Dementia — and its stepwise decline
Dementia is an umbrella term that covers different disorders and Alzheimer’s disease comprises the majority of it. It is a disorder characterized by a decline in at least one cognitive domain such as learning and memory, language, executive function, attention, perception, motor or social cognition . Most seniors suffering from dementia present initially with forgetfulness and it is often a family member who first notices it. They have difficulty retaining new information, handling complex tasks such as balancing a checkbook, orientation in familiar places, or even a change in behavior. The symptoms worsen over time, but the rate at which the disorder progresses varies. Most individuals go through different stages based on their independence and functionality — early, middle, and late-stage dementia . But, a clear delineation of these stages can be difficult as most people have overlapping symptoms.
- Early-stage dementia: Impairment in executive function may be subtle or prominent. Family members may notice the senior be less organized, and there is a significant difficulty in multitasking. During the early stage, the person is still able to carry out activities independently.
- Middle-stage dementia: As the disease progresses, impairments in other cognitive domains may become apparent. During the middle stage, symptoms can range from a change in behavior, forgetfulness of their past and recent events, and difficulty in doing simple skills such as dressing up.
- Late-stage dementia: When a person enters the late stage of dementia, they require complete assistance with their daily activities. They become disengaged with their surroundings and even have difficulty in mobility or swallowing. It is also during this stage that they are most vulnerable to infections.
Seniors with late-stage dementia need extensive care and assistance as they are mostly reliant on another person to carry out their activities of daily living. Emphasis is put on providing them the comfort and quality of life while having the freedom to enjoy regular activities. Personally tailored activities should be offered to seniors with late-stage dementia .
Activities for Severe Dementia
Make them listen to music they used to love
Listening to music that they like or are familiar with helps elicit a pleasurable response even to patients with late-stage dementia. One study showed that an 84-years old woman with severe cognitive impairment responded to familiar melodies by humming and singing with some words . This provides encouraging support to the role of music therapy in the management of late-stage dementia.
Go outside, visit the park or just chill by the porch
Nothing beats a beautiful day at the park surrounded by nature and just watching time pass by. It may be a good idea to take them out of the concrete walls of their homes and go out to places that they used to visit or enjoyed in the past - as long as they are comfortable and capable. If there is limited mobility or ambulation is too much for them, then, simply sitting on a bench at the park will do!
Spend time with pets
Cats and dogs have always been seen as therapeutic for most people. These furry friends of ours seem to bring joy without even trying! Spending time with them could help reduce anxiety and build a lovable relationship with seniors. They can even help groom and feed them.
Read them their favorite book
Reading them books that they used to love can also be a pleasurable activity for severe dementia. There are also sensory books perfect for seniors to fidget or fiddle with during storytelling! A fidget sensory book contains soft shapes and pages arranged in different layouts and typically made of felt. It is especially helpful in encouraging engagement and communication. It is also said to decrease agitation among seniors with dementia!
Brush their hair, massage their hands
Gentle touch can provide reassurance to seniors with late-stage dementia. An expressive touch, such as brushing their hair and offering to massage their hands, conveys the message of nurture and acceptance to them especially at this stage when they are mostly dependent on others to carry out activities and personal care.
With the progression of dementia, the burden of care can be heavy as well. Seniors with late-stage dementia become less and less interactive with their environment. The goal of these activities is not to help them return to their baseline function but to help improve their quality of life. Find activities that build on the remaining skills that they have even the slightest of it. It is extremely important that you focus on their enjoyment!
- Ballard C, Gauthier S, Corbett A, Brayne C, Aarsland D, Jones E. Alzheimer's disease. Lancet. 2011;377(9770):1019-1031. doi:10.1016/S0140-6736(10)61349-9
- Mitchell SL, Teno JM, Kiely DK, et al. The clinical course of advanced dementia. N Engl J Med. 2009;361(16):1529-1538. doi:10.1056/NEJMoa0902234
- Kovach CR, Magliocco JS. Late-stage dementia and participation in therapeutic activities. Appl Nurs Res. 1998;11(4):167-173. doi:10.1016/s0897-1897(98)80285-1
- Cuddy LL, Duffin J. Music, memory, and Alzheimer's disease: is music recognition spared in dementia, and how can it be assessed?. Med Hypotheses. 2005;64(2):229-235. doi:10.1016/j.mehy.2004.09.005