Dear Barbara, What is your experience dealing with Alzheimer’s and the dying process. It's hard to know if the disorientation is dying or Alzheimer's. Also she doesn't seem to have the awareness of dying. She's angry, confused. Physically she seems to be in the 1 to 3 months. She has cancer. Her oxygen is 94; her blood pressure was 120/55. She is on hospice.
Dementia isn’t a terminal illness in that it doesn’t have a limited prognosis. It is like dying from old age, it takes longer. Alzheimer’s, or any form of dementia, is difficult to gage as to approaching death. The personality changes and withdraws often over a period of years and sleeping habits are unpredictable as well. The only sign of approaching death that we can use for determining the closeness of death for someone with dementia is to look at their eating habits. When a person is not taking enough calories for maintenance, (under 1200 - 1500 calories) on a continuing basis because of difficulty swallowing, forgetting how to swallow, or choking then they begin entering the dying process.
This is the time we must make the decision of whether we should insert a feeding tube to keep the calorie intake at an appropriate level or not. If the decision is no feeding tube then we can know that death is approaching in a predictable manner. Part of the normal way a person dies is to gradually stop eating over a period of months. When the decision to not insert a feeding tube is made we always offer food (being aware of choking), but we don’t force food. Offer and accept what is eaten or not eaten as part of the normal dying process.
We eat to live, and if the body is not taking in enough calories for maintenance then death will come. In your description you do not mention food so I cannot determine if she has entered the actual dying process. Her blood pressure is good which tells me she is not dying soon. The other factor here is her cancer. The dementia takes precedence over the cancer when it comes to signs of approaching death. Sleeping and withdrawing (which are two of the signs of approaching death from disease that can give us guidance) can occur with dementia years before death approaches. It is only food intake that we can use as a guide when dementia is involved. I am pleased to see she is on Hospice. They can be a support and give you guidance during this uncertain time.
Something More about... Alzheimer's, Cancer and Hospice
I encourage anyone who has a friend or loved one with dementia of any sort to get How Do I Know You? Dementia at the End of Life. The aim of this booklet is to provide information regarding approaching end of life to those people, family and significant others, who are caring and making decisions for someone with dementia.