Treatment and care in the later stages

Medication and care may change in the later stages of dementia. Find out about treatment options, advance decisions, and living options.

Medication

There is good evidence that drugs commonly prescribed for the treatment of Alzheimer's disease known as the cholinesterase inhibitors (donepezil, rivastigmine and galantamine) have benefits for people in the later stages of the disease. Many doctors now continue to prescribe these for severe Alzheimer's disease.

Memantine is also recommended for people in the later stages of Alzheimer's disease. It can slow down the progression of symptoms including difficulties with everyday activities and disorientation. There is some evidence it can also help with symptoms such as delusions, aggression and agitation.

Memantine is recommended in the guidance used by health professionals as part of NHS care for the treatment of severe Alzheimer's disease, or in the moderate stage of Alzheimer's where drugs such as donepezil cannot be taken.

There is some evidence that both memantine and cholinesterase inhibitors (known as 'combination treatment') can be helpful. However, the guidance for health professionals does not recommend combination treatment.

Memantine is not suitable for people with other types of dementia.

Drug treatments for dementia

Read more about medication options for treating people with dementia.

Drugs for Alzheimer's disease Drugs for dementia symptoms

Planning for care in the later stages

If the person with dementia has made their wishes known regarding care in their later stages, you can support them and help them to meet these plans. These may consist of various things.

In England and Wales people can write an advance decision. This is sometimes written as ADRT - advance decision to refuse treatment - and used to be known as a living will or advance directive. They can also write an advance statement to express their wishes and preferences about future care (though this is not legally binding). They may also wish to appoint a Lasting power of attorney for health and welfare.

In Northern Ireland people can also make an advance directive and advance statement. They may appoint power of attorney under the Northern Ireland system, Enduring power of attorney and controllership.

We also have financial and legal tips for those in Northern Ireland.

Legal issues in the later stages of dementia

Find out more about advance decisions and lasting power of attorney for people with dementia.

Advance decisions (living wills) Lasting power of attorney

Assessment for care and support

As the person's dementia progresses, think about the most suitable place for them to live based on their wishes and needs, as well as the support available to them. This includes whether other people are able and willing to care for them. The local authority can carry out an assessment of need for everyone who may be in need of community care support.

See below for information about care and support assessment in England, or read more about assessment in Northern Ireland and in Wales.

Assessment for care and support in England

Some people with dementia and their carers will be entitled (often called ‘eligible’) to have their needs for care and support met by the local authority, free of charge or at a reduced cost. Find out more.

Assessment for care

Where will the person be cared for?

People in the later stages of dementia can live and be supported in different places. Find out whether the person's needs can be met in these settings.

  • Their own home - some people continue to live at home with support from carers and/or health and social care services. Devices and equipment can sometimes support the person to remain at home. Read more about devices to help with everyday living.
  • Sheltered and extra care housing - sheltered accommodation and extra care housing should have 24-hour emergency help available via an alarm system. Extra care housing also includes care and support on site (for example, meals may be provided).
  • Care home - staff in care homes (including residential and nursing homes) can provide help with personal care (such as washing and dressing). Nursing homes have a qualified nurse on duty 24 hours a day. If the home is registered as a care home with dementia care, they should have staff qualified in supporting people with dementia. The person with dementia will still be able to access NHS services.
  • Hospice - care in a hospice focuses on reducing physical and psychological distress and providing support to those who are important to the person. Hospice care is for people who have an illness that is no longer treatable, sometimes including people with dementia. Often this is near the end of a person's life. Read more about end of life care
  • Hospital - people with dementia are less likely to be cared for in hospital for long periods during the later stages. However, they may have short stays in hospital, often because of another illness. If this is the case, make sure hospital staff are aware of the person's dementia and other information about the person.

If you're thinking about the person moving in the later stages consider the impact this will have on them. Adjusting to a new environment in the later stages can be challenging. It's important that the person lives somewhere suitable for them where their needs can be met.

If you are concerned about any aspects of the person's care, ask the service or organisation providing the care for their complaints procedure. If, after following this procedure, you feel that your complaint has not been properly addressed, you can take the complaint further. The next steps should be explained in their complaints procedure.

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