How Does Dementia Kill You?

Dementia is well-known as a disease that impacts the brain, eventually robbing a person of most things that make them recognizable as an individual.

It’s also the leading cause of death in many places. One estimate suggests that close to 14% of deaths have dementia as an underlying cause, which is a shocking number (much higher than is often reported).

That might seem strange for a disease that mostly affects the brain. So, how does dementia kill you and what can you expect from the condition?

Does Dementia Kill You?

Let’s get the obvious question out of the way first, does dementia actually kill you?

The answer depends on how you define that idea, as dementia is rarely ever a direct cause of death. However, it is the underlying cause of death for many many people.

This is because dementia increases the risk of dying from a variety of causes. These risks increase as the disease progresses. 

This isn’t really so surprising. After all, dementia affects the brain and our brains influence countless processes throughout our bodies. When our brains aren’t working properly, there are all sorts of flow on effects.

And, at the very end of the disease, dementia impacts even the most basic functions in the body, leading to death.

How Dementia Leads to Death

Let’s dig into this a little more – as many dementia patients don’t die at the extreme end of their disease. They often die much earlier instead because of how the disease impacts their function.

Difficulties in General Health Management

Managing your health is relatively complex. It involves getting enough exercise, eating well, and keeping up with any vitamins and medications. People with co-existing conditions, like diabetes or high blood pressure, have other things to think about as well.

All these processes get more difficult with dementia. Even basic self-care practices become impossible in the late stages of the disease, so more complex ones certainly do. 

For example, dementia patients may forget they need to take a certain medication at a particular time. At some point, they may lose the ability to understand what medication is or how to take it.  

Increased Risk of Accidents

Accidents, large and small, are much more likely when patients have dementia. This is influenced by confusion, spatial awareness, and stability. Declines in these areas make it difficult to move around safely.

Besides, we often avoid accidents because we’re in a familiar place. But, dementia patients lose much of this familiarity. They’re easily disorientated, which raises the risk of accidents.

We’re not just talking about little accidents either.

In Where the Light Gets In, Kimberly Williams-Paisley talks about how her mother (in the early stages of dementia) still wanted to drive, even when it stopped being safe. She only had a minor accident in the car before she did stop driving, but had a more major one on a bicycle.

While an accident won’t necessarily kill a senior, the impact on their health can be considerable. Healing is also more difficult for dementia patients, especially when they don’t really understand what’s happening. It’s easy to see how this affects their overall health, their quality of life, and their risk of death.

Issues With Eating

Issues with food often start in the early stages of dementia, where a patient might find it more difficult to shop or to prepare food for themselves.

Some caregivers also find dementia patients are more unpredictable about food, often refusing to eat things they once enjoyed. Such issues become worse as the disease progresses.

In the book What I Wish People Knew About Dementia, Wendy Mitchell (who has dementia herself) explains some of the physical and emotional changes that occur around food. Her descriptions offer insight into just how food becomes so difficult and confusing for dementia patients.

Muscle control decreases in the later stages of dementia too. This can make it more difficult for people with dementia to chew their food. Even swallowing can become challenging.

The later stages of dementia also increase the risk of choking, particularly when seniors accidentally inhale fluids or even solid food. Choking like this can also lead to chest infections. 

Increased Risk of Infections

Patients with dementia are also at higher risk of infections.

This is partly because it’s more difficult for them to practice personal hygiene.

Some seniors may end up bathing less often, eventually being unable to bathe independently at all. Plus, as dementia progresses, seniors tend to move less, which raises the risk of ulcers and pressure sores.

Then there’s the issue of incontinence.

This is a big one for dementia patients, as they can become confused about the simple processes of going to the bathroom and cleaning themselves. Caregivers often need to clean the senior after each bathroom visit – a process that can make the patient confused or even angry.

Incontinence increases the risk of skin infections and UTIs. UTIs are a particularly big deal in seniors, as they can lead to delirium.

At the same time, patients in the later stages of dementia tend to have a compromised immune system. This makes them much more vulnerable to all types of infections. Indeed, patients with dementia often die from pneumonia following an infection – often related to choking and issues with eating.

Health Problems May Be Missed

Dementia limits people’s ability to express themselves, particularly in the late stages of the disease.

This means they mightn’t be able to indicate they’re in pain or show where the pain is. Other important information might be difficult to convey too.

Have you ever struggled at the doctor’s office to get them to understand your issue (or take you seriously)? How much worse would that be if you could barely express yourself?

So, serious health issues are sometimes caught later in dementia patients than in the general population. That puts their health at risk and contributes to the risk of death.

Body Systems Shut Down

Towards the end of life, dementia can cause such severe impacts that the body itself stops working as it should. This means that their lungs, digestive system, and heart may start having problems.

At this stage, careful around the clock care might be needed to support the senior. Even then medical intervention may only be able to make the senior more comfortable, rather than extending life.

These Issues All Interact

We’ve talked about a number of problems, like a compromised immune system, increased risk of accidents, and difficulties with nutrition. But, these aren’t isolated problems. They all interact with one another.

For example, if a dementia patient has a fall, their frailty increases the risk that their injuries are severe. If they’re undernourished, recovery may be more difficult and a compromised immune system increases the risk of an infection.

In the late stages of dementia, such interactions often mean that the patient is in and out of the hospital regularly for one problem or another. The transitions involved can be overwhelming for the patient and their family members, especially as the dementia patient may be confused, terrified, and combative.

Is Extending Life The Main Goal?

Many families of dementia patients choose to forgo some life saving measures as the disease progresses. Patients themselves may also request this as part of advance health directives.

This happens because in the late stages of dementia, medical interventions are often stressful, overwhelming, and terrifying for the dementia patient, while the benefits may be minimal. For patients who only seem to be partly there to begin with, it may feel better to allow them to pass gracefully.

Of course, this is a very individual decision, as the best approach for one person mightn’t be the best one for someone else.

The book, Making Tough Decisions About End-of-Life Care in Dementia offers insight into why and when families might take this approach. This includes a discussion of just how overwhelming the experience can be for the patient.

Final Thoughts

Dementia is an incredibly difficult disease from start to finish.

As you can see, it does eventually kill dementia patients. However, it’s normally an indirect cause of death and isn’t predictable at all. The senior’s health and the presence of any underlying health conditions have a strong impact on how long the senior lives. 

If your loved one is struggling with dementia, there are plenty of excellent resources that can help with your journey. These don’t stop the experience from being overwhelming at times, but they can give you a sense of what to expect as the disease progresses.

The 36 Hour Day is one of the best informational books out there on dementia. It provides as many details as possible about everything you can expect with the condition.

You can also check out movies, like The Father or Still Alice. These have their limits, but still offer important insight into dementia progression and the emotional toll it takes.