Loss and Grief in Dementia

Section 5
results in a decline in functioning.
in order to be effective. IV antibiotics are not effective
for repeat infections that have not responded to oral
antibiotics.
C
The figure above is taken from Hospice UK (185) and gives the reader an overview of the dementia
trajectory using a palliative care approach/framework. What is known is that people dying with
dementia have an ambiguous/ uncertain trajectory towards death. It is important to note that different
types of dementia have unique characteristics and may have different trajectories. Trajectories will
also be influenced by the person’s co-morbidities. Below is taken from (186) and gives a sense of
effective, and may result in injury to the body.
some of the differing presentations, however this is a guide only and does not replace the need to
take an increase individual comfort person-centred and do not improve approach quality of life. to supporting people with dementia.
Trajectory Table
Disease
Alzheimer’s disease
Vascular Dementia
Lewy Body Dementia
Trajectory
High level cognitive functioning is initially lost, followed by basic functioning, including ability to
complete ADL’s and basic motor skills. Eventually the person will lose the ability to chew, and then the
ability to swallow. This is a slowly progressive illness with a predictable decline but REMEMBER there
are always individual variations.
Cognitive and physical function is lost in a step-like fashion. Abilities will decline based on the area of
the brain affected by a large or small strokes. Therefore, the ability to swallow may be lost before the
ability to walk. Death is more likely to occur suddenly due to cardiovascular disease.
The person experiences clear periods amidst ongoing confusion. Hallucinations are a hallmark of this
disease even at the onset and the person may have periods where their function is better than others
– for example: walking one day and unable to the next.
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Loss and Grief in Dementia