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Late Stage Alzheimer's Disease
The working definition of those in the late stage of Alzheimer’s is "the individual in late stage dementia will lose the ability to respond to the environment, lose the ability to speak or swallow, lose the ability to control movement and carry out activities of daily living, will lose interest in eating and drinking, may experience weight loss and incontinence, difficulty breathing, and increased sleeping, confusion and restlessness."
The late stage of Alzheimer’s disease and related dementias may last from several weeks to several years. People should recognize that Alzheimer’s disease is a Terminal Illness, and planning for palliative care, hospice and advanced directives should be considered somewhere in the course of the disease. All too often, families wait too long to consider these important issues. Individuals should work with their families and professionals to develop advanced directives that state their wishes as well as selecting an individual who will honor their wishes. As the disease progresses, intensive around-the-clock assistance is usually required.
The late stage of Alzheimer’s may last anywhere from several weeks to several years. Intensive, around-the-clock assistance is usually required. Caring for the person with Alzheimer’s is most successful when the focus is on preserving quality of life and dignity and treating the person with compassion and respect.
Physical Challenges
- Difficulty swallowing food and liquids
Provide a quiet and calm environment, away from television and distractions. Allow plenty of time for the person to eat; several smaller meals or snacks throughout the day may be easier to manage than three bigger meals. Sitting in a comfortable upright position during and after a meal will ease digestion.
The person may not always realize that he or she is thirsty. Encourage fluid intake, substituting fruit juice, gelatin, sherbet, or thickened liquids if swallowing water is difficult. Foods that are soft or bite-sized may be easier to handle. Be prepared for the possibility of choking as swallowing becomes more difficult.
Encourage self-feeding by giving visual cues or gently using hand-over-hand prompting. If the person needs assistance, offer the food and drink slowly; you may have to remind the person to swallow.
- Maintaining skin integrity
Change the person’s position at least every two hours to relieve pressure. Protect bony areas with pillows and pads. Consult a health care professional about the proper technique to lift and turn the person. Wash the skin gently and blot dry using minimal force and friction.
Prevent contractures of the joints by maintaining the person’s range of motion. Carefully and slowly move his or her arms and legs two to three times a day. A physical therapist can demonstrate the proper technique for range of motion exercises.
- Maintaining bladder and bowel function
Set a toileting schedule. Eliminate caffeinated drinks, which stimulate urination. Provide adequate hydration during the day, but limit liquids at least two hours before bedtime. Use adult briefs and bed pads as needed.
- Decreasing the risk of infection
Pay careful attention to oral hygiene. Treat cuts and abrasions immediately. Make sure that both the person and his or her caregiver receive an annual flu vaccine. A pneumonia vaccine should also be administered every five years.
- Recognizing pain
People in this stage of the disease have difficulty communicating their pain. Caregivers must learn other ways of recognizing pain and illness. Signs to watch for include: a pale or flushed skin tone; dry, pale gums; mouth sores; vomiting; feverish skin; or swelling of any part of the body which can indicate illness. Pay particular attention to nonverbal signs and body language that may indicate discomfort. Be alert for changes in behavior (especially anxiety, agitation, shouting, and sleep disturbances) which can all indicate pain.
Staying Connected
When people with late-stage Alzheimer’s have lost most of their cognitive abilities, they experience the world through their senses. Although you may not be able to communicate with them verbally, there are many ways to show the person reassurance and love.
- Comfort by touch
- Comfort with your voice
What you say is not as important as how you say it. Speak gently and with affection. Your tone can help the person feel safe and relaxed.
Read a favorite story or poem. Even if the person does not understand the words, the tone and rhythm of your voice can be soothing. Play music, especially the type of music the person enjoyed when he or she was a young adult. Play videos with scenes of nature and soft, calming sounds.
- Stimulate the senses
The smell of a favorite flower, perfume, or food may bring back happy memories. Stroking a pet or soft fabric can be calming. Time spent outdoors may help relieve anxiety or depression.
- Reminisce and share
Fill a box with photographs and items that represent the person’s interests, favorite activities, and happy memories from the past. Use these to foster conversation when the person is able, and to help them feel connected to their loved ones.
The Role of Spirituality
For many people, their identity as a member of a faith community is a powerful component of their self-awareness. Tapping into the spiritual traditions which have been an important part of the person’s life can provide solace, continuity, and a sense of identity. Providing familiar rituals and symbols or reading familiar scripture passages can trigger preserved memories and connect with a person at a deeply emotional level when cognitive ability has been lost.
We CAN enhance his/her quality of life through soft music, soothing touch and massage and pleasant smells. This type of interaction will make a difference.
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