During the latter stages of Alzheimer’s disease, affected persons become completely dependent on their caregivers for survival. Interestingly, most people do not die from Alzheimer’s disease itself, but from a complication or secondary effect of the disease. Here are the five most common (and sometimes preventable) complications of Alzheimer’s:
Falls are the most common cause of injury in older adults both with and without Alzheimer’s disease. This is because there are so many causes of falls including muscle weakness, heart trouble, joint instability, visual disturbances, and sensory loss. Alzheimer’s patients are particularly vulnerable to falls because they frequently don’t recognize their own limitations and lack the judgment to act safely.
It’s easy to recognize fall risk. It’s harder to eliminate the risk. Many interventions can mitigate fall potential including physical therapy for strength and balance training, occupational therapy for environmental modifications, low vision strategies, and cognitive compensation, and alarms/bells/whistles to alert caregivers of unassisted movement- but there is no substitute for supervision and engaging in activities to decrease fall risk.
2. Skin breakdown
Decubitus ulcers (aka bed sores) are largely preventable. Sometimes the caregiving situation and the medical complexity makes proper skin care difficult.
Skin integrity depends on many factors- positioning and nutrition being major influences on the likelihood of a pressure sore. Here’s how it works: bony prominences, like hip and butt bones, push down through the tissue and compress blood vessels that supply the area with oxygen. Good nutrition helps to keep our “seats” padded, but prolonged pressure against those bony areas will eventually lead to skin breakdown. And it can happen quite quickly.
As able-bodied-and-minded people, we shift our weight quite regularly. We never just sit or lie still. Our bodies tell us when it’s time to shift our weight to the other hip, cross or uncross our legs, or lean forward and back again. We are constantly in motion, even when we think we are still. These impulses keep our skin safe.
Late stage Alzheimer’s patients cannot respond to those cues. They require others to reposition them frequently, while avoiding other skin damaging actions like skin tears and friction/shearing. In other words, Alzheimer’s patients require frequent change of position, but this should be done carefully and gently.
A contracture is a chronic loss of joint motion caused by shortening of a muscle or tendon. In late stage Alzheimer’s disease, contractures of the knees, elbows, and hands form mostly from lack of movement- enhanced by neurologic changes in muscle tone making joints more resistant to passive movement.
Many people in the later stages of Alzheimer’s disease sit… a lot. They stay in one position with their knees and elbows bent. Frequently, if they are seated in a wheelchair with sling upholstery and poor pelvic support, their thighs and knees touch. They may even pull their arms in tight against their chest if they feel cold. Sitting in this position for several hours, and then being transferred back to bed curled up in this same position, leads very quickly to limited joint movement. This makes it very hard to clean, feed, and dress someone whose limbs don’t move well.
Prevention of contractures is easy, but it requires diligence and consistency. Simple range of motion exercises- moving the elbows, fingers, wrists, shoulders, knees, and ankles to the limits of their range- will prevent contractures and painful stiff joints. If someone becomes resistant to range of motion, which is common if a person is confused or in pain, then there are ways to “trick” them into active movement that can be helpful. We’ll save those techniques for another post.
A good wheelchair with appropriate limb, trunk, and pelvic support, and physical activities that engage the person to reach, shift position, or use his or her hands can make a tremendous impact. Frequent range of motion, encouraging extension in bed, and providing medication or modalities for pain modulation can be all it takes to prevent contractures.
When someone with Alzheimer’s disease dies from pneumonia, aspiration is usually the cause. Aspiration is the inhaling of a substance or object into the lungs, and pneumonia is the infection caused by the fluids or particles that were inhaled.
Aspiration pneumonia can be prevented through proper positioning for safe swallowing. A person should never be fed while lying in bed. Ideally, the person should be sitting upright with the chin tucked slightly to prevent food or liquid from dropping down the airway and where gravity can assist the neck muscles in swallowing the food.
Food texture and liquid consistency also play a huge role. If the food cannot be chewed properly, or if the liquid is thin (like water), it can easily slide down the wrong pipe. Thickened liquids, like nectar or honey consistency, are actually easier to manage for someone with swallowing difficulties. A speech therapist can help determine the swallowing status and which food consistencies work best.
Dehydration can sneak up on the unsuspecting Alzheimer’s patient and the well-intended caregiver. Obvious conditions can lead to dehydration, like hot weather or a flu bug causing vomiting and diarrhea. Less obvious contributors include medications, insufficient fluid intake, or electrolyte imbalances.
Dehydration can cause confusion, dizziness, low blood pressure, rapid pulse, and weakness.
Prevention requires vigilance, a steady intake of a variety of fluids, and frequent monitoring of symptoms that could be attributed to dehydration.