Expert: Mary Gordon - 7/2/2010

Question
My grandmother has been sick for 7 years with Alzstimers. She can't talk and has to be rolled around
in a chair from room to room. She doesn't want to eat much and is sleeping a lot during the day. I have also
noticed that she does not want to get up in the morning. Does not sleep at night but lies in the bed awake all
night. My grandmother takes her medication but it is no longer working. How much longer can she last like this?
Is this close to the end? How much longer could I expect her to be around?

Answer
Hi Michelle, its very hard to tell when someone will enter their final months. Sometimes the smallest health issue will start a final spiral - and sometimes the person will live on for an extended time, despite being in very poor condition.  

A lot depends on your grandmother's age, overall health and condition. Obviously, someone who is very elderly and frail, who has a lot of health problems other than their dementia, will be much more fragile than someone younger and healthier.

As the dementia progresses, many families decide that there is no point to continue with medical treatments for other health problems, especially if those treatments are uncomfortable, scary or intrusive.  They may decide, for example, that palliative care is the best option - that it is better to keep the person comfortable and free of pain, and not to take them to hospital for tests, surgeries or procedures. This can mean the person's life is shorter, but at the same time, may mean their days are happier and more peaceful.

Signs that the dementia itself is moving toward end stage is that the person sleeps more and more and is less and less aware of their surroundings. They become weaker and often have to be propped up in the bed or chair because they can't sit up or hold their head up on their own.
They start to eat less and less and lose weight no matter what is tried in terms of careful hand feeding and special diets. They just seem to lose interest in food and drink and don't seem to feel hungry or thirsty - eating seems like a bother to them. They can have repeated infections, as their immune systems start to break down. Eventually, they will stop eating and drinking entirely, their organs begin to shut down, and they will lapse into a coma.

In some ways, it is merciful if other health problems carry them off before the natural end of dementia, as it is very hard on the family to watch and wait, and the last stage can be very slow.

Your family may want to discuss hospice type care with her doctors and other care providers and see if this might be a loving option for her at this point. I know this is very difficult.

On a side point, sleep disturbances are very common for people with dementia - they seem to be a product of the brain damage. Those who are looking after her may want to try putting her on a routine and keeping her awake and exercised as much as possible during the day. This may help improve her sleep at night and make her more comfortable.

Thinking of you. I wish there was a more definite answer for you with respect to how much longer you will have her with you.  

Mary