Expert: Michalene Peticca - 10/2/2006

Question
My father was dx with AD roughly 3 yrs ago, but looking back, he's had it much longer.  We had to put him in a nursing home in January.  He'd  had a couple instances of incontinence, but lots of confusion, and became physically threatening.  Probably stage 4 or 5 upon admission.  Well It's october and he's blown past the rest in 9 months is now stage 7.  He won't eat, cant talk, can't walk, but has brief periods where he can muster the strength to climb out of bed.  He's got bruises from falling.  He has had oral thrush now twice within the last month.  5 out of 7 days one of us is there to put him to bed at night.  My question is, is this normal to decline so rapidly?  We are so blown away, even the staff (which is absolutely wonderful) small town many of them knew him before
AD, are surprised at the rapid decline.  He's the first they've seen go so quickly....so should I try to get hospice care for him?  I don't think he has much longer.  And as a family we agree not to let him be tortured.  
He has a living will and advanced directive but I've read no treating infections.  We're treating the oral thrush because it's very painful.  He was admitted at 209 in January, he's now 170.  Most of the loss has been since june.  We are beside ourselves with confusion about his rapid decline.  

Answer
Hello Jan,
Thank you for writing.  This must be a very challenging and sad time for you and your family.  I admire your strength to do all you do for your dad.

Unfortunately, there is no set time line of how fast or slow Alzheimer's can progress.   Because it is a deterioration of the brain tissue itself, it is sometimes believed to "speed up" in the late stages.  That is, the symptoms magnify because as the brain shrinks it is taking more and more important components of daily abilities with it.

The oral thrush i assume is from using antibiotics to treat a urinary tract infection?  The UTI would definately be the worse of the two.  Using antibiotics is strictly a comfort and i never did understand why some living wills include it in advance directives.  They don't sustain life, but they sure do alleviate suffering.   

As for your father's not eating... if the dietary dept. hasn't already seen to it, please have them put your father on high protein, high calorie "milkshakes".  There are ones especially made as a meal.  

Lastly, indeed consider Hospice.  Alzheimer's disease is recognized as a terminal diagnoses and i think you'll find much comfort in the extra attention your father will receive.  

You've probably heard this before, but Alzheimer's disease is "a long good-bye".  Many thoughts for your family to endure and try to find a moment of happiness in each visit.

Best Regards,
Michalene Peticca, MA