For people with advanced illness, the priority may gradually shift from maintaining physical performance to preserving comfort and preventing injury.
Care plans should reflect the person's abilities and preferences.
Chapter 5: Sign Four β Changes in Memory, Awareness, and Communication
Changes in thinking and communication can occur in older adults with advanced illness.
Families may notice that a loved one becomes forgetful, has difficulty following conversations, repeats questions, or appears less interested in their surroundings.
Some people may become confused about the date, location, or identity of familiar individuals.
Others may have difficulty expressing their needs or understanding what is happening around them.
These changes can be associated with several different medical conditions.
Dementia and Progressive Cognitive Decline
Dementia is an umbrella term for conditions that cause progressive impairment in memory, thinking, language, judgment, and everyday functioning.
Alzheimer's disease is one of the most common causes.
Other forms include vascular dementia, Lewy body dementia, and frontotemporal dementia.
In advanced dementia, a person may eventually lose the ability to communicate clearly, recognize familiar people, walk independently, or swallow safely.
As the disease progresses, the risk of infections, falls, malnutrition, and other complications may increase.
However, dementia follows different patterns in different people.
It is not possible to predict an individual's remaining lifespan from memory problems alone.
Delirium: A Sudden Change That Requires Attention
One important condition families should understand is delirium.
Delirium is an acute disturbance in attention and awareness.
It can develop over hours or days and may cause sudden confusion, agitation, unusual sleepiness, or changes in behavior.
In older adults, delirium can be triggered by:
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Urinary or respiratory infections.
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Dehydration.
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Medication side effects.
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Severe pain.
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Constipation or urinary retention.
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Electrolyte disturbances.
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Low oxygen levels.
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Recent surgery or hospitalization.
Delirium is not simply a normal part of aging.
It requires prompt medical assessment because some causes are treatable and potentially serious.
An older person who suddenly becomes confused should not be assumed to be experiencing dementia or approaching the end of life.
Changes in Communication
As some illnesses progress, communication may become more difficult.
A person may speak less, need more time to answer questions, or struggle to find the right words.
In advanced neurological disease, they may eventually rely more on facial expressions, gestures, or other forms of nonverbal communication.
Families can help by:
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Speaking slowly and clearly.
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Using short, simple sentences.
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Allowing extra time for responses.
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Reducing background noise.
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Maintaining eye contact when comfortable.
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Avoiding unnecessary arguments about minor mistakes.
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Watching facial expressions and body language.
Even when verbal communication becomes limited, familiar voices, gentle reassurance, and a calm environment may provide comfort.
Chapter 6: Sign Five β Withdrawing From Social Activities and Changes in Emotional Well-Being
Another change families may notice is a gradual reduction in social interaction.
An older person who previously enjoyed family gatherings, conversations, hobbies, or outings may begin spending more time alone.
They may stop participating in activities they once enjoyed.
Some people become quieter, while others appear emotionally distant or less interested in their surroundings.
This can be difficult for relatives to understand.
They may interpret the behavior as rejection, stubbornness, or a loss of affection.
However, withdrawal can have several possible causes.
Physical Limitations Can Make Socializing Difficult
Social activities often require energy.
An older person who experiences pain, breathlessness, fatigue, or mobility problems may find it difficult to attend gatherings.
Even sitting through a long conversation can become exhausting.
They may prefer shorter visits or quieter environments.
Depression and Loneliness
Depression can affect older adults, particularly those experiencing chronic illness, bereavement, reduced independence, or social isolation.
Symptoms may include:
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Persistent sadness.
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Loss of interest in previously enjoyable activities.
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Changes in sleep.
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Reduced appetite.
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Feelings of hopelessness.
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Difficulty concentrating.
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Withdrawal from family and friends.
Depression is not an inevitable part of aging.
It is a medical condition that deserves assessment and treatment.
Older adults may not always describe themselves as feeling sad. Instead, they may report fatigue, pain, poor sleep, or a general loss of motivation.
Anxiety About Illness and Dependence
A person who realizes that their health is deteriorating may experience fear and uncertainty.
They may worry about becoming dependent on others, losing control over everyday decisions, or placing a burden on their family.
Some may avoid discussing their health because they do not want to upset loved ones.