Patient Referral

Final Stage Dementia Symptoms and Stages: 10 Signs Death is Near

Dementia is a general term for a chronic or persistent decline in mental processes including memory loss, impaired reasoning, and personality changes. Alzheimer’s disease is the most common form of dementia followed by vascular dementia, Lewy body dementia, and frontotemporal dementia. It is the 7th leading cause of death in the United States and does not have a cure.

Caring for a loved one with Alzheimer’s disease, vascular dementia, or any other form of dementia is challenging as the individual’s personality changes and cognitive function declines. They may even stop recognizing their nearest and dearest friends and relatives. As the disease progresses, they will require more and more care.

As a family caregiver, it’s important to be able to recognize the signs that death is near with dementia. When necessary, hospice can help by offering care wherever the individual resides, providing physical, emotional and spiritual care to the patient and support to their family.

10 signs death is near in dementia patients.

Understanding vascular dementia end-of-life symptoms as well as the final stages of death from Alzheimer’s or any other form of dementia helps ensure these patients receive appropriate care. These signs include:

  1. Increased physical weakness.
  2. Decreased appetite and thirst.
  3. More frequent and longer periods of sleep.
  4. Communication difficulties.
  5. Changes in behavior.
  6. Increased infections or susceptibility to infections.
  7. Incontinence.
  8. Difficulty swallowing.
  9. Labored breathing or changes in breathing patterns.
  10. Changes in skin color and temperature.

Sundowner’s Syndrome at the end of life is also common, although it can also occur during earlier stages. Sometimes referred to as “sundowning,” this symptom describes the worsening confusion, anxiety, and agitation that patients experience late in the afternoon and evening. 

Timeline for end-stage dementia in the elderly.

It can be difficult to know when dementia patients are near the end of their life because of the nature of the disease’s progression, but understanding what symptoms are most common at what times can help ensure the patient receives the right care. Below is a timeline of signs of dying in elderly people with dementia:

Final Six Months

  • A diagnosis of another condition such as cancer, congestive heart failure or COPD
  • An increase in hospital visits or admissions

Final Two-to-Three Months

  • Speech limited to six words or less per day
  • Difficulty in swallowing or choking on liquids or food
  • Unable to walk or sit upright without assistance
  • Incontinence

Final Days/Weeks

  • Hands, feet, arms and legs may be increasingly cold to the touch
  • Inability to swallow
  • Terminal agitation or restlessness
  • An increasing amount of time asleep or drifting into unconsciousness
  • Changes in breathing, including shallow breaths or periods without breathing for several seconds or up to a minute

When are dementia patients eligible for hospice care?

Patients with dementia are eligible to receive hospice care if they have a diagnosis of six months or less to live if the disease progresses in a typical fashion. Once a patient begins experiencing any of the above symptoms, it is time to speak with a hospice professional about how they can help provide added care and support.

Tips for managing dementia end-of-life signs. 

Because individuals with advanced dementia will often have difficulty communicating, it is important that caregivers keep a close eye on their loved one for signs of pain or discomfort. These signs may include moaning or yelling, restlessness or an inability to sleep, grimacing, or sweating. This may also signal that it’s time to call hospice or a palliative care team to help with the pain management.

If an individual with end-stage dementia is having trouble sitting up without assistance, hospice can provide a hospital bed or other equipment to lift their head.

Perhaps the hardest thing for families is when a loved one with dementia is no longer able to eat or swallow. Because an individual with dementia is unable to understand the benefits of feeding tubes or IV drips, they will often be incredibly distressed and attempt to remove them, causing added pain and risk of infection. Instead, focusing on keeping the individual comfortable. Supporting them with mouth care to prevent their mouth from becoming dry will allow them to make their final transition in peace.

What you can do for your loved one.

As an individual with dementia declines, you can help them by providing a loving and supportive presence. Sit with them. Hold their hand. Play music they enjoy.

One of the greatest gifts you can give your loved one is helping to get their affairs in order. Ensure that financial and healthcare powers of attorney are put in place, so you can make decisions when your loved one is no longer able. Look into funeral arrangements before you need them, so you don’t need to make important decisions in a time of crisis.

Talk to your loved one’s physician about the possibility of palliative care support in the home and hospice care when your loved one is ready.

How hospice can help with end-stage dementia.

In addition to helping you recognize the signs that death is near in patients with dementia, bringing in hospice care will help with the physical and emotional demands of caregiving. Nurses will be able to adjust medication and care plans as the individual’s needs change. Aides can help with bathing, grooming, and other personal care. Social workers can help organize resources for the patient and family. Chaplains and bereavement specials can help the family with any emotional or spiritual needs. Additionally, family members can contact hospice at any time, and do not need to wait until it is recommended by the patient's physician.

To learn more about the criteria for hospice eligibility or to schedule a consultation, please call us at 855-327-4677 to speak with a hospice professional 24/7, choose one of the contact options in the bar above, or view our hospice service areas to find care in your area.


End-of-Life signs by disease.

Learn about the specific end-of-life signs of common diseases and illnesses:

More end-of-life resources.