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Good Afternoon. Welcome to Demystifying Alzheimer’s. I’m your hostess Mary Yamin-Garone.

Today’s topic is “The Severe Stage of Alzheimer’s: Make Every Moment Count.”

Picture this: You and your mother decide to go out to eat at one of your favorite restaurants to celebrate her 85th birthday. She’s moved from her home to an assisted living facility but her Alzheimer’s has progressed to the point that she soon will have to move into a nursing home where she’ll get more skilled care.

Mom still likes to go for rides and sometimes for an ice cream cone. Because it’s her birthday, you want to make it special. So you take her to Lombardo’s one more time.

She’s in a wheelchair now, so you’ve asked for a special table in a private part of the restaurant. The waitress comes over to take your orders. Your mother’s been having some difficulty swallowing so you want her to select something that will be easy to swallow. You ask her what she’d like to order.

“You order,” she says. So you order the meal and then start a conversation with your mother. She becomes agitated watching people come in and out and the restaurant is noisier than usual. You see it’s best to cancel your order and leave. You drive through Moxie’s and get her an ice cream cone. She’s content as you go for a ride.

The capacity to deal with anything complicated is diminished in the severe stage of Alzheimer’s. Usually, other bodily functions weaken and begin to fail. Comfort and cleanliness become more important.

During this stage, the overall goal for caregivers and family members is to continue to give their loved ones the dignity and respect they deserve. You have to be able to “read” their body language and listen attentively to any words they express so you can accommodate their wishes. This process requires time and patience and you need to slow down and pay attention.

In the severe stage, the devastation caused by this disease moves into the brain’s frontal lobes. Once they’re damaged, the individual loses their ability to interact properly. Many AD sufferers are no longer able to be managed by caregivers at home. They lose judgment, the ability to reason and social skills. Having lost much of their civilized behavior, they also respond inappropriately and in an unacceptable manner.

Many of the brain’s functions have been consumed. Instead of focusing on what’s missing, as a caregiver, you need to focus on helping them maintain the remaining functions.

At different times during the frontal lobe stage, your loved one can be violent or docile, apathetic and immobile. Simple things, such as touching, can trigger violence to repel the contact and potentially injure the caregiver and/or the individual.

In the end stages of Alzheimer’s, the destruction has destroyed just about all of the nerve cells of the cerebral hemisphere except for the strip of motor cortex and the visual cortex. That’s why in nursing homes, the main activity appears to be walking and pacing. In the final stages, even these areas of the brain are destroyed and the individual becomes bedridden and relatively unresponsive.

As a caregiver, you’re now moving into the third phase of involvement with the Alzheimer’s sufferer. You’ll find yourself using a direct, authoritative approach.

· You need to take the lead in making most of the decisions regarding the welfare of the person you’re caring for. It’s important to keep your own health and energy level high so you can respond to their ever-changing needs.
· Your loved one’s extreme difficulty in communicating is frustrating for you and them. As a caregiver, it’s critical that you keep talking to them about the weather, food, family members, the family pet, upcoming or current events. Find ways to keep them in touch with what’s going on around them.
· You may have to deal with finances, alternative housing and legal and insurance issues. Hopefully, end-of-life issues already have been addressed.

Here are some tips when working with someone in the severe stage of Alzheimer’s.

· Speak in a slow, controlled manner, even if the person you’re speaking to doesn’t respond. The sound of your voice can be comforting.
· Care for the person with dignity. Be attentive to dress and their surroundings, even as their body loses control of its functions.
· Take time to listen.
· Don’t forget, the person you’re caring for is in control of accepting or rejecting the food, help and comfort you’re offering. Caregivers are in control of cleanliness, the individual’s safety needs and listening and watching to determine their loved one’s wishes.
· If your loved one has to go to the hospital, tell staff about their abilities and habits. If possible, avoid overnight stays. It’s better to bring your loved one home and have in-home assistance than to have them stay in an unfamiliar environment. If they do have to stay overnight, bring some familiar items along, like their blanket, pictures or their favorite music. This raises their comfort level and reduces agitation.
· Consider hospice care. It can be delivered in the home, at a nursing facility or at residence, such as a hospice house.
· Take time to be with the individual receiving hospice care. Hold their hand, kiss them on the cheek, rub or pat their hand, anything to let them know you’re there.

In the final stages of Alzheimer’s, care priorities shift. Instead of ongoing curative measures, the focus often changes to palliative care to relieve pain, symptoms and emotional stress.

Anticipating the demands of caregiving can help ease the journey from care and grief towards acceptance and healing.

“I am grateful that I can support my loved one. I know her pain and losses must be difficult to bear, and I wish I could do more to provide her relief. I’m glad I can at least be of some help and comfort during these challenging times.
While I am weighed down some days by the burden of caregiving, I am also blessed by this opportunity. It calls for a great deal of unselfish giving on my part—a level of love that I hardly knew I was capable of. What sweet irony that my loved one’s health problems have allowed me to drink deeper of the well of love. My heart fills with a mixture of compassion and appreciation, sorrow and joy. It’s good to know I have so much love inside of me.”
—Taken from Daily Comforts for Caregivers.
That’s all for today. Thanks for listening. I hope this information was helpful.
Join me at 1 pm Monday when I’ll talk more about the severe stage of Alzheimer’s.

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About Lillian Cauldwell

Own and operate an Internet Talk Radio Network for 10 years, 2005 to Present Published Author of Non-Fiction Book, 1996, "Teenagers! A Bewildered Parent's Guide. Published Author of several fiction books, 2006 "Sacred Honor" and 20010 "The Anna Mae Mysteries: The Golden Treasure." Playwright of Theater of the Absurd and Black Comedies. Screenwriter, Black Comedies

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