Barbara, Can you finish the portion on dementia and dying that was not finished on your The Art of Manliness podcast?
There are just two ways to die, fast (sudden death) or gradual (old age or disease). Fast death just happens, without warning. Gradual death has a process to it. If it didn’t it would be fast death.
The process of a gradual death from disease takes two to four months (old age with no disease takes longer). Three things are the sign posts that say the dying process has begun: decreased eating, increased sleeping, and withdrawal. These three things are on a continuum, gradually beginning in months before death and going right up to the moment of death.
Weeks before a gradual death there are signs we look for that come in addition to decreased eating, increased sleeping, and withdrawal. On this continuum, in the months before death a person looks frail and sick but does not necessarily look like they are dying. In the weeks before death the person now looks like they are dying. (See Gone From My Sight for a description of all the signs of approaching death).
Dementia doesn’t play by these rules. Someone with dementia does not follow the process of a gradual death; they do not show us the signs that death is approaching. Someone with dementia can withdraw from this world’s activities for years, by being not interested, non-interactive, uncomprehending, unfocused. Someone with dementia can begin sleeping more, or even sleep all the time, and not have entered the dying process. Again, they don’t play by the rules.
Their food intake can decrease but it isn’t until they begin forgetting how to swallow or have difficulty swallowing without choking that dying actually begins. If we don’t eat we can’t live. If the decision not to use a feeding tube is made then the dying process starts. ALWAYS, ALWAYS offer food. You don’t just one day stop feeding someone. Generally, at this point the person is struggling against eating. We are the ones that are concerned. The person’s body has already begun to shut down and is probably disliking food. Offer, but don’t plead. Also beware of choking.
When the decision to not use a feeding tube has been made, depending upon the person’s weight and how much they are eating and drinking, death will probably come within weeks. Now you will see all the signs of approaching death that occur from other diseases and old age. Those signs will fit into the normal timeline that affects others as death approaches.
Something more... about Signs of Approaching Death with Dementia
I suggest my booklet How Do I Know You? Dementia At End Of Life to families with a loved one who is dying with dementia.
188 comments
Hi Malaika, I do not know what is happening with your mom’s change of behavior. I can say enjoy this wonderful turn of events while you have them. Life for all of us is precarious. We need to enjoy the moments that we have. Treasure this special gift of time and clarity that life has given you and your mom. Blessings! Barbara
My mom has had dimentia for years. Recently, she is bedridden and had a difficult time speaking , showing happy emotions and swallowing. She loose much weight. We used to give her soup & vitamin supplements only for few months. She doesn’t speak unless she repeats what others say. However, last week she has started to eat solid food and has gain weight. She also gain appetite,laugh and starts to sit by herself on the bed. Is she feeling better?Any hope? I know it doesn’t have cure but may be in rare cases?
Hi Manuela, It sounds like you and your Dad are doing everything you can to help your mom. You are trying to get her meds and nutrition into her. Keep trying, keep offering and when she refuses know you are doing your best. What is happening is part of the disease process. There will come a time when she will probably refuse everything. Always offer, but no need to force or upset her. You are doing the best you can in a very difficult time. Blessings! Barbara PS: have you tried putting the crushed pills in a spoonful of ice cream?
Hello…my mother has cardiovascular dementia. She’s still eating well but my father says that she refuses to take her medication. He’s been crushing the pills and adding the powder to a liquid but she doesn’t always want to drink it. Any suggestions on how we could get her to intake more liquids and other ways of tricking the patient into taking the medication? (Whatever we can give in liquid form we do). Thank you for your help. Manuela
Hi Trish, I can see why you are confused and questioning how quickly your mother died. First I’ll say dementia doesn’t play by any rules. It is hard to anticipate its progress toward death. I see the gift in her death is that once her body shut down, it did it quickly. It is hard on us the survivors but for her there wasn’t a slow, drawn-out period of suffering. Now to the areas you expressed concern about in our letter: I have to take exception with the statement that her bedsore showed death was a few hours away.—just not so. Yes, the blood flow is slowing, repositioning is important, and skin breakdown will occur more rapidly as death approaches but I don’t consider it a valid sign of approaching death. What happened that resulted in your mother going from “ stage 4 to 7” in a matter of days? You’ll never know, but maybe there was a stroke or some other physical occurrence that occurred to begin her rapid decline. Whatever happened does not sound fixable. Whether she was at home, in a facility or in a hospital I think she would have died when she died. You might write her a letter and put your thoughts, concerns and love down on paper. Burn the letter and scatter the ashes to the wind, releasing all the concerns and unsaid words into the universe.
Blessings! Barbara
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