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Palliative care - what the final days are like

End of life - final days; Hospice - final days

 

Palliative Care

Palliative care is a holistic approach to care that focuses on treating pain and symptoms and improving quality of life in people with serious illnesses or who are in the final days of life.

The Final Days of Life

 

Dying is a process. Sometimes the process takes time. For a while, signs that death is near may come and go. Family and friends may need help understanding the signs that mean a person is close to death.

 

What you Might see

 

As a person gets closer to death, the person might:

  • Have less pain
  • Have trouble swallowing
  • Have blurry vision
  • Have trouble hearing
  • Eat or drink less
  • Lose control of urine and stool
  • Hear or see something and think it is something else, or experience misunderstandings
  • Talk to people who are not in the room
  • Talk about going on a trip or leaving
  • Talk less
  • Moan
  • Have cool hands, arms, feet, or legs
  • Have a blue or gray nose, mouth, fingers, or toes
  • Sleep more
  • Cough more
  • Have breathing that sounds wet, maybe with bubbling sounds
  • Have breathing changes: breathing may stop for a bit, then continue as several quick, deep breaths
  • Stop responding to touch or sounds, or go into a coma

 

What you can do

 

As family or friends:

  • If you do not understand what you see, ask a hospice team member.
  • Let other family and friends visit, even children -- a few at a time.
  • Help the person get into a comfortable position.
  • Give medicine to treat symptoms.
  • If the person is not drinking, wet his or her mouth with ice chips or a sponge.
  • If the person is hot, put a cool, wet cloth on his or her forehead.
  • Keep a light on. If the person has blurry vision, darkness can be scary.
  • Play soft music that the person likes.
  • Touch the person. Hold hands.
  • Talk calmly to the person. Even if you get no response, he or she may still hear you.
  • Write down what the person says. This may comfort you later.
  • Let the person sleep.

 

When to Call the Health Care Provider

 

Call a member of the hospice team if your loved one shows signs of pain or anxiety.

 

 

References

Arnold R. Care of dying patients and their families. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 3.

Rakel RE, Trinh TH. Care of the dying patient. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 5.

Smith LN, Jackson VA. How do symptoms change for patients in the last days and hours of life? In: Goldstein NE, Morrison RS, eds. Evidence-Based Practice of Palliative Medicine. Philadelphia, PA: Elsevier Saunders; 2013:chap 39.

 

        A Closer Look

         

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            Tests for Palliative care - what the final days are like

             

               

              Review Date: 2/6/2016

              Reviewed By: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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