At the later stages of Alzheimer’s, a patient’s quality of life can deteriorate substantially, necessitating palliative care services as a critical means for maintaining quality of life.
Families can enlist this tool to develop a daily routine that makes an Alzheimer’s patient comfortable, including physical exercise and memory therapy. These programs foster calm environments and healthy sleeping patterns, but what does it all entail?
Alzheimer’s Palliative Care: An Introduction for Caregivers & More
End-of-Life Care
As Alzheimer’s patients approach their final days, their medical needs become increasingly intense. New or worsening symptoms like these must be managed promptly, while eating, drinking and sleeping ability will likely decline significantly. Hospice nurses and aides can assist in helping manage food and fluid intake as well as medication administration. They can also educate caregivers how to recognize early signs of pain or distress and treat accordingly.
Hospice care should be used alongside other forms of treatments, but is most beneficial in the last six to 12 months of a person’s life. At this point, it’s crucial that family members discuss and understand your loved one’s end-of-life wishes and any recommendations from physicians and nurses. It would be a good idea to compare those wishes against his/her own cultural, religious or spiritual values and beliefs.
As they approach death, you can help your loved one accept this reality by talking with them, remembering past memories and listening to any fears or concerns they express. Honor their advance directives even if they no longer possess mental capacity to make decisions for them.
Advance Directives
For patients to ensure that their wishes are carried out, advance directives are an invaluable legal document that allows them to express their preferences when it comes to medical treatment in certain circumstances, such as an accident or terminal illness. An advance directive with this Alzheimer’s palliative care option, for example, can be as general or specific as desired by its creator. Any time they change or revise it a revision can take place; some types include health care proxy, durable power of attorney and medical instructions.
Conversations regarding what someone needs if they become incapacitated can spare family members the stress and burden of making decisions in an emergency situation. Studies have proven that advance care planning results in enhanced satisfaction with end-of-life care, decreased hospitalizations, and less anxiety among loved ones.
Health care proxy or surrogate decision makers do their best to uphold an advance directive, yet unexpected circumstances may arise that go beyond expectations. For instance, someone living with dementia might have an existing DNR order but still require lifesaving surgery despite this designation. When such situations arise, medical teams must carefully evaluate all available options – often including consulting the person’s agent and physician in this decision process.
Alzheimer’s dementia can bring physical and emotional changes that require special care during its final stages. People may lose interest in what’s going on around them, withdraw, and sleep more than usual. They might become restless or angry. Palliative care teams can provide essential assistance by teaching techniques for dealing with emotions as well as informing family members about end-of-life signs.
Cheyne-Stokes respiration indicates that blood supply to the brain is decreasing and that death may soon follow, making breathing labored and noisy for those left behind. Raising their head, turning them onto their side and using humidifiers or fans may provide comfort in these last days of life.
At the end, dying people’s hands and feet may feel cold and dry, and their appetite may diminish dramatically, leading them into dehydration. Therefore, it is vitally important that we encourage them to drink enough fluids — water included — in order to stay hydrated. They may have difficulty swallowing so offering easier-to-digest liquids such as fruit juice, sherbet, soup or broth may be easier for them.
As someone is dying, having someone nearby to speak on their behalf and hold their hand can often provide great comfort. Brain autopsies or donations after death may help researchers better understand Alzheimer’s through analysis of plaques and tangles found within their brains.
Pain Management
Untreated pain is common among those living with advanced dementia due to changes in brain’s pain-processing networks brought on by Alzheimer’s disease, making it harder to assess pain. The good news is there are effective solutions available for managing it when receiving palliative care services.
Step one of treating pain is to identify its source. This requires asking when and where the discomfort exists as well as whether it worsens with certain activities or improves with others. Your provider may perform a neurological exam to assess reflexes, balance and ability to walk; you may also receive an X-ray or radiograph of bones to see their condition.
You should know that while an EMG test (https://medlineplus.gov/lab-tests/electromyography-emg-and-nerve-conduction-studies/) is a complementary way of measuring muscle responses to determine whether pain originates in either the muscles or nerves.
Some pain treatments are straightforward, such as using a heating pad or over-the-counter medications like acetaminophen. Other solutions, like morphine or combinations of pain relievers and antidepressants may be prescribed depending on your symptoms.
