Exploring End-of-Life care

“Perhaps they are not stars but rather openings in heaven where the love of our lost ones pours through and shines down upon us to let us know they are happy.”

Comfort care is an essential part of end-of-life care. It ensures that the final days of your loved one are comfortable, and spent in the least possible pain. The goals are to prevent or relieve suffering as much as possible, and improve the quality of life while respecting the wishes of the person.

You are probably reading this because someone close to you is nearing his or her end of life. You wonder what is going to happen. You would like to know how to bring comfort, what to say, what to do. You might want to know how to make dying easier — how to help ensure a peaceful death, with treatment in helping to keep the wishes of the dying person.

A peaceful death could mean something different to different people. Some people want to have family and friends around them; others want to be alone. Of course, one often does not get to choose. However, avoiding suffering, trying to fulfill wishes for the end-of-life, and being treated with respect while dying are common hopes.

Generally, people who are dying need care in four areas—physical comfort, emotional needs, spiritual needs, and practical tasks.

What is End-of-Life Care?

End-of-life care is the term used to describe the medical care and support given during the time encircling death. There are many ways of providing care for a dying person. It can be physically and emotionally exhausting to be a caregiver for someone at the end of life. Ultimately, accept that there may not be a perfect death, only the best you can do for the one you love. The pain of losing someone close to you might be a little eased because you did what you could when you were needed.

Signs that end-of-life is near.

You may notice the following changes in the person when end-of-life is near.  

·      Pain

·      Sleeping more

·      Eating and drinking less

·      Withdrawing from people

·      Changing vital signs

·      Changing bowel movements

·      Dropping body temperature

·      Weakening muscles

·      Breathing troubles

·      Increasing confusion

End-of-Life: Providing Physical Comfort

There are ways to console a person who is dying. A person who is dying may be uncomfortable due to:

Pain. It is hard enough to watch someone you love die, but also to know that person is in pain makes it worse. Not everybody who dies experiences pain, but there are things that you can do to help someone who does. You can focus on relieving pain without worrying about possible long-term problems of medication dependence or abuse. Morphine is often offered to relieve pain. 

Breathing problems. People at end-of-life may have noisy respiration or difficulty breathing. This is caused by gathering fluids in the throat or relaxing muscles in the throat. Try to lift the head of the bed, turn the person to the side, open a window, use a humidifier, or get air to circulate in the room with a fan.

Digestive problems. Nausea, vomiting, constipation, and loss of appetite are all common end-of-life problems. Medicines can control nausea or vomiting, or relieve constipation, a common side effect of heavy pain medicines. If your loved one wants to eat but is too tired or weak, you can help with feeding. Try to gently offer their favorite foods in small quantities to fix the lack of appetite. Alternatively, try serving smaller, frequent meals instead of three big ones. You do not need to force a person into feeding. It is generally not painful to go without food or water and eating can add to the discomfort.

Sensitivity to Temperature. Your loved one may not be able to tell you that they are feeling too hot or cold, so observe for hints. For instance, someone who is too warm may try to remove a blanket repeatedly. You can take off the blanket and try a cool cloth on his or her head.

Fatigue. It is common for people to feel tired and have little or no energy near the end of life. Keep tasks simple. For example, instead of walking to the bathroom, a bedside commode can be used. A shower stool can save energy for a human, or try sponging off in bed.

End-of-Life: Managing Emotional Needs

Complete end-of-life care also involves supporting your loved one to manage mental and emotional distress. Management of emotional pain and suffering is essential. Having conversations about feelings might help. You may want to contact a counselor, maybe one who is familiar with end-of-life care. If there is severe depression or anxiety, medicines can help.

The simple act of physical contact — holding hands, touching, or a gentle massage — can make a person feel connected to those he loves. It can be extremely soothing. Warm your hands up by rubbing or running them under warm water.

Try to set a comforting mood. Know that listening and being present can make a significant difference. Often, just being present with a dying person is enough. It may not be necessary to fill the time with talking or activity. Your silent presence can be an easy and deep gift for a dying member of your family or a relative.

Have a meaningful conversation. People at the end of life want to remember pleasant moments with their loved ones and family members, and to find closure. Try to have a conversation on subjects like forgiveness, appreciation, and affection.

Spiritual Needs at the End of Life

Support spiritual needs. People who know they are close to the end of life may reflect on their beliefs, values, spirituality, or the purpose of life. If the person wants to talk about spiritual or religious concerns, you should listen and ask open-ended questions. You can read together, play music, or share the religious traditions if the person wants.

End-of-Life: Planning Ahead

A person who is dying may be concerned about who is going to take care of things when he or she is gone. Offering reassurance—"I'll make sure your flowers are watered," "Dad, Mom will live with us from now on"—might provide a measure of peace. It can also bring comfort to the dying person to know that his or her personal affairs are in safe hands.

Practical tasks

Prepare early. The end-of-life journey is eased considerably when conversations regarding placement, treatment, and end-of-life wishes are held as early as possible. Consider hospice and palliative care services, spiritual practices, and memorial traditions before they are needed.

Seek financial and legal advice while your loved one can participate. Legal documents such as a living will, power of attorney, or advance directive can set forth a patient’s wishes for future health care so family members are all clear about their preferences.

Signs of Death.

If you are using a heart rate monitor, it is a clear indication that your loved one is no more when the monitor stops. If you are not, then look for other signs that death has taken place, including:

• no pulse
• no breathing
• relaxed muscles
• fixed eyes
• no response
• a bowel or bladder release
• partially shut eyelids

After the death of your loved one, take your time. Spend some minutes with the people around you. The natural death of a human is not an emergency, and you do not need to call someone immediately. When you are ready, call your close family and friends. They will take care of most of the things like bringing flowers or making funeral arrangements.      

Finding support

It is never easy to lose a loved one. Even if you knew that death was coming, and you planned for it, it always hurts. Take your time to acknowledge, embrace, and experience every emotion in the first days and weeks after a loved one's death.

Seek out a support group when you are ready. This can be family and friends or you might want to seek professional help. For each person grief is different, so do not judge your progress by another person’s progress. Find a group that feels welcoming and comfortable.

With time, you will treasure the memories of your loved one and look forward to new memories with people you still have.