.
Eating and drinking will most likely become a problem. Being able to take any kind of pill may be impossible. My mother could eat but she had false teeth and it was a daily game to get her to let me take them out to clean them. When it came time to replace them it usually took several attempts. She just didn't understand. so I would try for a second and if I didn't get them in I would just try again 10 or 15 minute later. No arguing or fussing just accept the fact and try later. No big deal.
Occasionally she would forget how or just not want to chew. That's when I would use a juicer and organic fruits and vegetables. Sometimes she liked it but I couldn't get her to drink from a glass. So I got some of those large plastic eyedropper like things they use to give kids a dose of medicine and I would give her fresh juice.
As long as the person is getting sufficient liquids and nutrition the need for feeding tubes and IV's can be put off. They may sound like a good solution but they come with there own set of problems. Like trading one evil for another. Many times a feeding or drinking problem, like the disease itself occurs in cycles. It is easy to say put the tubes in but if you do there is a much greater chance that regular drinking or eating will not resume.
If or I should say as the parts of the brain that control the proper function of the body are effected things can start to decline. Sight may be effected to the degree of blindness. Any or all of the bodily functions or organs may not work well. Urine may concentrate and become strongly colored and have a strong smell. As these things stop working as well as they should energy levels usually decline. The person may hallucinate and see things that you can not see. They may become unconscious. Breathing may be shallow or a struggle. The lungs may start to sound like there is fluid starting to collect in them. Blood pressure often starts to lower and as it does the heart may try to pump harder. Or heart rate may decline too. Even if they are put on a breathing machine they may be gasping for air. Some people are lucky and just drift away while others seem to struggle to hang on.
If a natural death is taking place the brain sends out chemical messengers that tell the organs to shut down. If the heart stops and electric shock is used to try and restart the heart it is thought these chemicals are neutralized. If this occurs the body can be often kept alive. The automatic functions like the heart beating and breathing may resume. Often a breathing machine will be hooked up and the person may be breathing above the rate the machine is set at.
That does not indicate life. It is most likely the person is not there. Families often keep the body alive for days or even weeks refusing to accept the person has died. Continuing to return to the hospital everyday and stretch out the ordeal. As the person is actually dead with the machines giving the appearance of life. Even when you are prepared for a death it can be hard to accept. Turning the machines off isn't easy. Everyone needs to deal with it in their own way and do what they feel is right. Whoever has to make the decision will remember it for life. I know I've had to do it for a few family members.
Advice for those of us who still have the ability to think and choose...NOW is when we need to write a statement to guide those who will be given the responsibility to choose for us in later years. Families feel obliged to prolong life as if that is what must be done above all else.
Not for me. With my family history I probably have 30 more years left but I have already written my living will, spelling out my personal instructions in the event of things like feeding tubes and IV drips for advanced alzheimers.
I would spare my family and care givers of the agony of making that choice. It is the natural and only end to life, to die.
Went thru their death part time caring for my mother and sister. My sister and mother had hospice at home and it was much better than with my father in a nursing home. The nursing home didn't call us when he was getting ready to go. They said it was a mistake which didn't help us much. They had all indicated what they wanted done for them and this makes it much easier for all the family.
I am glad someone asked this question. It has been on my mind alot. Especially since my dad has lost controll of both bladder and bowels. When I think back to how he was when he moved in with me I can see how much he has declined, but like the only daughter I don't see it on a daily basis. At first I felt guilty when he quit walking. As he got worse I thought I must be doing something wrong, luckily I came to realize that it is all part of the disease. The latest thing is he has lost controll of his bowels. I wondered at first if I could handle it, he has had some accidents in the past 2 years but now it is almost daily, at least every time he goes. Yesterday I had atalk with myself, I do that alot, and with God and decided this is just another stage and I will keep on giving till I can't give any more! Once I made that decision I felt better about myself. My Dad needs 24/7 care and I am it! Sometimes I feel overwhelmed and think I can't do this anymore, then I think , no there is a rainbow at the end of this storm too! I am not talking about his death, I am talking about the times when his good humor comes back to him and we have a good laugh together, these times will be cherished and it is a shame my 4 sisters are missing out. But thats their choice, do you hear resentment, well you should, I have lots of it, but keep it well hid! Just wanted to add my thoughts and say thanks to those that responded to coles question. Rellim
My father seems to be in the last stages of Alzheimers and seems to display most of the characteristics listed in the first response, by Joyce Simard. I wake up everyday expecting "the call". I hope that it comes sooner rather than later.
I am a health care provider, and in Florida. Of course, we have the oldest per capita areas of elderly, Pasco is 1 in 3 are over 65. I have watched with horror, the acceleration of death using drugs and with holding drugs (like blood pressure) from family members. Especially since the 401K evaporation of retirement from younger children. But I want to stress the difference between alzheimers and dementia. If I was asked the end stage of alzheimers, I would say inability to remember to swallow, incontinence, but maybe because of hypertension. Kidneys arent functioning, women especially are using more immodium and gas-x to control bowel movements. It ends up destroying good bacteria in their stomach. Alzheimer patients are a little better to manage than Dementia patients. And we will see more dementia symptoms, and here's why. Dementia patients can have very violent swings in behavior. Because, dementia patients remember, then forget. And when they "come back to you" in a lucid moment, they dont understand why their memory is fleeting. If your bruits are blocked, the arteries going to your brain from the heart, you will have memory problems. Believe it or not, smoking can cause dementia! and the "Age of Aquarius" people will be a quick drain on your children's finances, but wont live as long as their healthier parents. Some forms of dementia are reversable. We are 5 years away from a cheaper form of PET and SPECT "nuclear imaging" tests for the brain. The neurologists will know what part of your brain is not functioning, and maybe what type and specific dosage to give you. Read Alzheimer book by Dr's- Daniel Amen and Shankle.
Im concerned about Rellim. Please take good care of yourself ! I focused on the caregiving, forgot myself, and broke my own health. Try contacting your county aging services to see if they offer any help like care giver respite or bathing assistance. Also see if united way can provide helpful info. I found out too late. Please remember that youre important too. God bless you all.
