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Final Stages of ALS

author image Christy Brogan
Christy Brogan is a nurse specializing in the fields of oncology, hospice and home care who has written educational materials for patients and students locally. She has been a clinical instructor teaching both patients and nursing students about health care issues. She graduated from Grand View College in 2005 with her Bachelor of Science in nursing.
Final Stages of ALS
Final Stages of ALS

ALS, or Amyotrophic Lateral Sclerosis, is a disease of progressive muscle weakness which occurs due to the destruction of motor neuron cells in the nervous system. Without these neurons, the brain is unable to send information to muscles. End-stage ALS occurs when muscles weaken to the point where vital systems are paralyzed and cannot function. Montgomery Hospice in Maryland lists the ability to breathe and swallow as crucial factors in end-of-life ALS.

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Swallowing Difficulty

End stages of ALS often include trouble swallowing and speaking. Weak and paralyzed vocal cords make speaking difficult and eventually impossible. Trouble swallowing occurs gradually in some patients, but can occur suddenly in others. According to the National Institute of Health, patients with ALS have a high risk of choking or inhaling food into the lungs. Without the ability to swallow, eating and drinking becomes impossible, and dramatic weight loss occurs in many ALS cases. The only solution then becomes artificial feeding through a feeding tube or intravenous solution. Many who choose not to replace nutrition artificially seek hospice end-of-life care.

Respiratory Failure

Breathing difficulty arises from the weakness of lung muscles and the diaphragm. Shortness of breath worsens as muscles become weaker. The Montgomery Hospice of Maryland states that patients in the final stages of ALS have shortness of breath even at rest. Breathing must eventually be assisted by using a BiPAP machine and then a mechanical ventilator. Again, patients who decline artificial ventilation are offered comfort and end-of-life care.

Risk for Infection

The National Institute of Health reports that ALS patients face risk for pneumonia. This occurs partially due to the fact that secretions pool in the lungs because the lungs are too weak to clear them effectively. Inhaling food or fluids, called aspiration, also causes pneumonia. Pneumonia is commonly treated with antibiotics, but these may not be effective. Pneumonia infection increases shortness of breath and can lead to death.


Patients in the final stages of ALS become totally paralyzed as a result of the disease. Typically, all muscles are effected, including those of the legs, arms, trunk and face. Due to mixed signals from the brain, muscle twitching often occurs without purposeful movement. At end stages, ALS patients are totally dependent on others for care.

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