A person with Late Stage Alzheimer’s Disease is totally dependent on the caregiver. The caregiver provides constant supervision and assistance with all activities of daily living: toileting, eating, dressing, bathing and mobility. It is absolutely essential that the caregiver have regular respite during this stage.

In this stage, a person will need constant supervision and assistance, Symptoms include:

1. Little to No Memory: Short- and long-term memory are severely impaired;
2. Great Difficulty Communicating With Others: The person may be unable to speak or understand words;
3. No Recognition of Family or Friends: The person may not recognize him or herself in the mirror. They may think that their spouse is a stranger or the person in the mirror is a stranger;
4. Need for Assistance: The person needs assistance with activities or interactions;
5. Difficulty Remembering How to Eat: The person may have difficulty coordinating the steps of biting, chewing, swallowing, etc. Despite good nutrition and meal supplements, typically there is weight loss;
6. Loss of Bowel and/or Bladder Control:
7. Difficulty With Coordinated Movements: The person may walk unsteadily. Fumble when grasping objects, to be unable to hold onto objects;
8. Increased Frailty: Muscles may weaken and people are susceptible to infections and other physical illnesses;
9. Upset Sleep Cycle: The person may be able to sleep only with the help of sleep medications.

Communication Tips:

Toward the end, a person with Alzheimer’s Disease loses almost all ability to communicate or understand. Both long- and short-term memory are severely impaired, and he or she is totally dependent on the caregiver.

1. Continue speaking warmly, quietly and with eye contact;
2. Pat or stroke the person. Touch with love;
3. Smile. After all else is lost, a smile can calm and bring joy.

Problem Behaviors

The person may scream or yell inappropriately and may resist a caregiver’s attempts to help with bathing, dressing or other personal care. Some physicians will prescribe anti-psychotic or calming medications.

Guidelines for Dealing With Behavior Problems

• Everything surrounding a person could contribute to the behavior problem;
• A thorough assessment of the elder, the environment and the caregiver by a trained professional is necessary in order to plan for intervention;
• Think ahead and plan for situations that could result in problem behaviors;
• Trying to argue or reason with a person who has Alzheimer’s Disease only results in frustration for both the caregiver and the elder. It is not possible to win an argument with a person who has Alzheimer’s Disease;
• Distract and divert whenever possible;
• Keep the routine the same. Changes in routine are upsetting to people with Alzheimer’s Disease and can cause behavior problems;
• Promote a sense of security and comfort when problem behaviors occur. Problem behaviors often happen because a person is frightened and unable to make sense out of the environment;
• Use positive reinforcement such as food, smiles, a gentle touch, personal attention and lots of praise. These tools are more effective than negative reactions;
• Allow a person with Alzheimer’s Disease some sense of control. Being able to save face is important even in a person who is very confused;
• Maintain a calm manner when confronted with threatening behaviors. This can defuse a very tense situation and help a person become less fearful;
• Keep things simple. Complex situations only cause frustration and can escalate behavior problems;
• If a caregiver becomes frustrated and angry, it is best to find someone else to handle the problem and have the caregiver leave the immediate area or take a break (respite). An angry caregiver will only intensify problem behaviors;
• Caregivers should practice ways to reduce stress when they become frustrated and angry. Deep breathing or talking to someone can be helpful. Remember that stress comes from many sources, including personal life;
• Behavioral problems result from the disease. Don’t take things that the person says and does personally. It is the disease speaking;
• Be creative when seeking solutions to difficult behaviors;
• Use good common sense when attempting to solve problem behaviors;
• Keep a sense of humor even in the most difficult situations. Humor will help you cope with the frustrations of caring for a loved one with Alzheimer’s Disease.