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NotHisFault Asked February 2014

If your loved one with later stage Alzheimer's is in pretty good physical health, what do they actually pass away from?

I don't mean for my question to sound harsh or morbid, so please bear with me. My husband, Bill, is only 73, but has later stage Alzheimer's and I will care for him at home as long as I am able. Bill needs help with everything now. He's ambulatory, but needs to be encouraged to get up. He shuffles around when he's up and is a little unstable, but I stay close or he uses his walker. He's incontinent and needs help with all ADLs. He still seems to swallow OK, but needs cuing to eat. He speaks very little and when he does, cannot form a sentence or makes up words. Physically, he seems to be in relatively good shape - so what actually causes death? To be clear, I don't think he's anywhere near the end, but I just don't know what to expect down the road and was hoping someone could shed some light.

norestforweary Feb 2014
Yes 2 pups.... I realize the statistics.....My mother in law was just restaged as severe Alzheimers last Tuesday. She is 94 a retired teacher. She would have never wanted her students to see her as ahe is now. Out of her wishes made prior to alzheimers diagnosis did not want extraordinary means. Her doctor suggested hospice 1 1/2 years ago. We did not think it was time then. She has deteriorated much since then. Either her heart or a fall will most likely be her demise. Sometimes I wonder what she has left on Earth to do that she has not done and that is why God has not taken her......Then I realize maybe it is something we all have yet to learn from her.

twopupsmom Feb 2014
no rest It has gone from 12 th leading cause of death to 6 th, rising faster than heart disease & all other major illnesses. NotHis Fault, I too have a husband that is healthy with mid stage ALZ I too have wondered what you have asked. I personally do not want to see the very end as I don't think my husband deserves that road to get to Heaven. It is horrible. I have followed Virtualhorizon on this forum as her father and my husband were just about the same age, same military history, but her a Dad started advancing quickly beyond where my husband was, then had to be moved to a NH where he fell and broke his hip, had surgery and as I write is living his last hours. So it can move fast or slow, each case is so very different, except for stages and the dreaded final stage. Any surgery is detrimental to anyone past mid stage.

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NotHisFault Feb 2014
Thanks so much norestforweary - The article you shared was very helpful, so I feel like I have a little better understanding about what might possibly happen down the road. I especially appreciate the 'causes and results' that were listed. In my own research on the subject, I found the following on the National Institute of Health website, which reinforces what your article stated: "Although one does not die of Alzheimer's disease, during the course of the disease, the body's defense mechanisms ultimately weaken, increasing susceptibility to catastrophic infection and other causes of death related to frailty. At some point after the mind has been lost to this devastating disease, the body will be lost as well." Clearly, it's not an exact science and is in God's hands. My husband, too, has an advance directive with a DNR, as well as nothing artificial or mechanical to keep him alive. I guess all I can do is keep his body as healthy as possible. He's given me 27 kind, gentle and wonderful years, so I'm so hoping I can make his last years as comfortable as possible. Thanks again.

norestforweary Feb 2014
NotHisFault.... thankyou for bringing up this subject, as hard as it is. It made us look back on my mother in law's advance directive. She did not want antibiotics given. Though she has heart problems, a pneumonia in the future is a possibility.

norestforweary Feb 2014
I found this article......not sure if it helps.....Your question is a good one......No one knows God's timing! I am sorry you have to go through this with your husband at such a younger age.

Death by Alzheimer's disease, a progressive brain disorder characterized by loss of memory, is usually caused by secondary infections that are common in incapacitated patients. There are about 4 million Americans with the disease, and the average length of time between diagnosis and death is eight years, although people can live with the illness 20 years or more. As the disease progresses, patients lose the ability to coordinate basic motor skills such as swallowing, walking, or controlling bladder and bowel. Difficulty swallowing can cause food to be inhaled, which can result in pneumonia. Inability to walk can lead to bedsores. Incontinence can result in bladder infections. These infections become particularly difficult to deal with because Alzheimer's patients are unable to understand and participate in their own treatment. While reports say that former President Ronald Reagan, an Alzheimer's sufferer, is recovering well from his broken hip, such falls often lead to death because the patient does not have the capacity to follow directions or motivation to try to walk again. Such incapacitation again sets the stage for deadly infections. Doctors say it is possible that an Alzheimer's patient could progress to the point that damage from the disease to the centers of the brain that control breathing could cause death, but patients rarely get that far without an infection setting in. Once a patient is extremely incapacitated, there is little medical motivation to aggressively treat such infections.

In 1998, Alzheimer's disease was the 12th-leading cause of death in the United States, with 22,725 deaths, and the ninth-leading cause for people 65 and over. That number is expected to increase when statistics for 1999 are released. That's because a new reporting system will reflect a change that lists Alzheimer's as the primary cause of death even if the patient died of Alzheimer's-related pneumonia. Experts say Alzheimer's deaths have been underreported because infections such as pneumonia were listed on death certificates instead of Alzheimer's. According to the Boston Globe, Massachusetts, which has released its 1999 numbers, has seen a 50 percent increase in reported Alzheimer's deaths under the new system and about a 25 percent drop in reported deaths due to pneumonia.

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