Recognising and managing common physical symptoms

It is important to remember that physical changes caused by dementia are different for everyone. These changes will affect the needs of the person you support as dementia progresses. Maintaining comfort can help to control and manage symptoms and changes.

In the earlier stages of the condition, the person may not change physically, and their ability to get around (mobility) and look after themselves may be the same. This may be the case for some time. However, as dementia progresses, changes in the brain also affect how the person’s body can function. As dementia advances, people may appear weaker, thinner and have less energy than they used to. Everyday tasks may become more difficult such as housework or going out. Walking, using the stairs and getting in and out of a chair or a bed may become difficult.

There are lots of ways you can support the person in these changes. For example organising help for everyday tasks, or installing equipment such as stair rails and adapted chairs. Your GP or social worker will be able to put you in touch with other healthcare professionals such as district nurses and occupational therapist who will be able to help.

When we see people daily or regularly, physical changes are less easy to spot. People who visit less often may notice marked changes in the person’s physical appearance or their mobility. As dementia continues to progress, and when people enter the advanced stages, some common physical signs and symptoms can occur: These might include:

  • Reluctance to eat and drink leading to weight loss
  • Changes in continence (for example losing control over passing urine or constipation)
  • Decreased mobility
  • Sleepiness and tiredness
  • Less interested in other people and their surroundings
  • Communicating less with others
  • Seeking physical comfort and affection (for example hand holding)
  • Recurrent infections (chest and urine are most common)
  • Becoming increasingly frail
  • Problems with swallowing and oral health

As dementia progresses further, towards the very end of life, the person may rapidly change. These changes can be frightening, particularly if they are unexpected. In the table below we have listed some common changes. We describe what might happen and how you may be able to maintain comfort and help to control and manage some symptoms.

Physical changes What to expect and what might help
Skin May become clammy or waxy to the touch. Skin or nails may have a blue tinge (cyanosis) or mottled.
Breathing May become shallow; or may be noisy. Secretions (fluid) on the chest may cause a rattling sound; medication can help.
Drop in body temperature They may feel cool or cold.
Unable to swallow Moistening their lips or using special lollipops may help to keep the person comfortable.
Unable to move They may be unable to turn over in bed to keep themselves comfortable. A special mattress can help.
Body movement and speech People may become unresponsive or they may call out or become agitated. Their limbs may twitch. You may be able to reassure the person and medications can help with agitation.
Other A slowing of pulse and drop in blood pressure; their eyes may appear sunken; they may have a large bowel movement (either just before or just after passing away).

Your GP and other healthcare professionals such as palliative and Macmillan nurses (in the UK) will be able to advise on appropriate medications to help keep the person comfortable towards the end of life. Planning ahead for this support can help to maintain the comfort of the person you support.

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This article is from the free online course:

Dementia Care: Living Well as Dementia Progresses

Newcastle University