End-of-life care is the term used to describe the support and medical care given during the time surrounding death. Such care does not happen only in the moments before breathing ceases and the heart stops beating. Older people often live with one or more chronic illnesses and need a lot of care for days, weeks, and even months before death. Sensitivity to the patient’s cultural and religious background is essential. They may need Palliative Care and Hospice Care People nearing the end of life may have spiritual needs as important as their physical concerns. Spiritual needs include finding meaning in one’s life and ending disagreements with others, if possible.[National institute of aging- Providing Care and Comfort at the End of Life]
Five Priorities for Care of the Dying Person
These are:
- The possibility that a person may die within the coming days and hours is recognised and communicated clearly, decisions about care are made in accordance with the person’s needs and wishes, and these are reviewed and revised regularly
- Sensitive communication takes place between staff and the person who is dying and those important to them
- The dying person, and those identified as important to them, are involved in decisions about treatment and care
- The people important to the dying person are listened to and their needs are respected
- Care is tailored to the individual and delivered with compassion – with an individual care plan in place.[ Health Education England (HEE)]
A dying person can be uncomfortable because of:
- Pain
- Breathing problems
- Skin irritation
- Digestive problems
- Temperature sensitivity
- Fatigue [National institute of aging- Providing Care and Comfort at the End of Life]
There are some common experiences very near the end , though there are some common experiences very near the end:
- Shortness of breath, known as dyspnea
- Depression
- Anxiety
- Tiredness and sleepiness
- Mental confusion or reduced alertness
- Refusal to eat or drink
Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson’s disease, and many others. Palliative care can be helpful at any stage of illness and is best provided from the point of diagnosis.
Hospice Care ( Anyone with a serious illness whom doctors think has only a short time to live, often less than 6 months) is an approach to care, so it is not tied to a specific place. It can be offered in two types of settings—at home or in a facility such as a nursing home, hospital, or even in a separate hospice center.
In cancer patients, the following signs are often associated with the dying phase:
- The patient becomes bedbound
- The patient is semicomatose
- The patient is able to take only sips of fluid
- The patient is no longer able to take oral drugs.[
Closer to death
When a person is closer to death, the hands, arms, feet, or legs may be cool to the touch. Some parts of the body may become darker or blue-colored. Breathing and heart rates may slow. In fact, there may be times when the person’s breathing becomes abnormal, known as Cheyne-Stokes breathing. Some people hear a death rattle, noisy breathing that makes a gurgling or rattling sound. The chest stops moving, no air comes out of the nose, and there is no pulse. Eyes that are open can seem glassy. After death, there may still be a few shudders or movements of the arms or legs. There could even be an uncontrolled cry because of muscle movement in the voice box. Sometimes there will be a release of urine or stool, but usually only a small amount since so little has probably been eaten in the last days of life. [National institute of aging- What Happens When Someone Dies?]
Bibliography
Fallon M, O’Neill B, eds. ABC of palliative care. London: BMJ Books, 1998
Kearney M. Mortally wounded: stories of soul pain, death and healing. London: Touchstone Books, 1997
Maguire P. Communication skills for doctors. London: Arnold, 1997
Neuberger J. Caring for dying people of different faiths. London: Lisa Sainsbury Foundation, 1987
Twycross R, Wilcock A, Thorp S. Palliative care formulary. Oxford: Radcliffe Medical Press, 1998
