10 Signs Death Is Near in Dementia & How Hospice Care Can Help

Watching a loved one’s health decline due to dementia is heartbreaking, especially when it becomes clear they are nearing the final chapter of their life. Families often wonder what to expect as the end approaches and how to know when it is time to seek additional support from professionals.

Alzheimer’s Disease – the most common form of dementia – is the seventh-leading cause of death in the United States, according to the National Institute on Aging. It is a progressive, terminal illness. As it advances, patients experience both physical and cognitive deterioration that leads to total dependence. 

Recognizing the 10 signs death is near in dementia can help families prepare emotionally and practically – and allow them to focus on comfort and quality of life during this precious time.

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In this article, we will explore these signs and explain how hospice care can bring compassionate support to both patients and caregivers during the final chapter of life.

Understanding the Final Stage of Dementia

In the last stage of dementia, also referred to as “end-stage” or “late-stage” dementia, individuals typically:

• Are completely dependent
• Require full-time care
• Have limited or no verbal communication
• Are bed-bound or wheelchair-dependent
• Experience difficulty eating or swallowing

Families may also notice changes that signal death is near. Many of these are physical, emotional, or behavioral. Knowing what to look for can help loved ones make informed decisions about hospice care and ensure their loved one’s final days are spent with comfort and dignity.

10 Signs Death Is Near in Dementia Patients

Each person’s experience with dementia is unique, but the following are the most commonly observed indicators that the end may be approaching. If several of these signs are present, it may be time to consider hospice or specialized home care.

1. Increased Sleeping or Unresponsiveness

Patients may sleep for longer periods, be much harder to wake up, and appear unaware of their surroundings when they first wake up. Their wakeful moments become shorter and less frequent. 

2. Difficulty Swallowing

One of the biggest signs that the end is approaching is dysphagia – sudden difficulties in swallowing when eating or drinking. Symptoms include:

• Coughing/Choking/Excessive Throat-Clearing
• Difficulty Chewing and Swallowing
• Food Getting Stuck in the Back of the Throat
• Holding Liquid or Food in the Mouth Without Swallowing
• Excessive Drooling
• Weight Loss

3. Minimal Verbal Communication or Complete Silence

As the disease progresses, the ability to speak may fade completely. You might only hear occasional murmurs or sounds, but nothing like an intentional attempt to communicate.

4. Loss of Interest in Eating or Drinking

Even favorite foods no longer appeal. The body begins to shut down and no longer signals hunger or thirst. In other circumstances, caregivers might look at a loss of appetite as a problem to be solved, but this is a normal part of the final stage. 

5. Cool Extremities/Changes in Skin Color

When the person’s heart starts to fail and stops pumping blood efficiently, circulation slows considerably. This often leads to cold hands and feet or patchy, purplish-blue skin with a marbled appearance. Mottled skin typically appears during the last week of life, appearing first on the feet and then moving up the legs. 

6. Frailty and More Falls

“Frailty” as a medical term means the person’s higher-order functions are failing, and as a result, their health problems are starting to accumulate including, cognitive impairment, poor mobility, and overall functional decline.

As a person nears their final days, their health problems start to pile up, resulting in:

• Loss of strength
• Exhaustion
• Greatly impaired mobility
• Reduced activity
• Frequent falls
• Extremely slow healing or recovery
• Infections 

7. Difficulty Breathing

One of the telltale signs that the body is preparing to shut down is a major change in the person’s breathing pattern. In the days and hours before death, their respiration becomes very irregular, with longer and longer pauses between breaths. It will also become much louder because they are unable to clear their throat or sinuses.

8. Changes in Heart Rate

As the person’s body weakens, their vital signs will fluctuate. They might experience an irregular heartbeat or a significant drop in blood pressure. This may, in turn, cause them to sleep more and lapse in and out of consciousness, often to the point of being unresponsive.

9. Agitation or Restlessness

Although dementia can cause some patients to be more aggressive, this can be much more pronounced in end-of-life patients.

Some patients exhibit terminal agitation – fidgeting, pulling at clothing or sheets, or appearing confused and anxious, all without any apparent reason.

When this happens, normal soothing tactics and efforts to calm them may not work, so tranquilizing medication may be the only viable option.

10. More Infections and Medical Complications

At the end of a person’s life, when their organs start to fail, their weakened condition can lead to a compromised immune system and frequent or recurring infections. This can make them even weaker, which means they have an even harder time fighting off or recovering from new health problems.

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When to Opt for Hospice Care at Home

You should consider hospice care for your loved one when a doctor believes the patient has six months or less to live. This decision often aligns with multiple symptoms from the list we explored earlier in this article. It is important for families to understand that considering hospice care does not mean giving up. Rather, it means prioritizing quality of life during this precious time. In many cases, opting for hospice care earlier leads to better outcomes and greater peace of mind.

How Hospice Care at Home Helps in the Final Dementia Stages

Hospice care provides holistic, compassionate support for patients and families during the final stages of a terminal illness. For dementia patients, in-home hospice care from Nurse Next Door focuses on:

• Comfort: Managing pain, breathing difficulties, and agitation
• Nutrition support: Offering gentle hydration and feeding options without force or discomfort
• Emotional care: Providing spiritual guidance and counseling for both patients and families
• Respite care: Giving family members time to rest, grieve, and be present
• 24/7 availability: Ensuring help is available when symptoms suddenly worsen

The goal is to help your loved one pass peacefully and with dignity, surrounded by love.

If you want more information on how in-home hospice care can help your loved one, reach out to Nurse Next Door today.

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Conclusion

By understanding the 10 signs death is near in dementia, families can provide their loved ones with compassionate care. These signs are also reminders to begin cherishing each moment, seek support, and focus on what truly matters. If your loved one is facing the final stage of dementia, know that help is available – and you do not have to go through it alone. Nurse Next Door’s in-home hospice care services provide relief, guidance, and dignity when they are needed most.