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End of life: Caring for a dying loved oneBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/cancer/CA00048
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End of life: Caring for a dying loved one
Whether you bring a dying loved one home or keep vigil at the hospital, you can take measures to provide comfort and relief at the end of life.By Mayo Clinic staff
Caring for a dying loved one isn't easy. Even when you know the end of life is approaching, you might not feel prepared. Understanding what to expect — and what you can do to increase your loved one's comfort — can help.
Choosing where to die
Your loved one may have various choices for end-of-life care. Options may include:
- Home care. Many people choose to die at home or in the home of a family member. You can assume the role of caregiver or hire home care services for support. Hospice care — services that help ensure the highest quality of life for whatever time remains — can be provided at home as well.
- Inpatient care. Some people may prefer round-the-clock care at a nursing home, hospital or dedicated inpatient hospice facility. Hospice and palliative care — a holistic treatment approach intended to ease symptoms, relieve pain, and address spiritual and psychological concerns — can be provided in any of these environments.
When you discuss the options with your loved one, consider his or her preferences as well as special physical, emotional and psychosocial needs. Evaluate how much support can be provided by family members and friends. For help determining the best option, talk with your loved one's health care team or a social worker. You might ask for a referral to palliative or hospice care specialists — health care providers trained in specific care for people nearing the end of life.
Spirituality at the end of life
As your loved one approaches the end of life, he or she may talk about spirituality or the meaning of life. Don't force the subject — but if it comes up, encourage your loved one to explore and address his or her feelings. You might ask your loved one open-ended questions about his or her beliefs and experiences or most meaningful moments. You may want to invite a spiritual leader to visit your loved one as well.
You can help your loved one communicate his or her final wishes for family and friends. Encourage your loved one to share his or her feelings, including thanks or forgiveness, and give others a chance to say goodbye. This may stimulate discussion about important, unsaid thoughts, which can be meaningful for everyone. Your loved one might also find it comforting to leave a legacy — such as creating a recording about his or her life or writing letters to loved ones, especially concerning important future events.
Recognizing when death is near
It's difficult to predict exactly when someone will die. As death approaches, however, your loved one may show various signs and symptoms indicating that the end of life is near. Look for:
- Restlessness and agitation. Your loved one may frequently change positions.
- Withdrawal. Your loved one may no longer want to participate in social events or other favorite activities.
- Drowsiness. Your loved one may spend most of his or her time asleep.
- Loss of appetite. Your loved one may eat and drink less than usual.
- Pauses or other changes in breathing. This may happen when your loved one is asleep or awake.
The active phase of dying usually begins several days before death. Although you can't change what's happening to your loved one, you can help him or her feel as comfortable as possible — ideally with the support of palliative or hospice care specialists.
|If your loved one:||Try these comfort measures:|
|Is no longer eating or drinking||Keep your loved one's mouth moist with ice chips or a sponge. Apply lip balm or petroleum jelly to his or her lips.|
|Has labored breathing||Turn your loved one's head to the side. Place pillows beneath your loved one's head, or try different sitting positions. Ice chips, oxygen and a cool-mist humidifier also may help. Ask your loved one's doctor about medications to ease breathing or to relieve feelings of breathlessness.|
|Has incontinence||Use incontinence pads or a catheter to keep your loved one dry and clean.|
|Has blurred vision||Use soft lighting.|
|Can't speak||Talk to your loved one in a soothing voice. Hold his or her hand.|
|Is agitated or confused||Be calm and reassuring. Create a quiet and peaceful atmosphere. Limit the number of people in the room, and repeat their names often.|
|Seems to be in pain||Ask the medical team to adjust your loved one's medication or treatment plan.|
Your loved one also may experience a brief, final surge of energy. Though it can be confusing to see your loved one with renewed vitality, remember that this is a normal part of dying. If it happens, take advantage of the opportunity to enjoy your loved one and say your final goodbyes.
For many families, keeping vigil near a dying loved one's bed is a way to show support and love. If you decide to keep vigil, continue talking to your loved one. If you think your loved one would want to share this time with others, invite family members or close friends to show their support as well. Express your love, but also let your loved one know that it's all right to let go.
- End-of-life care: Questions and answers. National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/Support/end-of-life-care. Accessed Oct. 4, 2010.
- Last days of life: Overview. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/supportivecare/lasthours/patient. Accessed Oct. 4, 2010.
- Last days of life: Care in the final hours. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/supportivecare/lasthours/Patient/page4. Accessed Oct. 4, 2010.
- End-of-life choices: Holding on and letting go. Family Caregiver Alliance. http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=400. Accessed Oct. 4, 2010.
- Preparation at the end of life. American Society of Clinical Oncology. http://www.cancer.net/patient/Coping/End-of-Life+Care/Preparation+at+the+End+of+Life. Accessed Oct. 4, 2010.
- Moneymaker KA. Understanding the dying process: Transition during final days to hours. Journal of Palliative Medicine. 2005;8:1079.