The Future and Death in Alzheimer’s Disease Care

In Hamlet, the undiscovered country refers to death. In Star Trek VI, it refers to the future. These are two things that caregivers of people with Alzheimer’s disease must occupy themselves with. In either case, the key is to plan ahead. The patient should be included in the decision-making process for as long as they retain lucidity. Ideally, you should handle the person’s healthcare, legal, and financial issues in the future – when they are in the last stages of the disease – according to their wishes today – when they still preserve most of their mental and physical faculties.

Healthcare, legal, and financial information

·         Durable Power of Attorney for Finances

Grants a trustee power to make legal and financial decisions on behalf of the person with Alzheimer’s disease.

·         Durable Power of Attorney for Healthcare

Grants a proxy power to make healthcare decisions on behalf of the person with Alzheimer’s disease.

·         Living Will

States the patient’s wishes for end-of-life healthcare.

·         Do Not Resuscitate (DNR) Form

Informs the medical staff how the patient wants end-of-life healthcare to be managed.

·         Will

States how the person’s property and money should be divided among his or her heirs after death.

·         Living Trust

Lets the trustee known how to divide said property and money.


Checking for money problems and protection from fraud

A person with Alzheimer’s disease is prone to making financial mistakes, and then hiding those mistakes to protect their independence – if they are even aware of them, which they may not even be. One such mistake is to allow themselves to be victim of telephone, mail, e-mail, or in-person scams. For example, pretending to be an old lady’s nephew on the intercom and to ask her for money, and sending an accomplice to collect the money pretending he is a friend of the old lady’s nephew. This scam was in the Argentinean film Nueve Reinas, so nobody knows about it. Moreover, the scammer can actually be a supposed friend of the family or even a relative.

Examples of scams

Signs the person is not managing finances well or is the victim of a scam

·         Identity theft.

·         Get-rich-quick offers.

·         Phony prizes.

·         Home/auto repairs.

·         Insurance scams.

·         Threats.

·         They seem afraid or worried when talking about money.

·         Missing money from the person’s bank account.

·         Signatures on checks that seem forged.

·         Unpaid bills for reasons the person can’t explain.

·         Changes in the person’s will without their permission.

·         The person’s home is sold though they didn’t agree to it.

·         Clothes, jewelry, and other belongings go missing.

·         The person has signed legal documents without knowing what they mean.


   How to manage the final stages of Alzheimer’s disease

As the patient progresses through the latter stages of the condition, it is the caregiver’s duty to ensure that they live out their remaining days and pass away as comfortably as possible. This isn’t easy due to the changes that occur during these stages, but the following pieces of advice may help you deal with these challenges.

Immobility. A home health aide, physical therapist, or nurse can teach you how to change the position of a person with Alzheimer’s disease who can’t move anymore, in bed or in a chair. Your doctor may be able to refer you to one of these healthcare workers. Additionally, a physical therapist can teach you exercises to improve range-of-motion and prevent stiffness in the limbs.

Comfort. You can make the patient more comfortable by buying special mattresses and wedge cushions to reduce pressure ulcers; changing the person’s position every two hours; using a lap board to rest the person’s arms and support their upper body when they are sitting up; and giving the patient a wash cloth or something else to hold while you’re moving them, so that they won’t cling to you or to furniture.

 Feeding. A person with late-stage Alzheimer’s disease may suffer from vitamin- and mineral-deficiency because they have lost interest in eating or are no longer aware that they are hungry.

Making sure the patient eats well

Possible problems

Potential solutions

Food and liquid suggestions

The person may not:

·         Be aware of mealtimes.

·         Know when they have had enough food.

·         Remember to cook.

·         Eat enough different types of food.

·         Serving meals at the same time every day.

·         Making the eating area a quiet space without TV and music.

·         Serving only one food at a time.

·         Serving bigger portions at breakfast.

·         Serving the food in colorful plates.

·         Limiting snacks between meals.

·         Ensuring the patient’s dentures fit tightly.

·         Tell the doctor about significant weight loss.

·         Finger foods like cheese, small sandwiches – preferably made with pita bread –, small pieces of chicken, fresh fruits, or vegetables.

·         High-protein milkshakes and drinks, or mix healthy foods in a blender and serve it as drink.

·         Cook with olive oil, extra cooking oil, butter, and mayonnaise.

·         Ask your doctor about vitamin and diet supplements.


Sometimes the person with advanced Alzheimer does not eat well because of chewing and swallowing problems, which may in turn lead to serious complications like pneumonia.

13 Tips to make swallowing easier:

  1. Cut food into small pieces and soften it up.
  2. Grind, blend, or liquefy food.
  3. Serve ice cream, milk shakes, yogurt, soups, applesauce, gelatin, or custard.
  4. Use a sippy cup instead of a straw.
  5. Limit milk if it catches in the throat.
  6. Favor cold drinks over hot drinks.
  7. Coffee, tea, water, or broth, because they are the hardest liquids to swallow.
  8. Buy Thick-It and add it to liquids to thicken them.
  9. Give the person enough time to chew and swallow each bite.
  10. Do not feed a drowsy or horizontal person. The patient must be sitting in an upright position during the meal and at least 20 minutes afterward.
  11. The person should have their neck forward and chin down while swallowing.
  12. Gently stroke the patient’s neck downward and say ‘swallow.’
  13. Ask the doctor if you can crush the patient’s pills, or if there is a liquid alternative available.

Body jerking. Tell the doctor if the person’s arms, legs, or whole body jerk as in a seizure but without passing out. It might be a condition known as myoclonus that sometimes occurs in Alzheimer’s disease.

Skin and foot care. Immobile patients who spend too much time sitting or lying down may develop pressure ulcers. To avoid this, move the person every hour if they are lying down, and every 2 hours if they are sitting up; place a 4” foam pad on top of the mattress and check that it is hypoallergenic and not too hot to sleep on (alternatives include pads filled with gel, air, or water); and make sure that the patient sinks a little when lying down on the pad, which should fit snugly around the body. Check the patient’s heels, hips, buttocks, shoulders, back, and elbows for redness or sores, and ask the doctor for advice if you find any.

As far as foot care goes, remember to soak the feet in warm water; wash them with mild soap; check for cuts, corns, and calluses; apply lotion to prevent dry and cracked skin; cut or file toenails; and talk to a podiatrist if the patient has diabetes or feet sores.

End-of-life healthcare

That death is the outcome of Alzheimer’s disease is a foregone conclusion, but that doesn’t make it any easier, especially since the end never comes easily or quickly. Particularly difficult is the inability to communicate. The caregiver can’t tell their loved ones how important they are – at least not with words. Conversely, the care receiver can’t express their needs and wants. This is problematic because the patient has the right to live – and die – any way they want to. That’s why it is so important for the person with Alzheimer to leave precise instructions concerning their end-of-life care (see living will and do not resuscitate for above), as well as choose a trustworthy person to execute these orders when the patient can no longer communicate their wishes. You may want to consult a lawyer on this one to make sure everything is in order. Talking about this with a relative is never easy, but later is not going to be better.