Caring for a loved one in their final days can be an emotionally taxing experience, leaving many caretakers feeling helpless and uncertain about how to alleviate the suffering of the dying person. The transition towards the end of life is a profound and delicate period where every small comfort matters. While it may seem daunting, there are practical and compassionate ways to ease this journey, ensuring that your loved one remains as comfortable as possible. This blog outlines nine essential areas of care—ranging from maintaining mouth moisture to managing temperature and sensory stimulation—that can significantly enhance the comfort of someone nearing the end of life. By attending to these needs, caretakers can provide not only physical relief but also emotional support, making the final days more bearable for everyone involved.
Mouth Care
When someone is actively dying, they often breathe through their mouth, which keeps it open constantly, leading to dryness. This can be compared to the unpleasant sensation commonly referred to as cotton mouth. To assist your loved one, use disposable mouth swabs dipped in glycerin or minty water to moisten their mouth regularly. This process will need frequent repetition. Additionally, it’s important to keep their lips hydrated, which you can achieve by applying a soft balm to prevent dryness.
Eye Care
It’s common for individuals nearing the end of life to stop blinking and have their eyes remain partly open, causing their eyes to dry out. This often results in the appearance of tears, as the body tries to compensate for the lack of blinking. When the individual can no longer produce tears, it’s essential to consult with their physician or hospice care team to determine suitable eye drops to maintain eye moisture. Opt for longer-lasting eye drops to minimize the frequency of application.
Skin Care
As a dying person may no longer be able to consume food or liquids, dehydration is a concern, making skin care crucial. To keep them comfortable, apply lotion to their skin, focusing on areas like the hands and feet, and consider using this as an opportunity to provide a gentle massage.
Joint Care
The bones in our hands are particularly delicate, and during the dying process, even minor pressure can cause discomfort. To mitigate this, you can roll up small hand towels, as illustrated, and position the individual’s hands around them, allowing for a comfortable rest and alleviating joint pressure. This can also be soothing due to the soft texture of the towels. This method can be extended to the legs and feet using pillows for additional comfort.
Temperature Control
A dying person’s ability to regulate body temperature can diminish, leading to fluctuations between fever and chills. Regularly check their temperature by touch, and be prepared with the necessary items, such as fans, cool (but not too cold) washcloths for the forehead and sternum, and warm blankets or a space heater to adjust their body temperature as needed.
Medications
While doulas are not medical practitioners, they are often familiar with the various medications found in hospice comfort packs. It is crucial that the dying individual has previously discussed the advantages and disadvantages of different end-of-life medications to make informed decisions. If they seem to be in pain or have difficulty breathing, consult the care team about the appropriate morphine dosage. Both doulas and hospice care teams can aid in identifying signs of pain in non-responsive individuals. Moreover, it’s important to consider the specific illness when deciding on pain management strategies. Medications like Lorazepam can address terminal anxiety, while laxatives may relieve constipation caused by opioids, and Haldol can help with restlessness or hallucinations. Anti-emetics like ondansetron can reduce nausea. Be attentive to the need for adjusting medication dosages as the dying process advances, and maintain regular communication with the hospice team and doula.
Positioning
Positioning is important for two reasons: preventing bed sores and managing terminal secretions. Bed sores, painful wounds that can become infected, occur from prolonged pressure on the skin due to immobility. To prevent these, it’s advisable to reposition the dying person every few hours, alternating between sides, and adjusting between upright and lying down positions. A hospice care team member, particularly a CNA, can demonstrate effective positioning techniques. Additionally, terminal secretions, which are accumulations of unswallowed saliva and other fluids in the throat and lungs, can be managed by adjusting the person’s position to more upright and side-to-side, reducing discomfort and distressing sounds. Medication to reduce these secretions is available, but the pros and cons should be discussed with the care team.
Speaking to Them
Hearing is often the last sense to remain functional, so speaking to your dying loved one can be comforting. Depending on their condition, they might not only hear but also understand you. Providing reassurance, expressing love, sharing memorable moments, or simply talking about daily events can offer comfort. If it seems they are struggling to let go, expressing your love, acknowledging the difficulty of separation, and giving permission to pass when they are ready can be profoundly impactful for both the dying person and the caregiver.
The Senses
The dying process is a sensory experience, and considering elements like sound, sight, smell, touch, and taste can significantly aid in comfort. Soft blankets, silk sheets, gentle touch, like hair brushing or hand holding, can be soothing. The environment can be enhanced with lightly scented candles, the aroma of a favorite meal, or natural scents like pine or rosemary. Background sounds, such as music, nature sounds, chanting, or movies, can also provide comfort. For taste, even if swallowing is difficult, offering a favorite drink on a mouth swab, lightly flavored water, or a small amount of sorbet can be soothing and bring a sense of normalcy and pleasure to the dying process.
By focusing on these practical aspects of care, you can significantly ease the journey of a dying person, ensuring their final days are as comfortable and dignified as possible.