End of life care is about caring for people who have an advanced, progressive and incurable illness so they can live as well as possible until they die. It is about providing support that meets the needs of both the person who is dying and the people close to them.
This care has a strong focus on managing symptoms to keep a person comfortable, helping them to adapt to the changes in lifestyle and cope with the emotional impact of their illness.
End of life means different thing to different people but generally refers to the last weeks and days in life when the person’s illness becomes too much for their body to cope with and death can no longer be postponed through treatments.
Changes occur as a person’s illness progresses because of the impact of the illness on the body’s ability to function normally.
Doctors and nurses monitor the person’s physical condition and symptoms to see how they are affecting the person’s wellbeing.
It is very hard to predict how long a person has to live and exactly when they will die because life expectancies vary from one person to the next. It also depends on the type of illness and the person’s response to it.
Health professionals are cautious about saying when they think someone will die. Over time, they should have a clearer idea of how long the person has to live, although they can never be exact. Indicators they will look at include:
Some of the things that happen at this time may seem strange or frightening especially if you are not expecting them. Knowing what might happen may help you understand what questions you want to ask and the help and support you may need.
People are individual so it is not easy to say exactly what will happen or the order in which changes might occur, but we can explain what may happen in the last few days and hours of life.
People generally become weaker and the effort of eating and drinking may become too much for them - so they will need help. They may also feel sick or find it difficult to eat and take their medication. If this happens it is important that their nurse or doctor is aware so they can make them comfortable and provide medication in a different way.
As people approach the end of their life they often don’t want to eat or drink, this is normal and you should not worry. Just give them what they want.
As the illness progresses they are likely to become weaker and sleepier each day. Even when people are drowsy or asleep, they may still hear what’s going on and can take comfort from hearing someone talking to them.
Towards the end some people may lapse into unconsciousness. How long they remain unconscious before they die varies from person to person. Some people die in their sleep.
The person will pass less urine and it will become darker in colour as they drink less. As muscles weaken they may be unable to control their bladder. If this happens their nurse will advise you how to keep the person comfortable and provide aids to keep them dry.
The skin will change as the illness progresses. It may become hot, cold, dry, moist or clammy. For many people the arms and legs will become cool to the touch, the skin may look bluish or patchy and the underside of the body may become darker as a result of blood circulation slowing down.
Some people may become restless, agitated or confused as they near the end of life because they are not drinking and the body is no longer working properly. This can lead to them behaving out of character. They might pull at the bedclothes or try to do something they are not capable of. If this happens you should tell the nurse or doctor so they can assess the person’s condition and their medication.
Many people experience changes to their breathing in the last days of their life. People who have previously had difficulty breathing may find it becomes easier as the body becomes less active and needs less oxygen.
Breathing can become difficult with anxiety. Talking to the person and comforting them can help to relieve their anxiety and have a calming effect. People who are unconscious may start to breathe noisily because of a build up of mucus in the back of the throat which they are no longer able to cough up.
When death is very close (within minutes or hours), the person’s breathing pattern may change again. Breaths become shallow and irregular. Sometimes there are long pauses between breaths, or the abdomen rises and falls instead of the chest. Gradually there will be longer pauses between each breath until the last one is taken.
Most people die peacefully, comfortably and quietly.
Find out essential tips for end-of-life care.
What to expect as someone approaches death.
Guidance on the things which happen when a person dies.
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