What is stage 6 severe dementia?

According to the Functional Assessment Staging Tool (FAST), stage 6 severe dementia is marked by moderately severe cognitive decline. Individuals in this stage lose significant functional abilities, requiring substantial help with daily tasks, and exhibiting major shifts in personality and memory.

Quick Summary

Stage 6 severe dementia, a phase of moderately severe cognitive decline, is characterized by a dramatic loss of functional abilities, compelling individuals to need extensive assistance with all activities of daily living. Symptoms include severe memory loss, profound behavioral changes, and difficulty recognizing loved ones, signifying a major progression of the disease.

Key Points

• Significant Dependence: Individuals in stage 6 need hands-on assistance with all daily living activities, including dressing, bathing, and toileting.

• Profound Memory Loss: Memory loss intensifies, with individuals forgetting the names of close family members like a spouse or children and having little awareness of recent events.

• Behavioral Changes: Pronounced personality shifts, including wandering, agitation, anxiety, delusions, and paranoia, become common and challenging to manage.

• Incontinence: Bladder and bowel control are typically lost during this stage, requiring specialized management strategies from caregivers.

• Communication Breakdown: The ability to speak and communicate effectively declines significantly, often leading to limited vocabulary or fragmented speech.

• Intensified Care Needs: The demands of caregiving increase dramatically, often necessitating professional home care, memory care, or transition to hospice services.

Understanding the Functional Assessment Staging (FAST) Scale

To accurately describe what is stage 6 severe dementia, it is essential to understand the Functional Assessment Staging (FAST) scale, a framework commonly used by healthcare professionals to track the progression of dementia, particularly Alzheimer's disease. The FAST scale delineates seven stages of functional decline, with Stage 6 representing severe cognitive decline, or moderately severe dementia. This phase is critically important as it signifies a loss of independence and the start of an intensified need for care.

The Breakdown of Stage 6: The Sub-stages

Stage 6 of the FAST scale is further divided into five distinct sub-stages, each marking a progressive loss of functional ability. This detailed breakdown helps caregivers and medical professionals anticipate and manage specific needs as they arise.

• Stage 6a: Dressing. The individual loses the ability to choose and put on their own clothes properly without assistance. They may wear pajamas over daytime clothes or be unable to use buttons and zippers.
• Stage 6b: Bathing. The person can no longer bathe independently. This may begin with an inability to adjust the water temperature and eventually escalate to needing full assistance.
• Stage 6c: Toileting. The individual needs assistance with managing the mechanics of toileting, such as flushing or using toilet paper correctly.
• Stage 6d: Urinary Incontinence. The loss of bladder control occurs, requiring regular toileting reminders and protective products.
• Stage 6e: Fecal Incontinence. The loss of bowel control, which typically follows urinary incontinence, necessitates comprehensive management.

Key Characteristics and Symptoms of Stage 6 Severe Dementia

The symptoms of stage 6 dementia are profound and directly impact the person's daily life and interactions. They mark a turning point where full-time supervision and assistance become necessary for safety and well-being.

Cognitive Symptoms

• Severe memory loss: Individuals have significant difficulty with both recent and remote memories. They may struggle to recall recent events and may not remember the names of schools they attended or their former occupations.
• Impaired orientation: Confusion about time and place worsens. The person may not know the day of the week, month, or year. They are often unaware of their current circumstances and surroundings.
• Difficulty with recognition: While they may still recognize familiar faces, individuals in this stage may confuse a spouse with a parent or become uncertain about the identity of close family members.
• Speech and language decline: The ability to articulate sentences and find words begins to break down. Speech may become sparse, and individuals may use made-up words or repeat words (verbigeration).

Behavioral and Psychological Symptoms

• Wandering and agitation: Many people with stage 6 dementia become restless and may wander, especially in the late afternoon or evening (often called 'sundowning'). Agitation, anxiety, and aggression are also common behavioral changes.
• Delusions and paranoia: False beliefs and paranoia can emerge. The person might believe their caregiver is trying to harm them or that they need to go to work when they are no longer employed.
• Obsessive and compulsive behaviors: Individuals may exhibit repetitive, purposeless actions, such as fidgeting, pacing, or moving objects around constantly.
• Changes in sleep patterns: Sleep-wake cycles can be disrupted, with increased sleepiness during the day and restlessness at night.

Essential Caregiving Strategies in Stage 6

Caring for someone in stage 6 severe dementia requires a shift from guiding and assisting to providing direct, hands-on care. Caregivers must focus on creating a safe, calm, and predictable environment to minimize stress and maximize the person's comfort.

1. Prioritize safety: Implement safety measures to prevent wandering, such as installing locks on doors and using monitoring devices. Secure hazardous materials and adjust water heater temperatures to prevent burns.
2. Establish routines: Create a consistent daily schedule for eating, bathing, and sleeping to provide a sense of stability and reduce confusion.
3. Use clear communication: Keep communication simple and direct. Avoid complex sentences and ask only one question at a time. Approach from the front and use gentle touch to get their attention.
4. Manage incontinence: Use a scheduled toileting routine and provide absorbent protective products. Be patient and maintain the person's dignity while assisting with this sensitive task.
5. Address behavioral issues: Rather than arguing or correcting, use redirection and reassurance to handle delusions or agitation. Reduce environmental triggers like noise and clutter that can cause distress.
6. Focus on sensory connection: As verbal communication declines, connect through touch, music, and favorite scents. Brushing hair, playing familiar songs, or holding hands can be very comforting.

Comparison of Stage 5 and Stage 6 Dementia

Feature	Stage 5 (Moderately Severe Decline)	Stage 6 (Severe Decline)
Independence	Needs significant assistance with complex tasks (finances, planning) and some basic tasks (choosing clothes).	Needs full, hands-on assistance with all activities of daily living (dressing, bathing, toileting).
Memory	Forgetfulness of recent events, personal history (address, phone number) but can recall personal information about themselves and loved ones.	Profound memory loss, forgetting names of spouse or children, unaware of recent events.
Orientation	Often confused about date, time, and location.	Severe disorientation to time and place; may confuse identity of loved ones.
Behavior	Possible personality shifts, mood swings, wandering may begin.	Pronounced personality and behavioral changes, including agitation, delusions, paranoia, and wandering.
Physical Health	Basic physical health is generally maintained with supervision.	Incontinence becomes a significant factor, requiring management.
Cognitive Awareness	Often still aware of their decline, which can lead to frustration and withdrawal.	Generally has little to no awareness of their condition or surroundings.

Navigating Care Options for Stage 6 Dementia

Making decisions about care becomes critical in Stage 6. Family caregivers often find the demands of 24/7 care to be overwhelming, and various options can provide support.

• Professional Home Care: Hiring trained caregivers to provide assistance with daily living activities can offer respite for families and ensure the person's needs are met in a familiar environment.
• Memory Care Facilities: These specialized residential facilities offer a secure environment and staff trained in dementia care. They can provide comprehensive, round-the-clock support.
• Hospice Care: For individuals whose prognosis is six months or less, hospice can provide comfort-focused care, emotional support for the family, and management of advanced symptoms. A specific FAST score (Stage 7a or greater) is a common criterion for hospice eligibility in Alzheimer's cases.

Conclusion

Stage 6 severe dementia represents a critical phase of profound decline where the person's functional abilities are severely compromised, and their world is primarily defined by instinct and immediate needs rather than memory. The escalating need for assistance, coupled with significant behavioral changes, places a tremendous burden on family caregivers. Understanding the specific symptoms and sub-stages, like those outlined by the FAST scale, is vital for providing empathetic and effective care. The focus of care shifts entirely to ensuring the individual's safety, dignity, and comfort. Caregivers must be prepared to seek support from professional home care, specialized memory care, or hospice services as the disease progresses, ensuring the best possible quality of life for their loved one throughout this challenging journey. The Alzheimer's Association is a valuable resource for caregivers seeking further information and support: alz.org.

Frequently Asked Questions

What is the primary difference between stage 5 and stage 6 dementia?

The primary difference lies in the level of dependence. In stage 5, individuals need help with complex tasks and choosing clothes, but still retain some independence. In stage 6, they require comprehensive, hands-on assistance for all basic activities like dressing, bathing, and toileting.

How long does stage 6 severe dementia typically last?

The duration can vary widely among individuals. However, based on the FAST scale, stage 6 severe dementia is estimated to last an average of 2.5 years in otherwise healthy individuals.

How can caregivers manage the behavioral issues of stage 6 dementia, such as agitation?

Caregivers can manage behavioral issues by creating a calm environment, sticking to a routine, and using redirection instead of direct confrontation. Reducing environmental triggers and focusing on sensory stimulation can also help soothe agitation.

What should I do if my loved one with stage 6 dementia wanders?

Safety is the priority. Implement locks to prevent wandering, use monitoring devices, and ensure the home is secure. Consider informing neighbors and local authorities, and if possible, use an ID bracelet with emergency contact information.

Is it normal for a person with stage 6 dementia to lose bowel and bladder control?

Yes, incontinence is a very common and expected symptom in the later sub-stages of stage 6 dementia. Establishing a toileting schedule and using appropriate absorbent products are necessary management strategies.

Will a person with stage 6 dementia still recognize me?

Recognition becomes unreliable in stage 6. While they might still register familiarity, they may not remember names and could even confuse a close family member for someone else. Caregivers should not take this personally but should gently remind them of their identity.

What kind of professional care is available for stage 6 severe dementia?

Options for professional care include professional home care, which provides trained assistance in the home; specialized memory care facilities, which offer a secure, full-time care environment; and hospice care, which focuses on comfort in the final stages of the disease.