is an umbrella term for the impaired ability to remember, think, or make decisions that interfere with doing everyday activities. can occur in varying types, and the most commonly reported ones are:
- with Lewy bodies
- Loss of memory
- Loss of initiative
- Limited spatial skills
- language problems
- Unable to perform simple tasks
- Changes in abstract thinking
Dementia and Dysphagia
Dysphagia refers to the problems associated with swallowing. The reason for this condition can be varied, and includes a range of factors, which include damage to parts of the brain that control swallowing.
For people with dementia, dysphagia is seen progressively, as the disease progresses and the patient gets older, the issue aggravates.
Dysphagia can lead to a range of complications from weight loss and malnutrition to choking and aspiration pneumonia, a serious form of chest infection. Reports indicate that 9 out of 10 people with dementia experience dysphagia at some point in time.
People who have been suffering from dementia for long can develop problems with eating and drinking, and they gradually lose their ability to swallow as they progress through every stage of their illness, and their physical and mental health deteriorates over a period of time.
We understand how difficult it is when your loved one with slowly loses their appetite and their ability to swallow solids and liquids.
It is an extremely difficult time; emotionally for the family and caregivers as they try to work out how to best respond and . for the personHowever, It is important to try and maintain and drinking, even in very small amounts, for nourishment.
How long can someone live without food and water with
It is difficult to estimate how many hours or days a person with who is not drinking or can live.
Every individual is different and the process depends on how long the has been bed-ridden, whether they are in the stages of where there is irreversible , and what they have been receiving.
Depending on these factors, it could be hours to days, days to weeks, or weeks to months. It’s important to realize that every situation is different, with every individual responding differently.
has the biggest effect on immediate survival. Our bodies tend to have several weeks’ worth of reserve energy from food stores, but lack of fluid causes problems with kidney function within a few days. When someone is no longer taking in any fluid, and if he or she is bedridden (and so needs little fluid) then this person may live as little as a few days or as long as a couple of weeks.
In the normal people lose their sense of hunger or thirst. In addition, they may not be alert enough to swallow safely. This is a sign that body systems are starting to shut down. Death may be days or hours away. The may feel more comfortable if the mouth is moistened, but this is to relieve a , not to satisfy thirst.
Now, the following question may arise:
Should the person be administered fluids and food by mouth?
Yes. It is important that the people who are able to swallow are given food and drink, preferably only spoonfuls of pureed food or sips of fluid. The point is, they should be encouraged to do so in order to prevent . It is important to support them to eat.
Also, at this point in time, you need not worry about them not a balanced diet. If they seem to want sweet foods, you don’t want to restrict them. Let them enjoy and eat what they are craving.
Tips to Administer Food and Drink
1. Be mindful of quantity: Offer small amounts of food and fluids at intervals. The patient does not have to consume food or drink like a meal, you can just feed them whenever they seem receptive to fluid intake and eating their choice of food.
2. Consistency of Food: For a dementia patient the swallowing problem means that you will have to give them food in puree consistency. Make sure that the person can manage to swallow it safely.
Is ANH ( and Hydration) recommended?
To get a onto ANH, they will have to be admitted to the hospital, This is because ANH requires inserting tubes or IV drips.
In all honesty, this can be very distressing for the and studies have reported that a third of people in who have a tube inserted for die within a month of being administered with ANH.
Also, people with go through a steep and are mostly not able to make sense of what is happening around them. They may pull out the and drips that have been inserted for ANH and there is a high possibility of infection at the site.
Here’s why is not recommended anymore:
- It does not stop the from choking or coughing while or food or fluids pass through their windpipe
- It does not improve quality of life or prolong their life
- It does not minimize the risk of chest infections
- It does not help with the person losing weight
Caring for people with Alzheimer’s or other dementias at home can be demanding and stressful for the family caregiver. A lot of studies indicate that depression is a consequence of being a caregiver for prolonged periods of time.
Fatigue and stress are commonly seen as they are always on call. It is important that we understand and sympathize with the bystanders and caregivers as they witness their loved ones lying on the hospital bed without intaking any fluids or food.
What is Terminal Restlessness?
This is the situation where the person is pronounced as near to death, and the patient shows signs of ‘restlessness’.
Keep in mind that the restlessness or signs of distress in the patient could be a warning sign of pain and feverishness, so it is crucial that you report it to a doctor or nurse immediately.
If it is a case of infection and consequent fever, a doctor will need to prescribe medications so that the patient feels relieved.
What can you do in a situation of Terminal Restlessness:
If you notice the person is restless and you think they are uncomfortable, you could try helping them move into a more comfortable position.
Consult with a doctor, if the patient does not seem to find relief. You can try to apply a cold compress or keep the temperature down with a fan.
The doctor may prescribe rectal paracetamol for reducing the temperature. They may also need additional medication to relieve the restlessness if the above does not help.
What do you mean by Cheyne-Stoke breathing?
As death approaches the person’s breathing pattern can change. This is caused by the person going into unconsciousness. It is often called ‘Cheyne-Stoke breathing’.
The person may have periods where they have regular breathing, then stop breathing for a few seconds. The patient starts breathing faster than usual and there can be long gaps in between.
The person who is dying is unaware of this but family members may find this quite distressing. It is important that you or another senior member of staff explain to the relatives that this is what is to be expected and that the person is unaware.
This is a natural process, as a family member or caregiver, you need to understand that the patient most often does not feel any physical pain in this stage.
In the final stages, you might notice bubbly secretions, these are also known as ‘death rattle’.
Here, the person’s breathing will sound wet or gurgling. This can occur in the last few days or hours of life. It is important to inform the family that the person is unaware of this and it is not distressing for them.
The problem is that many a time, the family members feel very distraught over the situation, so it is important to know what is happening and why or find someone who can.
What you can do in this situation is to try and change the person’s position; you might try to raise the head of the bed and/or change their position onto the side, and seek advice from a doctor or nurse as medication can be given to dry up secretions.
The person’s skin may become quite pale and clammy. Their fingers and feet may have a blue tinge. This is because the person’s blood flow around the body is slowing down as death approaches.
This is natural and the person is unaware of this. It is important to inform the family when this occurs and explain why.
To conclude, the final stages of Dementia can be a very distressing time for the family as well as the caregivers. It may help to know that the patient would mostly not be aware of many of the physical changes that are happening and does not feel a lot of pain while in the last few moments.