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28 Sep 2020

Pearl Gem: Late-Stage Dementia


Pearl represents late-stage dementia. A Pearl was chosen to represent this stage because the gem is hidden inside a shell. It looks as if there is nothing of value on the outside (the shell), but if you open the shell and look inside, you see the amazing gem we are talking about. When interacting with your loved one, you must remember to look past the shell and see the gem they are on the inside.

Some of the basic characteristics of a Pearl include:

  • Muscle control is greatly diminished, leaving their muscles turned on; you will notice them curled up and leaning to one side.
  • They are unable to have isolated muscle movement.
  • You may notice them writhing as they have moments where their muscles are unable to relax.

Be careful forcing them to move; it can be very painful for them.

What to Expect

The top of the brain (muscle control) dies at this stage of dementia leaving all of the muscles turned on, and there is no off switch. For the muscles there is no relaxing and no quitting. The disease is destroying a lot of the control the brain has over the body. Since a Pearl’s muscles are turned on all the time it's important to remember to try not to straighten a persons arms or legs, without relaxing them first. Trying to straighten their arms or legs may cause them a great deal of pain and they may yell out.

When walking, a Pearl’s back is curled forward and their arms are pulled in. They're also taking smaller steps and walk on the front of their feet. A Pearl no longer has isolated movements, making it impossible for them to sit down fluidly. As a result, they fall into a chair when trying to sit down. The strongest muscles in their bodies are pulling across, in, and down, which is why the arms and legs are pulled in. If a Pearl is sitting for a long period of time, their body is curled up. They fall off to one side, unable to keep their balance and continue to sit up straight. A Pearl can also fall forward from a sitting position. Due to no longer having isolated movements, they cannot straighten out their legs or arms to catch themselves. This results in falls and injuries can occur.

Some helpful tips in caring for and interacting with a loved one at this stage:

  • Don’t be in a hurry to get a task done. Many believe that moving quickly to get the task done faster is the best way to do things. However, the worst thing you can do is hurry up and try to get things done quickly. They can get frightened since they don’t know what you are doing, and injuries can occur.
  • Slow down. When giving your loved one any type of cue (verbal or visual), give them up to 30 seconds to respond. It may seem like a long time, but it will be beneficial to both you and them.

The Five stages of Grief

Knowing and understanding the five stages of grief is very important and helpful at this stage of dementia. You and your family will be dealing with the loss of a loved one and will understandably go through a variety of emotions.

Understanding the stages of grief will help you and your family through the process, remembering that everyone goes through them differently and not necessarily in this particular order.

1. Denial and Isolation

This stage may come prior to the loss of your loved one as well as after the loss. Denial can be a reaction to first learning of the diagnosis of Alzheimer’s or dementia. In the denial stage, words are blocked out, and we hide from the facts. We try to convince ourselves that our loved one isn’t gone.

2. Anger

As denial starts to wear, the reality of the pain you are facing reemerges. Anger may be directed at family, friends, inanimate objects, or strangers. Your anger may even come out toward the love one you have lost, feeling resentment toward them for causing you pain. You may feel guilty for being angry with them, which in turn makes you more angry. Anger may also come out toward the doctor. You may feel angry with them that they were unable to cure your loved one. Take your time when trying to work through this stage.

3. Bargaining

During this stage, we are trying to regain control of a situation that is not in our control. We try to bargain with a higher power or our loved one in an attempt to postpone the inevitable. Some common statements are ,“If only we had sought medication attention sooner,” or “If only we got a second opinion from another doctor.”

4. Depression

Two different types of depression come in this stage. One is the worry of the costs and burial of our loved one as well as the worry that we have spent less time with our other loved ones. The second type is more private, and it is our way or preparing to say goodbye.

5. Acceptance

The last stage is being able to come to terms with the loss of your loved one. This comes at different times for each person, and some people may never reach this stage. Allow yourself to feel the grief and go through the stages to hopefully be able to come to terms and be accepting of your loss.

For more information call Senior Helpers today to get the help your loved one and family need today.

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Don't forget to learn more in this series by reading Parts 1-4 below:

Part l: Senior Gems: Sapphire and Diamond

Part ll: Emerald Gem:Early to Mid-Stage Dementia

Part lll: Amber Gem: Mid-Stage Dementia

Pat IV: Ruby Gem: Mid-Stage to Late Dementia