Physical changes at end of life

People in the final months of dementia will experience increased mental and physical deterioration and will need care for 24 hours per day. It is always best if care can be provided with a palliative care approach in the person's home or long-term care home as transfers to a hospital may cause great distress for the person.

The progressive nature of dementia means symptoms will ultimately worsen over time. How quickly this occurs varies from person to person. In the final weeks before death, the person goes through changes as the body gradually shuts down. As they lose their capacity for recognizable speech, nonverbal communication through the senses of touch, smell, vision and hearing will become increasingly important.

Some of the physical changes which often occur in the later stages of dementia include:

  • Profound memory loss and loss of ability to communicate with words
  • Loss of mobility, inability to sit up
  • Difficulty swallowing foods and liquids
  • Decreased interest in taking food and liquids, weight loss
  • Poor blood circulation (colder hands and feet)
  • Impaired bladder and bowel function
  • Prone to infection
  • Loss of facial expression
  • Decreased senses
  • Increased sleepiness or agitation/restlessness
  • Increased phlegm and mucus/secretions
  • Irregular breathing
  • Irregular pulse
  • Skin problems
  • Hiccups
  • Pain

Please note that some of the above changes may occur months/weeks prior to the end-of-life stage.

Effects of dehydration

Dehydration of the body as the person is dying is generally not painful in itself, and with the physical changes that occur at this stage, the person generally does not feel pain as intensely. A lower volume of fluids in the body also decreases cough, congestion, nausea and bloating.

Mouth and eye care

At the end-of-life stage, breathing through the mouth can cause the mouth and tongue to become dry and create discomfort. You can learn the steps from a home care person or staff at the long-term care home to keep the lips moist and to provide mouth care including cleaning the teeth, tongue and inside of the mouth.

For relief of dry eyes, you may need to use artificial tears in the person’s eyes a few times throughout the day.

Additional resources

  • For practical suggestions and tips to help you respond to these care issues, please read Late stage and End of Life in the Alzheimer Society “Progression” series.

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