The late stage of the disease can last from a few weeks to several years. During this period, the patients require intensive, 24-hour assistance.
Dementia symptoms become severe in the final stage of Alzheimer’s. Individuals lose the ability to respond to their surroundings, converse, and, eventually, control movement. They can still pronounce words or sentences, but expressing their feelings and pain becomes difficult. As memory and cognitive skills deteriorate, substantial personality changes may occur, necessitating extensive care.
What to expect
Alzheimer’s is a progressive disorder spanning several stages. The journey to the late stage of Alzheimer’s is part of the disease’s general progression, which can be a protracted process that can take years. The demands of Alzheimer’s patients vary and deepen as the disease advances.
Late-stage Alzheimer’s patients typically:
- Face difficulty eating and swallowing
- Requires assistance when walking and eventually becomes unable to do so
- Demands full-time assistance with personal care
- Is susceptible to illnesses, including pneumonia
- Is incapable of verbal communication
Maintaining the person’s quality of life and sense of self-worth is crucial. Always treat them with respect and kindness.
Skin and body health
A person with late-stage Alzheimer’s disease may become confined to a chair or bed. The inability to move around might result in skin damage, pressure ulcers, and the “freezing” of joints.
The following tips can help you keep your patient’s skin and body healthy:
- Relieve body pressure and enhance circulation by switching the patient’s positions at least every two hours. Maintain alignment of the body and make the person comfortable. Support their arms and legs by using pillows.
- Learn how to lift the individual. Consult a medical expert to know how to lift and turn the Alzheimer’s patient correctly to prevent injury.
- Keep skin dry and clean. When cleaning, use soft motion and avoid friction because the skin can easily tear or bruise. Use a mild soap to wash, then blot dry. Check for breakouts, blisters, or rashes every day.
- Utilize pillows or pads for protecting bony areas like elbows, hips, and heels. Apply moisturizer softly over bony areas; avoid massaging the lotion into these areas.
Maintain joint mobility. Being confined to a chair or bed can cause “freezing” of the joints (limb contractures). When a person’s skin and muscles are warm (like right after bathing), it can sometimes be beneficial to undertake range-of-motion exercises like slowly and carefully moving the arms and legs two to three times per day. Be mindful that not everyone should perform range-of-motion activities. Talk to your doctor if you are unsure whether they could be helpful.
Bowel and bladder function
Incontinence can occur in a person with late-stage Alzheimer’s disease for several reasons, including a urinary tract infection or fecal impaction. To rule out any medical issues, visit the doctor first.
The following tips can help you maintain the bowel and bladder function of your late-stage Alzheimer’s patient:
- Make a toileting schedule. Keep a written log of the person’s eating and drinking schedule and when and how much they use the bathroom. With their natural routine in mind, you can build a plan using this information. Use a bedside commode if the person is unable to use the bathroom.
- Restrict liquids before going to bed. Limit fluids two hours before bedtime, but ensure drinking plenty of water during the day.
- Utilize incontinence products. The nighttime use of bed pads and adult briefs can help support the daytime toileting routine.
- Keep track of bowel motions. The patient does not necessarily need to go to the bathroom every day, but if three days go by without a bowel movement, they may be constipated. Natural laxatives like prunes or foods high in fiber, such as bran or whole-grain bread, may be helpful in such situations.
Foods and fluids
Everyone must consume wholesome foods and get enough liquids to stay healthy. However, a person with late-stage Alzheimer’s may experience difficulty swallowing, which could result in food or fluid entering the airway or lungs. Pneumonia may result from this.
To help your patient eat and drink safely:
- Create a peaceful atmosphere for eating. Serve food away from the TV and other enticing distractions. Use a simple place setting if the person can eat at the table.
- Give plenty of time for eating. Allow one hour for a meal at least. Do not rush or pressure the patient to eat. Eating smaller meals or snacks throughout the day might be more effective than three larger meals.
- Ensure that the patient is in a relaxed and upright position. Keep them upright for about half an hour after eating to aid digestion.
- Adapt foods. Consult your doctor to select foods that are easy to chew and safe to swallow.
- Promote self-feeding. A person may occasionally require cues to begin. Start by loading food onto a spoon, gently placing their hand on it, and guiding it to their mouth.
- Assist the patient with feeding, if necessary. Alternate between small bites and fluids. Before continuing, ensure they have swallowed everything. You may need to remind the patient to chew or swallow.
- Encourage fluid intake. The person may not always be aware that they feel thirsty. If they have difficulty swallowing water, try fruit juice, gelatin, sherbet, or soup.
- Make the fluids easier to swallow. A person with dementia has a higher risk of choking due to swallowing issues. Add cornstarch, unflavored gelatin, or food thickeners (found at pharmacies and health supply stores) to liquids, such as water, juice, milk, broth, and soup, to make them thicker.
- Know what to do in case the patient chokes. Swallowing difficulties might result in coughing and choking. Prepare for an emergency by learning how to do the Heimlich maneuver.
- Observe your patient’s weight. Weight loss at the end of life is typical, but it might also indicate malnutrition, a different condition, or pharmaceutical adverse effects. Visit a doctor to get your patient’s weight loss assessed.
Infections and pneumonia
A person with late-stage Alzheimer’s disease may be more susceptible to infections due to decreased mobility.
The following tips can help prevent infections:
- Maintain good oral hygiene. Good oral hygiene decreases the risk of bacteria in the mouth that can cause pneumonia. Brush your patient’s teeth after every meal. If they wear dentures, take them out and clean them every night. Clean the tongue, gums, and other sensitive mouth tissues using a gentle toothbrush or damp gauze pad.
- Treat wounds and scrapes right away. Apply antibiotic ointment to cuts after cleaning them with warm soapy water. Seek professional medical attention if the injury is deep.
- Prevent flu and pneumonia. The flu (influenza) can cause pneumonia. It is critical for both the individual and the caregiver to obtain flu vaccines every year to help lower the risk. There is also a vaccine available to protect against pneumococcal pneumonia. (Normally, only one dose is required, but in some circumstances, a second dose may be administered five or more years following the first dose.)
Pain and illness
The person with late-stage Alzheimer’s has increased difficulty communicating pain. If you suspect pain or illness, seek medical attention as quickly as possible to determine the source. The doctor may recommend pain medication in some instances.
To identify pain and illness:
- Look for physical indicators of pain, including pale skin tone, flushed skin tone, feverish skin, mouth sores, pale and dry gums, vomiting, or swelling of any part of the body. These physical symptoms may be indicative of illness.
- Take note of nonverbal cues. Gestures, spoken words, and facial expressions (such as wincing) can all indicate discomfort or pain.
- Keep an eye out for behavioral changes. Agitation, anxiety, yelling, and sleeping difficulties can all indicate pain.
Residential and hospice care
Late-stage Alzheimer’s patients frequently need round-the-clock assistance. A lone caregiver may find it very challenging to provide such continuous care. The best course of action might be to transfer the person to residential care.
Hospice care is another choice. Hospice upholds a core philosophy that prioritizes quality and dignity by offering consolation, care, and support services to terminally ill people and their families.
For a person with Alzheimer’s to be eligible for hospice services under Medicare, a doctor must diagnose that they have less than six months to live.
End-of-life decisions
The best time to discuss end-of-life care preferences is when the dementia patient is still mentally capable of making decisions.
Alzheimer’s patients have the legal right to restrict or refuse medical or life-sustaining care. These include mechanical ventilators, antibiotics, cardiopulmonary resuscitation, and artificial nutrition and hydration. Advance directives can help express these wishes.
Family members should not mistakenly think that refusing or stopping treatment, particularly for life-threatening illnesses (infections, bleeding, heart attacks, etc.), equates to euthanasia or assisted suicide. In truth, someone receiving severe medical care who is in a new setting and does not comprehend the motives of the care providers may see it as torture.
More information
- Late-Stage Care (12 pages)
- End-of Life Decisions (15 pages)
- Medicare Hospice Benefit (2 pages)
- Hospice Foundation of America
This site offers information on how to locate a hospice, questions to ask when selecting a hospice, and resources related to hospice care and grief. - National Hospice Foundation
This organization’s site offers guidance in finding and selecting a hospice program. Medicare benefit information related to hospice services is also available. - National Hospice and Palliative Care Organization
This site offers a variety of free resources on topics such as advance care planning, hospice and palliative care, and grief and loss.
