Late stage dementia is marked by the inability to communicate or take care of personal needs such as eating and dressing, as well as an increasing lack of responsiveness. Family members are often most disturbed when a loved one does not seem to recognize them. In addition, medical complications such as infections, range of motion limitations and skin breakdown occur due to lack of mobility, incontinence and swallowing disorders.
Sensory Stimulation Stage
As the person in the late stage of dementia loses the abilities to speak, understand language and perform motor skills such as grasping a spoon or walking, she relates more and more to the environment using her senses rather than higher cognitive functions. The patient may have pleasurable responses to music, aromas such as vanilla, hugs, massage and listening to a familiar voice. During this stage, many people spend most of their time with their eyes closed. Stimulating them through the other senses becomes increasingly important.
Loss of Mobility
As the disease progresses, people with dementia develop balance problems that ultimately require use of a wheelchair. During the late stage of dementia, the patient loses abilities to voluntarily move, making it necessary for caregivers to reposition the patient's to provide comfort and prevent bed sores. Gentle stretching exercises to arms and legs may prevent discomfort caused by stiffness and contractures. Fear of movement due to confusion or pain may contribute to agitation.
Swallowing Complications
During the late stage of dementia, patients need to be fed, but even then complications related to difficulties chewing and/or swallowing impact eating and ultimately threaten survival. Patients typically lose weight due to decreased food intake. Foods may be blended and liquids thickened to make swallowing safer. Even then, swallowing difficulties may cause choking, aspiration and pneumonia. Occupational therapists may recommend adapting the meal time environment, use of adaptive equipment, changes in food textures and feeding techniques to help the patient avoid these complications.
Retrogenesis?
"Retrogenesis" literally means back to birth. Professor Barry Reisberg used the term to describe the gradual loss of skills experienced by the dementia patient as the person ultimately functions much as a newborn baby. In other words, during the years between the first symptoms of the disease and eventual death, a patient gradually loses abilities in inverse relationship to the phases of child development. This view of function loss helps health care personnel plan and deliver care. Indeed, the individual in the late stage may well respond to a soothing voice and simple sensory stimuli in much the same way as an infant.
References
- "The Forgetting", David Shenk, 2001.
- Bigtree Murphy.com: Functional Assessment Staging of Alzheimer's Disease
- "The Source for Alzheimer's and Dementia"; Pam Britton Reese; 2000
