Alzheimer’s disease (AD) is a very complex condition that is always fatal. It manifests initially with marked memory failure and lapses in judgement, but as it progresses, it also has a devastating effect on higher brain functions that many people take for granted. In the later stages of the disease, balance and coordination as well as autonomic functions like heart rate, breathing, digestion and sleep cycles are severely affected.
In the final stage, patients will be unable to perform the tasks that keep their bodies alive and functioning. Neurological damage and muscle weakness cause patients to lose the ability to coordinate even simple movements. Eventually, they are unable to walk, communicate, maintain control of their bladder and bowels, feed themselves, chew, and swallow food without significant assistance and careful supervision. The later stages can be both emotionally and physically taxing not only for patients themselves, but also for their family caregivers. At this point, if the subject has not already been discussed, family members may wish to consider hospice care for their loved one.
A lack of self-awareness and self-care, prolonged confinement to a bed, feeding failure, inability to receive proper nutrition and dehydration are all factors in the development of other life-threatening health conditions. While brain damage associated with AD is the driving force behind the patient’s decline and incapacitation, these secondary illnesses and conditions are ultimately responsible for causing the patient’s decline and death. Complications from Alzheimer’s disease are commonly cited as such on death certificates. Because of this, deaths with a primary cause of Alzheimer’s disease and other forms of dementia are seriously underreported. This is especially true since dementia can go unnoticed as it progresses slowly over the course of many years. Furthermore, a significant number of patients never receive an official neurological diagnosis while alive or after passing.
The most prevalent cause of death in dementia patients is a secondary infection, commonly pneumonia. Bacterial infections could be easily remedied with a course of antibiotics in healthy individuals. However, advanced AD patients are usually too frail and immunocompromised to fight bacterial infections, even with the assistance of these drugs. Infections often return after treatment, and many patients or their family members make the decision to forgo aggressive treatment options and/or resuscitation efforts that may cause pain and discomfort for only a short-term benefit.
The following conditions can cause or contribute to multiple organ failure and death in seniors with severe Alzheimer’s disease:
- Heart attack
- Dehydration and malnutrition, whether due to a voluntary stopping of eating and drinking (VSED) health care directive or due to the natural dying process
- Injuries and fractures caused by falls
- Pressure ulcers (bedsores)
- Kidney failure
- Lung infections like aspiration pneumonia caused by dysphagia and inhalation of food particles
- Sepsis (if infections like urinary tract infections (UTIs) and pneumonia spread)
Because these secondary conditions and their treatments can cause a great deal of anxiety and discomfort, many patients and their family caregivers prioritize quality of life over quantity and opt for comfort care in lieu of extensive life-sustaining measures. This is a difficult and highly personal choice for families, but it should be taken into consideration as early as possible before Alzheimer’s disease progresses to the point where patients can no longer make informed decisions about their own end-of-life care.