We have been going through the seven stages of Alzheimer's over the past few episodes and today's episode is going to be a recap of all seven stages and what you as a caregiver should do throughout each stage. If you know someone that has recently been diagnosed with Alzheimer's or has a loved one with a new diagnosis, this could be a good episode to share with them, as well. For more in-depth information on each individual stage, please listen to our recent episodes on the Seven Stages of Alzheimer's. Now let's move on to the rest of the show.

 

The National Institute on Aging tells us that Alzheimer's disease is a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. In most people with the disease - those with the late-onset type - symptoms first appear in their mid-60s. Early-onset Alzheimer's occurs between a person's 30s and mid-60s and is very rare. Alzheimer's disease is the most common cause of dementia among older adults.

 

Alzheimer's is currently the sixth-leading cause of death in the United States and nearly 6 million Americans are living with Alzheimer's right now. Scientists are still unsure of what causes this progressive disease, but they are actively learning more about it and trying to develop a cure. There might not be a cure at the moment, but there are treatments that can be helpful in slowing the progression of the disease.

 

Some treatments are only effective during the first few stages of the disease, so it's important to talk to a doctor as soon as you notice any signs or symptoms of Alzheimer's. Early detection of this disease really can make all the difference.

 

According to the CDC, Alzheimer's disease is not a normal part of aging. Memory problems are typically one of the first warning signs of Alzheimer's disease and related dementias. In addition to memory problems, someone with symptoms of Alzheimer's disease may experience one or more of the following:

• Memory loss that disrupts daily life, such as getting lost in a familiar place or repeating questions.
• Trouble handling money and paying bills.
• Difficulty completing familiar tasks at home, at work, or in leisure time.
• Decreased or poor judgment.
• Misplacing things and being unable to retrace steps to find them.
• Changes in mood, personality, or behavior.

 

All of these signs can also be signs of normal aging, which is why it can be hard to spot the disease in the beginning. Talk to your doctor if you notice any of these signs. There are a few tests they can run to see if someone has Alzheimer's or not.

 

Similarly, if Alzheimer's runs in your family, talk to your doctor to see if you have any genetic markers that can put you at a higher risk for developing Alzheimer's. The CDC also says that getting checked by your healthcare provider can help determine if the symptoms you are experiencing are related to Alzheimer's disease or more treatable conditions such as a vitamin deficiency or a side effect from medication. Early and accurate diagnosis also provides opportunities for you and your family to consider financial planning, develop advance directives, enroll in clinical trials, and anticipate care needs.

 

According to Penn Medicine, just like with many other diseases, changes in the brain that are related to Alzheimer's begin before symptoms are noticeable. Dr. David Wolk, MD, co-director of the Penn Memory Center, says that "This time period - often called 'pre-clinical Alzheimer's disease' - likely begins 10 or 15 years before people have symptoms. Currently, there is no treatment for this pre-clinical stage, but we hope in the future that we will have medicines that can halt the progress before people have symptoms and prevent the disease."

 

It is rare to detect the disease in stage one, but it can happen. People found to have Alzheimer's during this stage are diagnosed through medical history, EEGs, genetic testing, physical examination, MRIs, CT Scans, PET Scans, neuropsychological examinations, or a combination of any of these exams. At this stage, someone with Alzheimer's will have no impairment and will exhibit normal behavior. It will be impossible to tell they have Alzheimer's from simply observing them.

 

A BioSpace article tells us that jumping into stage 2 will show very mild changes in behavior. The symptoms can be simple and are usually not caught by doctors. Simple signs such as misplacing objects or trouble finding the right words to say may be a sign that someone is in the second stage. During stage two, all of the signs and symptoms of Alzheimer's mimic the normal signs of aging, and since they are only shown to be very mild, most people will assume they are only experiencing normal aging and not Alzheimer's.

 

Stage three is where we begin to physically see the signs and symptoms of Alzheimer's. According to Alzheimer's.net, at this stage, the family members and friends of the senior may begin to notice cognitive problems. Performance on memory tests is affected and physicians will be able to detect impaired cognitive function.

 

People in stage three will have difficulty in many areas including finding the right word during conversations, organizing and planning, and remembering the names of new acquaintances. People with stage three Alzheimer's may also frequently lose personal possessions, including valuables.

 

Dr. Wolk says that "For many, this stage brings noticeable changes, and it will become harder to blame it on age. It's common to be diagnosed in this stage because this is when a person's daily routine becomes more disrupted."

 

Penn Medicine also states that this stage may bring about more anxiety for your loved one, and some people may even deny that anything is wrong. These feelings are normal, but not talking to a physician will only allow symptoms to get worse. The best way to keep symptoms at bay is to talk to your loved one's physician about treatment options, including medications, and care planning.

 

If you suspect your loved one may have Alzheimer's or another form of dementia, keep a written record of signs and symptoms you notice and when you notice them. This record can be helpful for their doctor since they most likely will not be able to witness any bouts of forgetfulness themselves.

 

When the disease progresses further, you will be able to notice some level of cognitive decline in your loved one. Many people are diagnosed either at the end of stage three or the beginning of stage four.

 

According to Seniorlink, stage four comprises what is clinically described as early-stage dementia. A person with early-stage dementia (in stage four of the seven-stage model) will experience increased forgetfulness, often forgetting recent events, as well as difficulty concentrating, difficulty with problem-solving, and difficulty managing finances. They may have challenges when traveling to unfamiliar areas alone, and they may have difficulty performing complex tasks or organizing and expressing thoughts.

 

People in stage four may also be in denial about their forgetfulness and other symptoms, and as socialization becomes increasingly difficult, they may begin to withdraw from family and friends. In stage four, a healthcare provider can easily identify cognitive decline in an examination and interview with the patient. The average time spent in this stage is approximately two years.

 

In this stage, someone with Alzheimer's is still able to do things on their own and most likely do not need day-to-day help. In stage five, however, VeryWell Health says that some assistance with daily tasks is required. Problems with memory and thinking are quite noticeable, including symptoms such as an inability to recall one's own contact information or key details about one's history, disorientation to time and/or place, and decreased judgment and skills in regard to personal care. Even though symptoms are worsening, people in this stage usually still know their own name and the names of key family members and can eat and use the bathroom without assistance or with very little assistance. Each case of Alzheimer's is different, so the amount of help your loved one will need at any stage is hard to anticipate.

 

Penn Medicine says that until now, your loved one may have been able to live on their own with no significant challenges. You may have dropped in to check on them every so often, but for the most part, they were able to function without your regular assistance. In this stage, your loved one will likely have trouble remembering people that are important to them, such as close family and friends. They may struggle with learning new things, and basic tasks like getting dressed might be too much for them.

 

Emotional changes are also common during this stage, including:

 

hallucinations, which are seeing things that aren't there, delusions, or false beliefs that they believe to be true, and paranoia, which is the feeling that others are against them. If your loved one is experiencing any of these symptoms, they may be able to take medication that can help. Make sure you keep their doctor updated on any new developments so that they can make sure they are able to provide the best care they can to your loved one.

 

Stage six, also known as a severe cognitive decline, is where many individuals with Alzheimer's find themselves unable to live alone. Dr. Wolk says living on your own requires you to be able to respond to your environment, like knowing what to do if the fire alarm goes off or the phone rings. During stage six, this becomes difficult for people with Alzheimer's. Your loved one will be experiencing more significant symptoms at this time, which impact his or her ability to manage their own care and they will be more dependent on others.

 

VeryWell Health tells us that stage six is often the most difficult stage for caregivers because it's characterized by personality and behavior changes. In addition, memory continues to decline, and assistance is required for most daily activities. The most common symptoms associated with this stage include reduced awareness of one's surroundings and of recent events, problems recognizing one's spouse and other close family members, although faces are still distinguished between familiar and unfamiliar, sundowning, which is increased restlessness and agitation in the late afternoon and evening, difficulty using the bathroom independently, bowel and bladder incontinence, suspicion and paranoia, repetitive behavior (verbal and/or nonverbal), and wandering.

 

Most people with stage six Alzheimer's require 24/7 care. There are many types of care that can help your loved one, as well as yourself. There is 24-hour care, where professional home care provides trained staff to be with your loved one at all times. With this type of care, you could also provide some of the care and the company could help you supplement the time you are unavailable if that is something you are interested in. There are memory care units in facilities that are equipped to help your loved one live in a safe environment. If you would like to learn more about 24-hour care and live-in care, you can listen to our recent episode on that topic. We have also talked about other types of care in previous episodes. You can find all of our topics and episodes on our website, YouTube channel, or wherever you listen to your podcasts.

 

The final stage, stage seven, is a lack of physical control. According to Penn Medicine, Alzheimer's destroys brain cells, and eventually, this can cause severe mental and physical impairment. Your loved one's body may begin to shut down as their mind struggles to communicate and delegate tasks effectively. At this point, your loved one's needs will significantly increase. They may need round-the-clock care for help with walking, sitting, personal care, and eventually swallowing.

 

Because of their reduced mobility, their body can also become vulnerable to infections, such as pneumonia. To help avoid infections, keep their teeth and mouth clean, treat cuts and scrapes with an antibiotic ointment right away, and make sure they, and anyone they will be in contact with, including yourself, get their flu shot each year. Protecting your loved one from the flu can help lessen their chances of developing pneumonia, which is one of the highest causes of death during this stage.

 

In stage seven, death is unfortunately inevitable. The best thing you can do for your loved one is make them as comfortable as possible. They will need your help to move and to do everything else at this point. You will want to make sure they are moved every two hours to prevent bedsores and also ensure they are getting the fluids and nutrition they need. They won't need as much food and nutrients as they used to at this stage. When they become stationary, they don't use as much energy, but they will still need to eat, so make sure they get nutrients in their body, even if they no longer eat on their own. Choking is another risk factor in this stage. Be careful around mealtimes and make sure their mouth is clear of food, too.

 

Visiting a loved one with Alzheimer's can be difficult, especially if they are in the later stages, but it's still important to visit them, even if they don't seem to recognize you or pay attention to your visit.

 

DailyCaring gives us a few items we can do to create a visiting plan. They say to limit visitors to one or two people at a time. Too many people can be overwhelming. Schedule visits for the time of day when your loved one is usually at their best and minimize distractions by keeping the environment calm and quiet. Turn off the TV or loud music and ask any non-visitors to go to another room. Tell any visitors your visiting plan ahead of time so they will know how to interact with your loved one to make the most of their time.

 

There are many ways you can connect with your loved one during a visit. You can make a memory book, play games, or listen to music. We recently did an episode on How to Talk to Loved Ones with Dementia if you would like to learn more about how to talk to your loved one during your visit. This would also be a good episode to send to other visitors or people that are nervous about visiting.

 

Your loved one isn't the only one affected by this progressive disease, you are, too. As the disease progresses and their needs and level of ability and independence change, yours change, as well. It is important to assess your situation at all stages and determine when you need help. Caregiver burnout will happen if you are not taking care of yourself correctly, which can be hard to do when you are taking care of someone else.

 

To avoid caregiver burnout, reach out to your support group and ask for help. If you need a day off, let them know. Having even a few hours to yourself can help you come back and be ready to continue providing care. If it's hard for you to get away, try scheduling time for respite care in advance, or sign up for an adult daycare program. If you're interested in learning more about preventing caregiver burnout, we've done quite a few episodes covering the topic. Check out our website for more information.

 

If you or a loved one has been diagnosed with Alzheimer's, you may be wondering what the next steps are and where you should go from here. The first thing you should do after getting diagnosed is research the disease and listening to this episode is a good place to start! Next, you should sit down with your family and anyone else you want to include and make your future plan. This plan is not going to be set in stone. You can change and adjust it along the way as you see fit, but being able to talk to your family about your wishes while you have the mental capacity to do so will help you and them later. They won't have to second guess themselves when they make decisions for you if you have already talked about it beforehand.

 

If you are still working, now is also a good time to talk to your employer and create a work plan. This plan should include ways you can do your job as the disease progresses, as well as an exit strategy. You can also start looking into financial planning at this stage. With the help of a lawyer, you should decide who you want to be in charge of your finances and healthcare decisions when you are no longer able to control them yourself.

 

You don't have to make all of these plans at once, either. You have time to plan, but the more you plan now, the more you will be prepared for later.

 

As the disease progresses, you will also want to make sure your living space is safe. You should remove items on the floor that could cause you to trip, like rugs and footstools, and install handrails in stairways and bathrooms. You should also ensure there is bright lighting throughout the home. As we get older, it gets harder to see in dim light. Having bright lights can help you see where you are going better and prevent you from falling.

 

There are several clinical trials happening right now that are focusing on Alzheimer's. You can talk to your doctor about getting on a clinical trial or contact an Alzheimer's Disease Research Center for more information.

 

We hope that learning about the seven stages of Alzheimer's and some of the strategies we mentioned can help ease your mind. If you are worried about how Alzheimer's will affect you and your loved ones, consider joining a support group or talking to a therapist. You can find a support group through your local Alzheimer's Association or Senior Center. Talking to someone in a similar situation can be helpful.

 

An Alzheimer's diagnosis is not the end of all things. Many individuals with the disease live up to twenty years after a diagnosis. More and more people are being diagnosed as the aging population rises, too. With a larger number of people living with Alzheimer's, the concept of dementia-friendly communities has been gaining popularity. For more information on dementia-friendly communities and how your local community can work on accessibility for those with dementia, visit our website or YouTube channel to listen to the episode we did on dementia-friendly communities.

 

We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode, please share it with them.

 

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Sources:

https://www.nia.nih.gov/health/what-alzheimers-disease

 

https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

 

https://www.cdc.gov/aging/aginginfo/alzheimers.htm

 

https://www.pennmedicine.org/updates/blogs/neuroscience-blog/2019/november/stages-of-alzheimers

 

https://www.biospace.com/article/the-seven-stages-of-alzheimer-s-disease-explained/

 

https://www.alzheimers.net/stages-of-alzheimers-disease

 

https://www.seniorlink.com/blog/the-7-stages-of-alzheimers

 

https://www.verywellhealth.com/alzheimers-symptoms-98576

 

https://dailycaring.com/visiting-someone-with-alzheimers-dos-and-donts-for-visitors/