Dear @ jsaved 74.

The laying down itself is not alarming but I would suggest that you consider motivating him to do more at that stage. Here are the things that lead me to suggest that:

1. It is important (for both of you) for him to stay as phycally strong and mobile as possible. At stage 5 he still likely has quite a long time to live, and quite happily. If he lays in bed a lot, his muscles are likely to atrophy. If that happens, both of you may prematurely move into a much more difficult, and limiting, practical situation. He could soon start to have trouble doing basic things that he may be able to do now with either no assistance or minimal assistance (e.g. getting out bed, standing up from a sitting position, getting in and out of a car, going up steps, walking). There are few ways to fight the cognitive effects of the disease, but his physical strength and mobility are much more within your control. Specifically, in this stage we did a lot of walks in a variety of different places, and even daily exercises prescribed by physical therapists every day before dinner. All of this was aimed at:
• Keeping him mobile as long as possible, and
• Getting the emotional lift that comes from moving your body and changing your scenery.

2. The laying down may be a form of withdrawal. As people progress in the disease, they often stop doing things that have traditionally been very positive parts of their lives. They don’t stop doing those things because they don’t like them, they stop because, with the cognitive losses, those things have gotten difficult to do. If that is the case you have several options
• Have someone do things with him, so that, with the assistance of you or someone else, he finds that he actually still can do some of those things he used to enjoy.
• Find a modified way that he can do the activity. When my husband could no longer golf, I took him to the driving range or to the putting practice area. When all sports were beyond what he could do, I started taking him to watch sports at a nearby university.
• Substitute new pleasant activities. Pick things that you will enjoy as well.

3. Bigger picture of the situation: It is likely that he can no longer manage his life. Moderate dementia is when I started taking full responsibility for “programming” my husband’s days. Simply put, I curated a sequence of ability-appropriate and enjoyable experiences for him every day, all day. This may seem excessive, but the fact is that as their dementia increases, when they are left with their own thoughts, they suffer. The confusion can lead them to dark thoughts, fear, sadness. I found that I could keep that from happening by filling his conscious mind with pleasant inputs and experiences. Doing that every day may sound like a big job. It kind of is, but once you take it on it gets easier. You develop a menu of pleasant experiences in various categories and cycle through them, always scouting for other experiences. For example, as a base, we would make big deal about each meal. I would play music a lot of the time, matching the music to the mood that I was trying to have him feel. There was at least one walk, with the dog. There was one fun activity in the early afternoon, etc.

Is there a senior day program in your area? It was in the Moderate stage that my husband really enjoyed going there a few days per week. They had varied activities, and a such a supportive, positive environment. It took some pressure off me.

Of course, the number and nature of the activities has to change over time to align with his capabilities. We started with lots of activities each day and, toward the end of his life, in accordance with his mental and physical capabilities, toward the end of his life the days included two naps, one special activity per day, and the rest gentle pleasant experiences.

4. Circadian rhythms. You don’t mention if he naps or just lays in bed. As we age our bodies do not manage our circadian rhythms as effectively, which can lead to sleep disturbances and mood changes. A doctor friend of mine suggested I try using one of the Seasonal Affective Disorder lights. We shone it every morning as he ate breakfast and it seemed to make him more energetic.

Best of luck to you! By experimenting you’ll find the right balance of stimulation and rest for your husband. But keep in mind the implications for you and the amount of caregiver assistance you may need: Try to keep him mobile.