In the book Being Mortal, author Atul Gawande wrote about an example of a man called Ivan Ilyich, who faced progressive traumatic pain since falling off a stepladder. At the point in time of his end of life care when he started growing weaker and increasingly feared death, there were “certain moments after prolonged suffering where he wished most of all, for someone to pity him as a sick child is pitied. He longed to be petted and comforted. He knew he was an important functionary, that he had a beard turning grey. That therefore what he longed for was impossible, but still he longed for it.”
End of Life Care and Comfort is an important stage at end of life. It helps to reassure and calm a person facing death. It aims to relieve torment as much as possible and to improve the patient’s quality of his remaining life. Different people require different types of care. Some would like to be surrounded by loved ones towards the end, while some may like to die at home.
No matter the types of care needed, there are many areas family caregivers can give support in. Here, you can find ways to help with end of life comfort and care by alleviating physical comfort, meeting emotional and spiritual needs, and fulfilling a loved one’s last wishes.
Alleviating Physical comfort
- Relieving pain by medication
Some physical symptoms patients face at the end of their lives are breathlessness, gasping, pain, fever and fits. Most doctors will subscribe morphine subcutaneous ongoing infusion to relieve pain and breathlessness. If additional pain relief is needed, breakthrough medicine is given to help alleviate physical discomfort. If your loved one chooses to die at home, nurses from the respective hospital or hospice or home care providers will prepare and educate family caregivers on the breakthrough medicine to use. Don’t be afraid of giving pain medicine to your loved ones. Successfully end of life care reducing pain or breathlessness can provide needed comfort for someone who is close to dying.
- Relieving bed sores and pain
Another way of end of life care is helping to relieve bed sores. Turning a person side to side in blocks of time may help relieve pain. Here are some proper turning and lifting techniques that you can follow when turning and lifting a patient:
Lift and turning techniques:
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- Elevate bed to working height.
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- Legs shoulder width apart.
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- Use sliding sheet.
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- Grab the sliding sheet at/close to the shoulder blade area and the other hand at/close to the buttock area.
- Shift patient opposite to the direction of one side and turn (E.g. If you want patient to face Left side, shift patient to closer to right side before turning patient to face Left)
To note:1-2 hourly turning means patient will face the direction for that period till next due turning. Every 1-2 hourly rotate between Left, Supine, Right position with a pillow tucked beneath patient’s back to support.
- Relieving skin irritation and pressure sores
Patients at their end of life who are bed bound may also face skin irritation and breakdown that may lead to physical discomfort. This is caused by pressure and friction when sitting or lying in one position for more than one or two hours, moisture, or other irritants like chemicals including urine. Some warning signs of skin breakdown are when skin is redder or warmer and the area remains the colour for more than an hour. For dark skin, appearance is mahogany or blue-brown in colour and shiny.
At this point in time, it would be good to practice proper skin care techniques on your loved ones. Take note to not massage the area as rubbing increases tissue damage. Here are some tips and techniques you can follow to prevent and manage pressure sores:
Preventing pressure sores:
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- Keep skin clean and dry.
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- Reposition patient at least every one to two hours.
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- Apply lotion and barrier cream to dry and bony areas
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- Keep linens dry and free of wrinkles and objects that could hurt the skin.
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- Check incontinent patients every two hours
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- Clear urine and feces immediately
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- Make sure shoes and clothing fit properly.
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- Pat skin dry instead of rubbing it.
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- Make sure patient gets enough nutrition and fluids
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- Observe the skin for reddened areas or other changes.
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- Encourage mild exercise and activities.
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- Use prevention devices, such as air mattress bed, sliding sheet.
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- Keeps heel off bed
- Avoid pulling or dragging patient during change of position.
Managing pressure sores:
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- Eliminating pressure
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- Protecting the area from further damage
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- Reduce exposure to friction, irritation and moisture.
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- Follow instructions given by the health care providers.
- Changing the dressing as needed
Meeting spiritual and emotional needs
Spiritual and emotional care may be as important as physical care for a patient at his or her end of life. For example to find peace in one’s own religion, or to settle unresolved relationships with certain friends or family members. Hence, you can help your loved one meet his or her spiritual and emotional needs by engaging with social workers or pastors if needed for respective religions. Such care services offering to help with spiritual and emotional needs are available at HCA Hospice Care Association (HCA) and other hospitals in Singapore.
Preparing a loved one for death and helping them in their end of life care can be challenging. It is normal to feel unready for the death of a family member, or be at a loss for what to do when the patient do pass on eventually. However, there are many places that can offer professional help, resources and support for you and your family. For example, you can engage in in home healthcare like palliative care and respite care services that can help ease some of your burdens. Or you can contact HCA hospice care for more support and help. Do seek professional advice if it will help you in your process of end of life care for a loved one. It will help.
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