If your loved one has Alzheimer’s disease, you probably have many questions about what lies ahead. Alzheimer’s disease is the most common type of dementia in older adults and the seventh most common cause of death in the United States. Most people live from four to eight years after their diagnosis, but some live for 20 years.

Many people don’t know that Alzheimer’s leads to death, let alone why. Although these topics can be difficult to talk about, understanding how this form of dementia progresses can help set expectations and preparations for what’s ahead.

No Cure for Alzheimer’s

Alzheimer’s disease is due to brain cell damage that builds up over time. Many people view the brain as a vessel for memory, understanding, and emotion — and these are some of the first functions affected by Alzheimer’s. However, the brain also is the coordinator for most bodily functions. Your brain tells your lungs to keep breathing, your heart to keep beating, and your intestines to digest. All these vital functions can be affected as damage accumulates and Alzheimer’s progresses, causing symptoms that appear after cognitive decline (reduced ability to think and memory loss).

Although you can survive with poor short-term memory, you can’t live without breathing or eating. The many physical manifestations of Alzheimer’s include malnutrition, pneumonia, loss of balance, and heart disease. Further, reduced cognition, coordination, and spatial awareness (ability to understand your body’s position within what’s around you) puts people with Alzheimer’s at greater risk of accidents and injuries.

There’s no cure for Alzheimer’s disease, but medications can help to slow its progression and reduce many symptoms. Despite treatment, however, many of the following symptoms and complications eventually occur in the later stages of Alzheimer’s.

Nutritional Challenges

As Alzheimer’s disease advances, individuals may have trouble getting proper nutrition. They may find it hard to chew and swallow food, have a poor appetite, or simply forget to eat. These symptoms get in the way of good nutrition, causing weight loss and dehydration over time. Malnutrition can lead to many health problems, including an increased risk of infection due to a weakened immune system.

The body needs less food near the end of life, especially during the final weeks. At this time, loss of appetite is normal, and it’s rare for someone to die of starvation or dehydration directly.

However, lack of nutrition makes people with Alzheimer’s more susceptible to other life-threatening illnesses. It’s important to help your loved one consume a nutritious diet, but this may not be easy. You can try strategies to encourage eating, and talk to your loved one’s doctor for more medical advice and support.

Aspiration Pneumonia

There are also more immediate risks to the inability to chew and difficulty in swallowing. When the average person gets food “down the wrong pipe,” they cough it up. However, people with Alzheimer’s don’t have a strong cough reflex, so their lungs become more vulnerable to aspiration. This is why a top cause of death in Alzheimer’s is aspiration pneumonia, a lung infection caused by inhaling liquids or food particles into the lungs. The millions of bacteria in the mouth and throat are likely to cause infection when carried through the lungs by choking on food, drinks, or even saliva.

If your loved one has trouble chewing, provide soft foods cut into small pieces or pureed. Look out for signs of choking, and know what to do if it happens.

Infections

Alzheimer’s plus aging makes the immune system weak — and so do other factors, such as taking certain medications or developing HIV. The weaker the immune system is, the harder it is for the body to fight off infections from viruses or bacteria. The bugs that enter the body can cause severe, even life-threatening infections. That’s why respiratory infections like the flu cause more complications in older populations than younger age groups.

People with Alzheimer’s need to be up to date on their vaccinations, including the annual flu shot and COVID-19 boosters. Keep loved ones with dementia away from people who are sick, and stay in touch with their doctor if you notice any signs of infection.

Urinary Tract Infections

One type of infection that often leads to death in Alzheimer’s dementia is a urinary tract infection (UTI). People with Alzheimer’s are prone to UTIs for several reasons, including:

• Poor hygiene, such as forgetting to change clothes or clean up properly
• Incontinence (not being able to make it to the bathroom), causing accidents that increase the risk of infection
• Dehydration, which leads to less urinating, so bacteria build up instead of being washed from the body
• Use of catheters during hospitalization
• Failure to recognize UTI symptoms, such as burning pain and fever

In addition, many people with Alzheimer’s who get UTIs can’t communicate their symptoms to a caregiver. Severe UTIs, if left untreated, can lead to a serious bloodstream infection called sepsis, which can be deadly. Watch for sudden changes in your loved one’s behavior, such as delirium associated with fever, and tell a health care provider right away if you suspect a UTI.

Falls

Difficulty with coordination and awareness of one’s surroundings puts people with Alzheimer’s at a greater risk of injury from falls. Falls from standing height may not seem like a big deal to a younger person with strong bones and muscles, but they often lead to a series of negative health events for a frail older person.

Because of malnutrition and weaker bones, a fall can easily cause a broken bone. A trip to the emergency room may lead to the operating room, followed by a stay in the intensive care unit. Not only are people with dementia slower to heal physically, but they’re also likely to pick up an infection in the hospital. Older adults, especially those with Alzheimer’s, are unlikely to fully heal from a major injury.

Preventing falls is one of the best ways to help your loved one stay out of the hospital. The National Institute on Aging offers a room-by-room guide to making your home safer and reducing the risk of serious injury to a loved one.

Dying ‘With’ Alzheimer’s, Not ‘of’ Alzheimer’s

Alzheimer’s disease tends to affect older age groups. Most people with Alzheimer’s have other health conditions at the same time (comorbidities). Heart disease, diabetes, and cancer are common in older people and are some of the leading causes of death in the United States. One study in Sweden found that ischemic heart disease, including heart attacks, is the second most common cause of death among people with dementia, after bronchopneumonia (which affects the lungs’ air sacs).

Alzheimer’s may make it harder to take care of chronic conditions. Doctors’ appointments and daily medications may be forgotten, blood pressure or blood sugar may not be checked, and screenings may be skipped. If you have a loved one with Alzheimer’s, do your best to help them take care of their other health conditions.

Preventing Alzheimer’s Complications

Caregiving for someone with dementia is a hard job. Discussions about death, like this article, can be difficult. Make sure to seek support for yourself during this time.

Knowing about late-stage complications of Alzheimer’s equips you to help prevent them as long as possible. The first step is being aware of malnutrition, dehydration, and infection.

In the final stages of Alzheimer’s disease, people with dementia are often unable to get out of bed, are nonverbal, and depend on their caregivers for all of their needs. They may be unable to move, become incontinent, and develop severe cognitive impairment. It’s critical to access comforting, compassionate palliative care to ensure that your loved one maintains their dignity and has the best possible quality of life as their Alzheimer’s progresses.

Talk With Others Who Understand

On myALZteam, the social network for caregivers of people with Alzheimer's disease, more than 85,000 members come together to ask questions, give advice, and share their stories with others who understand life with Alzheimer’s.

Do you worry about what will happen during the later stages of Alzheimer’s disease? What have you done to prevent the complications of Alzheimer’s? Share your experience in the comments below, or start a conversation by posting on your Activities page.