The later stages of dementia

11. Health problems

There are a number of common factors during the later stages of dementia that can affect a person’s health. These include problems with movement (see ‘Loss of mobility’ above), the side effects of medication and illness (such as infections) or discomfort and pain. The person may also develop health problems related to age, such as arthritis and rheumatism.

Side effects of medication

All drugs have possible side effects. Some of the drugs often prescribed for behavioural symptoms in people with dementia can have severe side effects and may increase the person’s confusion and their risk of falls. Some people in the later stages of dementia are prescribed drugs that are no longer appropriate to their needs, or in doses that are too high. Anyone who is concerned about the effects of the person’s medication should talk to their GP. It may be possible to change the dose or the medication. For more information see factsheet 408, Drugs for behavioural and psychological symptoms in dementia.

Illness and discomfort (including pain)

Infections such as urinary tract infections (UTIs) can increase confusion in people with dementia, and can also speed up the progression of the condition. They are also common in the later stages. It is important that infections are quickly diagnosed and treated. A person in the later stages of dementia may be unable to communicate to others that they are feeling unwell or are in pain. However, there may be a change in their behaviour that is a sign of this. Observing the person and looking for any changes in them can help you to notice any problems. If you think the person may be unwell or in pain, speak to the GP.

If the person with dementia is unwell and there is a sudden change in their mental abilities or behaviour that lasts several hours, it is often a sign they have delirium. Symptoms of delirium include:

  • not paying attention or concentrating
  • confused and muddled thinking
  • disturbed language (for example, speech that doesn’t make sense)
  • change in consciousness (for example, feeling drowsy or much more alert)
  • change in the person’s sleep/wake cycle
  • hallucinations and delusions.

The symptoms will change as the day goes on (for example, the person may be agitated earlier in the day but be lethargic later on). The symptoms are often better in the morning than the evening. If the person suddenly becomes confused or develops these symptoms they should see a doctor immediately.

A person still feels pain in the later stages of dementia even though they may not be able to verbally communicate it. The person may be unable to tell you they are in pain, and as a result they may start to behave in ways that are unusual. It’s important to consider pain as a cause and make sure that it is properly managed.

Many people in the later stages aren’t given enough pain medication and may be left in pain that could otherwise be treated. Common causes of pain in people with dementia include urinary tract and other infections, constipation and other conditions (for example arthritis). If you think the person may be in pain, speak to a GP about medication and non-drug approaches (such as massage) that may help.