The later stages of dementia can cause problems with communication, brought on by memory loss, personality changes and confusion. But help is available at this difficult time.

The Later Stages of Dementia

In the late stages of dementia your loved one will be dependent on others for all of their needs. With planning and care support you can help them maintain their comfort and their dignity.

It is a very difficult time for friends and family, with care required around the clock. But by understanding the challenges that lay head, you can plan, prepare and put the right support in place to help your loved one maintain their comfort and their dignity.

Communication and connection

As dementia progresses to the late stages, communication can be limited to single words or short phrases. Your loved one may be unable to talk and express their needs, so use their facial expression and body language to identify if they are in pain or distress.

Although the loved one you remember may seem to be disappearing, research suggests that a core of their being may still remain, so you can still enjoy moments of connection, however brief.

What can I do?

Chat to your loved one, as you always have, to maintain their sense of self and dignity. Sometimes, instead of just using words to communicate, you can stimulate their senses by playing music that they have always loved.

Massaging their hands gently with a favourite scented lotion can help. Reading excerpts from old letters or books or flicking through family photos will increase wellbeing, decrease agitation and unlock memories.

Memory loss

Memory loss increases as dementia develops and can be very severe in the later stages, leaving your loved one unable to recognise family and friends, or even their own reflection.

Staying in a familiar environment can help maintain function, but eventually, even at home they may be unable to find their way around or identify everyday objects. However, they may still show flashes of lucidity and recognition.

They may sometimes believe that they’re living in a different place, one that they remember from the past. This can cause agitation, wandering and searching for someone from that earlier time.

What can I do?

Try not to get angry and dismiss their beliefs, instead use them as an opportunity to talk about the past and reassure your loved one.

Try to unlock memories with pictures, scents, music or films from the past.

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 If your loved one tends to wander, use bolts, gates or door alarms to keep them safe, compile a contact list of friends and neighbours who can keep an eye out for them and make sure they have ID so that they can be returned safely and with their dignity intact.

Personality changes and unusual behaviour

This later stage of Alzheimer’s disease can be the most challenging for family and carers because the personality becomes affected and there can be significant behaviour changes. Individuals need constant supervision and may require professional care.

Your loved one may experience hallucinations, delusions and feel paranoid that someone is out to hurt him. Agitation can be common and this may be worse in the early evening, so called ‘sundowning’.

What can I do?

It’s important to check that all your loved one’s needs are being met and that they are not hungry, thirsty or in pain.

Agitation can be a sign of too little stimulation, so see if you can give them more individual attention at this time, or arrange extra help at home.

A box of objects from the past, gentle exercise or sitting in a rocking chair may ease their distress. Your doctor can also provide medication if some form of sedation is required.

Food for life

In the latter stages of dementia, your loved one may lose their appetite, struggle to eat and lose weight.

In the final stages their muscles and reflexes may fail and they may be unable to chew and swallow. Without adequate nutrition, they can become weak and more vulnerable to infections, falls and fractures.

What can I do?

Try to ensure that they are getting enough to eat and drink. Make sure they are in a comfortable, upright position and encourage self-feeding whenever possible, try demonstrating or placing food on a spoon to jog their memory. Choose foods that they love to stimulate appetite.

Soft foods may be easier to chew and swallow and you can thicken soups and liquids with cornflour to help them go down. Alternate mouthfuls with sips of fluid to keep them hydrated.

If swallowing is a problem, seek medical help because it can lead to chest infections and choking.

Incontinence issues

Many people may lose control of their bladder and sometimes their bowels in the later stages of dementia. This may happen occasionally or can be a constant problem.

It is not directly caused by the dementia but infections, constipation, medication or simply being unable to remember how to express their toileting needs can lead to accidents occurring.

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What can I do?

If your loved one develops problems with continence then set a toileting schedule, monitor bowel movements and ask your doctor to refer you for help. A continence advisor or community nurse or local continence can advise and help with getting incontinence pads and other aides.

There are lots of different care options that can help you at this difficult time, and the HomeTouch team are happy to help. We can provide you with advice and support, and help you to find a top quality carer in your local area.

Just call 020 7148 0746.

In the final stages of Alzheimer’s disease, when life is sadly coming to an end, your loved one will lose their ability to respond to the environment. There is a progressive decline in physical abilities and they will need help day and night with all aspects of daily living.

They are at risk of dehydration, chest and bladder infections and skin ulcers and sores.

This time can be heartbreaking for family and friends and the care requirements can be physically and emotionally exhausting, so plan your support in advance.

By getting help earlier you may be able to look after your loved one at home for longer or find the right place for them to get the care they need.

Find out more:

Dr Jane Gilbert

Jane has over 20 years’ experience as a health writer and TV presenter. Jane writes on a wide variety of clinical and care topics – from explaining the latest studies and research to unpacking conditions and discussing treatment options. Jane holds a MBBS degree from Imperial College, London and spent seven years working in the NHS.

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