This post has no content created by me. It's a bunch of quotes from links I collected.
The following is the Google search results for the words in the blog heading
These are the some of the interesting links and excerpts.
Can a patient’s ability to make decisions in the last days of life be impaired and how is this managed?
In a North American study of 47 carers of idiopathic PD patients in the last months of life most described the goal of care as comfort, and almost half “of the patients were described as unable to make any decisions in the last month of life.” "
https://www.verywellhealth.com/end-stage-parkinson-s-disease-hospice-criteria-5205423
- "Significant speech changes: Patients may have a very soft voice and experience speech freezing (when they cannot get their words out).
- Increased fall risk: Patients are at an increased risk of falling from a combination of poor balance, severe stiffness, and orthostatic hypotension (low blood pressure when changing positions).
- Severe dysphagia: Difficulty swallowing can lead to weight loss, malnutrition, dehydration, and a lung infection called aspiration pneumonia.
- To clarify, rapid disease progression means that patients are bedridden, have unintelligible speech, require a pureed diet, and/or need major assistance with activities of daily living (ADLs). All of these symptoms or circumstances are common in end-stage PD.
- "A critical nutrition impairment is common in end-stage PD and means that patients are:
- Unable to maintain sufficient fluid/calorie intake
- Continue to lose weight
- Experience dehydration
- Refuse artificial feeding methods
https://www.webmd.com/parkinsons-disease/guide/drug-treatments
"Like the newly reported study, patients who were older when their Parkinson’s disease was diagnosed had a greater risk for early death."
https://www.nia.nih.gov/health/end-life-care-people-dementia
Support for Dementia Caregivers at the End of Life
Caring for people with Alzheimer’s or other dementias at home can be demanding and stressful for the family caregiver. Depression is a problem for some family caregivers, as is fatigue, because many feel they are always on call. Family caregivers may have to cut back on work hours or leave work altogether because of their caregiving responsibilities.
Many family members taking care of a person with advanced dementia at home feel relief when death happens—for themselves and for the person who died. It is important to realize such feelings are normal.
https://parkinsonsdisease.net/basics/stages
Stage four of Parkinson’s disease
In stage four, PD has progressed to a severely disabling disease. Patients with stage four PD may be able to walk and stand unassisted, but they are noticeably incapacitated. Many use a walker to help them.
At this stage, the patient is unable to live an independent life and needs assistance with some activities of daily living. The necessity for help with daily living defines this stage. If the patient is still able to live alone, it is still defined as stage three.
Stage five of Parkinson’s disease
Stage five is the most advanced and is characterized by an inability to rise from a chair or get out of bed without help, they may have a tendency to fall when standing or turning, and they may freeze or stumble when walking.
Around-the-clock assistance is required at this stage to reduce the risk of falling and help the patient with all daily activities. At stage five, the patient may also experience hallucinations or delusions.
While the symptoms worsen over time, it is worth noting that some patients with PD never reach stage five. Also, the length of time to progress through the different stages varies from individual to individual. Not all the symptoms may occur in one individual either. For example, one person may have a tremor but balance remains intact. In addition, there are treatments available that can help at every stage of the disease. However, the earlier the diagnosis, and the earlier the stage at which the disease is diagnosed, the more effective the treatment is at alleviating symptoms.
https://www.compassus.com/for-caregivers/end-of-life-signs-the-final-days-and-hours nice suggestions
https://www.healthline.com/health/parkinsons/stages#stage-4
What is Parkinson’s disease?
Parkinson’s disease (Parkinsonism) is marked by the presence of certain recognizable symptoms. These include uncontrollable shaking or tremor, lack of coordination, and speaking difficulties. However, symptoms vary and may worsen as the disease progresses.
The main symptoms of Parkinson’s include:
- uncontrollable shaking and tremors
- slowed movement (bradykinesia)
- balance difficulties and eventual problems standing up
- stiffness in limbs
Many doctors who diagnose this brain disorder rely on the Hoehn and Yahr rating scale to classify the severity of symptoms. The scale is broken into five stages based on disease progression. The five stages help doctors evaluate how far the disease has advanced.
Stage 1
Stage 1 is the mildest form of Parkinson’s. At this stage, there may be symptoms, but they’re not severe enough to interfere with daily tasks and overall lifestyle. In fact, the symptoms are so minimal at this stage that they’re often missed. But family and friends may notice changes in your posture, walk, or facial expressions.
A distinct symptom of stage 1 Parkinson’s is that tremors and other difficulties in movement are generally exclusive to one side of the body. Prescribed medications can work effectively to minimize and reduce symptoms at this stage.
Stage 2
Stage 2 is considered a moderate form of Parkinson’s, and the symptoms are much more noticeable than those experienced in stage 1. Stiffness, tremors, and trembling may be more noticeable, and changes in facial expressions can occur.
While muscle stiffness prolongs task completion, stage 2 does not impair balance. Difficulties walking may develop or increase, and the person’s posture may start to change.
People at this stage feel symptoms on both sides of the body (though one side may only be minimally affected) and sometimes experience speech difficulties.
The majority of people with stage 2 Parkinson’s can still live alone, though they may find that some tasks take longer to complete. The progression from stage 1 to stage 2 can take months or even years. And there is no way to predict individual progression.
Stage 3
Stage 3 is the middle stage in Parkinson’s, and it marks a major turning point in the progression of the disease. Many of the symptoms are the same as those in stage 2. However, you’re now more likely to experience loss of balance and decreased reflexes. Your movements become slower overall. This is why falls become more common in stage 3.
Parkinson’s significantly affects daily tasks at this stage, but people are still able to complete them. Medication combined with occupational therapy may help decrease symptoms.
Stage 4
Independence separates people with stage 3 Parkinson’s from those with stage 4. During stage 4, it’s possible to stand without assistance. However, movement may require a walker or other type of assistive device.
Many people are unable to live alone at this stage of Parkinson’s because of significant decreases in movement and reaction times. Living alone at stage 4 or later may make many daily tasks impossible, and it can be dangerous.
Stage 5
Stage 5 is the most advanced stage of Parkinson’s disease. Advanced stiffness in the legs can also cause freezing upon standing, making it impossible to stand or walk. People in this stage require wheelchairs, and they’re often unable to stand on their own without falling. Around-the-clock assistance is required to prevent falls.
Up to 50 percent of people at stages 4 and 5 experience confusion, hallucinations, and delusions. Hallucinations occur when you see things that aren’t there. Delusions happen when you believe things that aren’t true, even when you have been presented with evidence that your belief is wrong.
Dementia is also common, affecting between 50 and 80 percent of people with Parkinson’s, according to the Alzheimer’s Association.
"Signs of late-stage dementia
Some symptoms of later-stage dementia can suggest the person is reaching the final stage of their condition. These include:
- speech limited to single words or phrases that may not make sense
- having a limited understanding of what is being said to them
- needing help with most everyday activities
- eating less and having difficulties swallowing
- bowel and bladder incontinence
- being unable to walk or stand, problems sitting up and becoming bed-bound.
If a person with dementia has most or all of these symptoms, they are probably nearing the end of their life. They may have other problems such as being very frail, having infections that keep coming back, or pressure ulcers (bedsores).
Signs of the dying process
As someone’s condition gets worse and they are within a few days or hours of dying, further changes are common. The person may:
- deteriorate more quickly than before
- lose consciousness
- be unable to swallow
- become agitated or restless
- develop an irregular breathing pattern
- have a chesty or rattly sound to their breathing
- have cold hands and feet.
These changes are part of the dying process when the person is often unaware of what is happening.
https://www.medicalnewstoday.com/articles/320794#after-death
Additional reading
- https://www.verywellhealth.com/movies-about-dementia-and-alzheimers-disease-97664
- Caregivers: Don’t Forget to Care for Yourself
- https://neurosciencenews.com/dementia-blueberries-20562/
- https://neurosciencenews.com/parkinsons-biomarker-20673/ Marker to detect Parkinson's
- https://neurosciencenews.com/aging-depression-21228/
- https://wapo.st/3FtxS3b: Relief at the end
- https://wapo.st/3F8CYkh: Walking reduces possibility of dementia
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