(Very limited awareness, fragile health, full-time comfort care)

Stage 9 dementia reflects profound loss of cognitive function, very limited awareness, and near-complete physical dependence.
The person spends most of the time sleeping, has almost no communication, and relies fully on compassionate caregivers.

This stage focuses entirely on:
Comfort
Pain management
Gentle presence
Dignity

Even when they cannot speak or respond, they still feel safety, warmth, love, music, and human presence.

• Little to no recognition of family
• Minimal response to surroundings
• Brief moments of eye opening or mild awareness
• Appears in a “deep inner world”
• Very short periods of wakefulness

• No meaningful words
• May produce occasional sounds or murmurs
• Communication becomes fully non-verbal

• Usually bed-bound
• Needs full support to reposition
• Unable to sit or hold head upright without assistance
• Muscles become rigid or extremely weak
• High risk of contractures (joint stiffness)

• Swallowing is slow and unsafe
• Very high choking risk
• May require puréed diet or thickened liquids
• In some cases, swallowing may stop altogether
• Needs full supervision for every sip and bite

• Full assistance with feeding
• Total incontinence
• Requires constant hygiene care
• Needs repositioning every 2 hours

• Very high risk of infections (pneumonia, UTI)
• Weight loss and dehydration risk
• Difficulty regulating temperature
• Skin breakdown and pressure sores

• Moaning, calling out, or restlessness (often signalling discomfort)
• Body stiffening or fidgeting
• Shallow or irregular breathing
• Long periods of stillness

• Sleeps 18–22 hours a day
• Awake only briefly
• May not respond even when awake

At Stage 9, the person:

• Cannot communicate needs
• Cannot move independently
• Cannot eat or drink safely without full help
• Needs 24-hour hands-on care
• Lives mostly in a state of deep confusion or minimal awareness

But they may still respond to:

• Soft music
• Gentle touch
• Warm blankets
• A familiar voice
• Calm lighting

These small comforts still reach them.

• Speak softly and slowly
• Use gentle touch: holding hands, stroking the forehead
• Play quiet, familiar music throughout the day
• Keep the room warm, calm, and peaceful
• Reposition regularly to prevent pressure sores
• Use soft pillows to support limbs
• Monitor facial expressions for signs of pain
• Offer emotional presence even if they don’t respond

Love, safety, and comfort are the main goals.

• 2-hourly repositioning
• Careful bed transfers with support
• Safe feeding to avoid aspiration
• Use night lights to prevent distress
• High-focus skin care and hygiene
• Monitor breathing patterns
• Avoid overstimulation (noise, bright lights)

Contact healthcare professionals urgently for:

• Signs of pain (grimacing, moaning, stiffness)
• Sudden fever or breathing difficulty
• Choking or inability to swallow
• Rapid weight loss
• Skin breakdown
• Extreme agitation or distress

Palliative or hospice care may be appropriate to ensure comfort and dignity.