During the late stages of Alzheimer’s disease, the
patient generally loses the ability to walk, speak
and even swallow. At this point in the disease
progression, the role of caregiver can shift to focus
on preserving quality of life and the dignity of the
individual. Since care needs are extensive during
the late stages of the disease, this may mean
moving the individual into a skilled nursing facility
where intensive, around the clock care can be
provided. Additionally, because these patients are
by and large elderly, they may suffer from one or
more complicating conditions. Approximately 80
percent of all people with Alzheimer’s disease live
in a nursing home.
Nursing homes choose differing strategies for
meeting their residents’ end of life needs. Many
U.S. nursing homes have chosen to partner with
hospice programs to help them address the end
of life palliative care needs of their residents and
their families. Hospice includes an interdisciplinary
team, such as that recommended by NIA,
comprised of physician, nurse, social worker,
home health aide, spiritual counselor and trained
volunteers. They work together to address the
physical, emotional and spiritual care
of the person as well as the family.
Family members of nursing home
residents have noted improvements
in care after hospice
admission, such as
fewer hospitalizations
and lower levels of
pain and other
symptoms,
as well as
enhanced
quality of
life.
Even in the last
stages, patients
with Alzheimer’s
disease
communicate
discomfort and
pain. Pain and
suffering cannot
always be totally
eliminated, but
the hospice team can help make the patient
comfortable.
Managing pain and discomfort for a patient
with late-stage Alzheimer’s disease requires
careful monitoring and reassessment of subtle
nonverbal signals. Slight behavioral changes can
signal unmet needs. The hospice team, from
the physicians to the volunteers, are experts in
recognizing symptoms of distress and experiences
in both pharmacological and non-pharmacological
interventions to manage pain. The soothing
properties of touch, massage, music, fragrance
and a loving voice can help ease distress. Hospice
team members can utilize a variety of techniques,
traditional and non-traditional, to keep the patient
comfortable.
The impending death of a family member
is an emotional time for everyone and
hospice professionals are there to
provide support for the family during
the very last stages of the disease.
They also provide bereavement
support for up to 13 months
after the patient’s death. This
is because the families may
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