What Is End Of Life Care?

End-of-life care is the term used to describe the support and medical care given during the time surrounding death. This type of 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 illness and need significant care for days, weeks, and even months before death.

The end of life may look different depending on the person’s preferences, needs, or choices. Some people may want to be at home when they die, while others may prefer to seek treatment in a hospital or facility until the very end. Many want to be surrounded by family and friends, but it’s common for some to slip away while their loved ones aren’t in the room. When possible, there are steps you can take to increase the likelihood of a peaceful death for your loved one, follow their end-of-life wishes, and treat them with respect while they are dying.

Generally speaking, people who are dying need care in four areas:

• physical comfort
• mental and emotional needs
• spiritual needs
• and practical tasks

Of course, the family of the dying person needs support as well, with practical tasks and emotional distress.

Skin Irritation

Skin problems can be very uncomfortable for someone when they are dying. Keep the person’s skin clean and moisturized. Gently apply alcohol-free lotion to relieve itching and dryness.

Dryness on parts of the face, such as the lips and eyes, can be a common cause of discomfort near death.

These tips may help:

• Apply a balm or petroleum jelly to the lips
• Gently dab an eye cream or gel around the eyes
• Placing a damp cloth over the person’s closed eyes
• If the inside of the mouth seems dry, giving ice chips
• Wiping the inside of the person’s mouth with a damp cloth, cotton ball, or specially treated swab might help.

Sitting or lying in one position can put constant pressure on sensitive skin, which can lead to painful bed sores (sometimes called pressure ulcers). When a bed sore first forms:

• The skin gets discolored or darker. 
• Watch carefully for these discolored spots, especially on the heels, hips, lower back, and back of the head.
• Turning the person in bed every few hours may help prevent bed sores and stiffness
• Try putting a foam pad under the person’s heel or elbow to raise it off the bed and reduce pressure
• Ask a member of your health care team if a special mattress or chair cushion might also help.

Fatigue

It is common for people nearing the end of life to feel tired and have little or no energy. Keep things simple. For example, a bedside commode can be used instead of walking to the bathroom. Providing a stool so the person can sit in the shower, or sponge baths in bed can also help.

What About Morphine & Other Painkillers?

Morphine is an opiate, a strong drug used to treat serious pain. Sometimes, morphine is also given to ease the feeling of shortness of breath. Successfully reducing pain and addressing concerns about breathing can provide needed comfort to someone who is close to dying.

Side effects may include:

• Confusion
• Drowsiness
• or Hallucinations

Talk with the person’s health care team if you have any questions about the side effects of morphine or other pain medications.

Breathing Problems

Shortness of breath or the feeling that breathing is difficult is a common experience at the end of life. The doctor might call this dyspnea.

To help ease breathing for your loved one, try:

• Raising the head of the bed
• Opening a window
• Using a humidifier
• or Using a fan to circulate air in the room
• Sometimes, morphine or other pain medications can help relieve the sense of breathlessness.

There may be times when a dying person has an abnormal breathing pattern, known as Cheyne-stokes breathing. The person’s breathing may alternate between deep, heavy breaths, and shallow, or even no breaths. Some people very near death might have noisy breathing, sometimes called a death rattle. In most cases, this noisy breathing does not upset the dying person, though it may be alarming to family and friends. You may try turning the person to rest on one side or elevating their head. Prescription medicine may also help.

Digestive Problems

Nausea, vomiting, constipation, and loss of appetite are common issues at the end of life. Swallowing may also be a problem. The causes and treatments for these symptoms vary, so talk to a doctor or nurse about what you’re seeing. Medicines can control nausea or vomiting or relieve constipation, all of which are common side effects of strong pain medications.

If the person loses their appetite, try gently offering favorite foods in small amounts. Serve frequent, smaller meals rather than three larger ones. Help with feeding if the person wants to eat but is too tired or weak.

Don’t force a dying person to eat. Losing one’s appetite is a common and normal part of dying. Going without food and / or water is generally not painful, and eating and drinking can add to a dying person’s discomfort. A conscious decision to give up food can be part of a person’s acceptance that death is near.

Should There Always be Someone in the Room With a Dying Person?

Staying close to someone who is dying is often called keeping a vigil. It can be comforting for the caregiver or other family members to always be there, but it can also be tiring and stressful. Unless your cultural or religious traditions require it, do not feel that you must stay with the person all the time. If there are other family members or friends around, try taking turns sitting in the room.

Providing Support for Practical Tasks

Many practical jobs need to be done at the end of life — both to relieve the person who is dying and to support the caregiver. 

A person who is dying might be worried about who will take care of things when they are gone. A family member or friend can offer reassurance — "I'll make sure your African violets are watered," "Jessica has promised to take care of Bandit," "Dad, we want Mom to live with us from now on" — which may help provide a measure of peace.

You also may remind the dying person that their personal affairs are in good hands.

Everyday tasks can also be a source of worry for someone who is dying and can overwhelm a caregiver. A family member or friend can provide the caregiver with a much-needed break by helping with small daily chores around the house such as:

• picking up the mail
• writing down phone messages
• doing a load of laundry
• feeding the family pet
• or picking up medicine from the pharmacy.

Caregivers may also feel overwhelmed keeping close friends and family informed. A family member or friend can:

• help set up an outgoing voicemail message
• a blog
• an email list
• a private Facebook page
• or even a phone tree to help reduce the number of calls the caregiver must make.

below are some organizations that make setting up such resources easy and secure.

End Of Life: Managing Mental & Emotional Needs

End-of-life care can also include helping the dying person manage mental and emotional distress. Someone who is alert near the end of life might understandably feel depressed or anxious.

It is important to treat emotional pain and suffering. You might want to:

• Contact a counselor, possibly one familiar with end-of-life issues, to encourage conversations about feelings
• Medicine may help if the depression or anxiety is severe

The dying person may also have some specific fears and concerns. He or she may fear the unknown, or worry about those left behind. Some people are afraid of being alone at the very end. These feelings can be made worse by the reactions of family, friends, and even the medical team. For example, family and friends may not know how to help or what to say, so they stop visiting, or they may withdraw because they are already grieving. Doctors may feel helpless and avoid dying patients because they cannot help them further.

Some people may experience mental confusion and may have strange or unusual behavior, making it harder to connect with their loved ones. This can add to a dying person's sense of isolation.

Here are a few tips that may help manage mental and emotional needs:

• Provide physical contact
• Try holding hands or a gentle massage
• Set a comforting mood
• Some people prefer quiet moments with less people
• Use soft lighting in the room
• Play music at a low volume. This can help with relaxation and lessen pain
• Involve the dying person. If the person can still communicate, ask them what they need
• Be present. Visit with the person
• Talk or read to them, even if they can’t talk back
• If they can talk, listen attentively to what they have to say without worrying about what you will say next
• Your presence can be the greatest gift you can give to a dying person.