Whether or not you choose hospice, if your loved one is dying, you probably have a lot of questions about how to provide adequate comfort and support during their final days. Here are answers to some frequently asked questions related to end of life:
How Do I Manage My Loved One's Symptoms?
Symptom management is one of the most important aspects of end of life care because COPD symptoms often worsen in the final days. Common symptoms associated with end of life and COPD include a worsening of dyspnea and cough, increased pain, anxiety and depression, confusion, anorexia, and cachexia.
Dyspnea and anxiety have been reported as being the most troublesome COPD symptoms associated with end of life. Controlling these symptoms involves careful assessment and treatment (preferably by your hospice nurse) using a combination of medication and non-medication-related interventions that may include:
- Bronchodilators -- to reduce dyspnea
- Diuretics -- if fluid retention due to related heart problems is worsening dyspnea
- Opioid narcotics -- preferably taken orally or bucally (between cheek and gums)
- Oxygen therapy -- used carefully and if indicated
- Glucocorticoids -- the drug's negative side effects are no longer a consideration at this stage
- Benzodiazapines -- for relief of anxiety
- Thorazine -- an antipsychotic drug used for severe agitation
Non-medication-related interventions for managing dyspnea that you can implement on your own include:
- Elevating the head of the patient's bed at least 30 degrees
- Using a gentle fan directed towards the patient's face
- Pursed-lip breathing
- Relaxation and visualization techniques
- Therapeutic massage
- Music therapy with live instruments, CD or radio
Pain control is also an issue during the final stages of life with COPD and every effort should be made to alleviate it. Pain medication should be given around-the-clock to avoid an exacerbation of pain due to the medication wearing off or a delay in administration.
- Warm, humidified oxygen or use of a humidifier in the room
- Opiods, such as codeine or morphine, taken orally
- Nebulized lidocaine -- patients should not eat for at least 30 minutes after administration due to risk of aspiration
Be sure to talk to your loved one's hospice nurse regarding any medical treatments.
What If My Loved One Won't Eat?
It's difficult to watch someone we love refuse life-sustaining nourishment, but this is a very common trait among dying patients. In fact, in the last three days before death, 55% of all patients are unable to eat. It is advisable, however, to ensure that something else is not contributing to loss of appetite, such as loose-fitting dentures, sores in the mouth, oral thrush, pain or nausea. Some tips to be aware of in regard to nutrition and hydration are:
- If your loved one does not feel like eating, don't force them.
- Offer foods that they enjoy, regardless of nutritional value. If they want ice cream for breakfast, give it to them.
- Consider enteral tube feeding if this is something that your loved one has expressed a desire for.
- Provide frequent oral care using moisture swabs and ice chips to avoid oral conditions related to dehydration.
What If My Loved One Becomes Confused?
When a COPD patient is terminal, there are a number of factors which may cause confusion: medications, hypoxia, uncontrolled pain, lack of sleep, urinary retention, and physiological imbalances. Treatment should be directed at the cause, if it can be determined.
For example, if the underlying cause of confusion is hypoxemia, then supplemental oxygen can be used to correct it; if related to urinary retention, you can discuss foley catheter placement with your hospice nurse.
What If My Loved One Gets Depressed?
The end of a person's life can be a time of deep reflection for both patient and family. It can also be a time of great sadness. What can you do to help? Just holding someone's hand and listening may provide the comfort that words cannot. Be sure to address any spiritual needs that your loved one may have. You may even want to ask a priest, pastor or counselor to help. Finally, encourage your loved one to talk about their feelings, and to address any unresolved issues openly and freely.
How Will I Know When My Loved One is Dying?
When death is near, the body naturally begins to shut down. Manifestations of this may include:
- Increased sleepiness
- Increased confusion and agitation
- Visions and hallucinations
- Unresponsiveness and/or unconsciousness
- Decreased interest in food or water
- Withdrawal from others
- Inability to control bowels and/or bladder
- Decrease in body temperature; skin feels cold to the touch
- Dark, concentrated urine; decrease in urine output
- Increased, uncontrollable pain
- Irregular breathing patterns
- Gurgling or other disturbing noises heard when breathing
- Unintentional movement
- Changes in blood pressure, respiration and heart rate
- Loss of reflexes
What Do I Do Once Death Has Occurred?
After your loved one has passed, you will undoubtedly feel a number of mixed emotions from relief, to anger, to intense sadness. It is important to understand that these are normal reactions and part of the grieving process. About.com's Palliative Care GuideSite offers a series of articles for those who are left behind that may prove useful, including:
Curtis JR. Palliative and end-of-life care for patients with severe COPD. Eur Respir J. 2008 Sep;32(3):796-803. Epub 2007 Nov 7.
Helen M. Sorenson MA RRT FAARC. Controlling COPD Symptoms at the End of Life.
HÃÂ¶rfarter B, Weixler D. Symptom control and ethics in final stages of COPD. Wien Med Wochenschr. 2006 May;156(9-10):275-82.