Dementia and the Struggle to Stay Healthy

Bathing. Eating. Accepting help. These are only a few of the health essentials that dementia patients may have difficulty with.

Deaths due to dementia are strikingly high. In fact, Alzheimer’s disease, which accounts for about 60 percent of all dementia cases, is the sixth leading cause of death in the United States. One of the goals of dementia care is to reduce the number of daily risks that are inherent in living with dementia. But even with dementia treatment, the progressive nature of the disease inevitably increases the risk of death.

“People die of complications associated with dementia,” explains James Ferrendelli, MD, professor of neurology at the University of Texas Medical School at Houston. The majority of patients (70 percent) die in nursing homes.

Dementia’s Impact on Physical Health:
Dr. Ferrendelli points out that in the early stages of dementia, normal recommendations for healthy aging still apply.

“You have a healthier aging if you’re physically active, watch your weight, and eat well, regardless of whether you have Alzheimer’s or not,” he says. The reality is that people who are living with Alzheimer’s disease or other forms of dementia still develop the other health conditions associated with aging: high blood pressure, heart disease, diabetes, stroke, cancer, and so on — all of which require treatment, even at the same time as dementia treatment.

However, over time, dementia symptoms make it increasingly difficult to follow through on these common health goals. Dementia impairs patients’ physical health by making these essential things more difficult:

Self-care routines, such as bathing, eating, and managing medicines Making appropriate and safe choices Controlling the bladder or bowels Accepting help Controlling movements Staying calm Swallowing Clearing secretions (mucus) from airways An inability to swallow and clear secretions from airways can be a direct threat to life — and as dementia progresses from mild to moderate, patients become more vulnerable to a variety of dangers that they might otherwise be able to control or avoid.

“If you’re more severely impaired, you could wander off into a highway, which means you’re more susceptible to being run over. If you’re bedridden, you’re more susceptible to the things associated with being bedridden,” Ferrendelli explains.

“There are people who live for long periods of time with dementia, and people who live for short periods,” says Ferrendelli, who advises caution when interpreting numbers around longevity after diagnosis. Dementia progresses differently for each individual, adding to the challenge of predicting length of life.

Here is a sample of the variability in how long a person can live with various forms of dementia:
Creutzfeldt-Jakob disease. Death usually occurs less than a year from disease onset. Frontotemporal dementia. If there is no motor neuron degeneration, people can live seven to eight years with this condition; average survival for people who have frontotemporal dementia with motor neuron degeneration is less than two and a half years. Diffuse Lewy body disease. Life expectancy is about three to five years from onset. Alzheimer’s disease. Estimates suggest that most people die within six years of diagnosis.

Reducing the Daily Risks of Dementia:
A good dementia care plan will assess your ability to move safely through your daily life. Your doctor and your care team may want to know about how well you are driving, managing your medications, or taking care of cooking at home. This is in part to make sure that you are still safely managing activities that can be a danger to you.

Once in a nursing home, the focus on risk reduction includes controlling the spread of infection, supporting regular feedings, and managing ongoing chronic diseases.

Ferrendelli also offers a word of sympathy and caution to caregivers. Many family members of loved ones end up blaming themselves when their loved one dies, feeling that somehow they should have been able to prevent the death. He stresses that death is inevitable, even with the best of care

By Madeline Vann, MPH
Medically reviewed by Pat F. Bass III, MD, MPH