The Impact of Treatment Refusal on Life Expectancy in Alzheimer’s and Dementia

The life expectancy of individuals with Alzheimer's or dementia who refuse medication and treatment can vary widely, but the progression of the disease tends to be more rapid without medical intervention. Generally, on average, individuals with Alzheimer's live around 4 to 8 years after diagnosis, though some may live as long as 20 years. Without treatment, complications such as infections, malnutrition, and other health issues can arise, potentially shortening life expectancy.

Understanding Alzheimer’s and Dementia

People with Alzheimer’s dementia likely have the disease for up to twenty years before symptoms are noticeable. At this point, brain damage is ongoing and irreversible. To date, there is no definitive cure for Alzheimer's. The medications available such as Aricept and Namenda only slow down the progression of the disease in the early stages. By middle stages of the disease, these drugs are no longer effective.

Emerging treatments aim to reverse the plaques and tangles associated with Alzheimer's. However, even if plaques and tangles are removed or managed, neuron damage may be irreversible. Some studies suggest an increased risk of brain swelling and death with medications targeting these plaques and tangles. Intervention and support are crucial once an individual is diagnosed, typically well into the middle stages.

Symptoms and Management in Early and Middle Stages

During the earlier stages, people with Alzheimer's are often aware that they are forgetting things and may try to manage their symptoms with lists, notes, and other coping mechanisms. They can usually manage well in their own home, using familiar stories and banter to hide their symptoms. However, as the condition progresses, they may struggle with paying bills, keeping up with grooming, or completing household chores. They may also have trouble using the stove or microwave, signaling a need for family members to step in and assist more regularly.

The involved family members often become concerned about the individual's driving, missed appointments, and getting lost in familiar surroundings. By this point, intervention for safety becomes necessary. Many people can continue to live in their home with family supports, possibly including meal delivery services and home healthcare.

Advanced Stages and Care Options

As the caregiving burden increases, or if the individual starts to wander, become combative, or poses a safety risk, it may be necessary to explore care options beyond the home. Assisted living is often considered first because it is more affordable, but just moving to an unfamiliar environment can exacerbate symptoms. If assisted living does not prove sufficient, a nursing home may be the next step. For individuals who wander or are at risk of elopement, a memory care unit might be necessary.

Conclusion

The decision to refuse medication and treatment for Alzheimer's or dementia can significantly impact life expectancy. While there is no definitive cure, early intervention can help manage symptoms and potentially slow the progression. Caregivers play a crucial role in supporting individuals at all stages of the disease, ensuring their safety and quality of life.