Medliorate

Improving medical students

Practical Advice for the Care of Dying Patients

Posted by medliorator on August 13, 2008

Excerpts from The Last Hours of Living: Practical Advice for Clinicians by Linda Emanuel, MD, PhD et al.

Of all patients who die, only a few (< 10%) die suddenly and unexpectedly. Most people (> 90%) die after a long period of illness, with gradual deterioration until an active dying phase at the end.

While it is possible to give families or professional caregivers a general idea of how long the patient might live, always advise them about the inherent unpredictability of the moment of death.

Most dying patients lose their appetite. Unfortunately, families and professional caregivers may interpret cessation of eating as “giving in” or “starving to death.” Yet, studies demonstrate that parenteral or enteral feeding of patients near death neither improves symptom control nor lengthens life. Anorexia may be helpful as the resulting ketosis can lead to a sense of well-being and diminish discomfort.

Clinicians can help families understand that loss of appetite is normal at this stage. Remind them that the patient is not hungry, that food either is not appealing or may be nauseating, that the patient would likely eat if he or she could, that the patient’s body is unable to absorb and use nutrients, and that clenching of teeth may be the only way for the patient to express his/her desire not to eat. …Above all, help them to find alternative ways to nurture the patient so that they can continue to participate and feel valued during the dying process.

Given our inability to assess a dying patient’s comprehension and the distress that talking “over” the patient may cause, it is prudent to presume that the unconscious patient hears everything. Advise families and professional caregivers to talk to the patient as if he or she were conscious.

Encourage families to create an environment that is familiar and pleasant. Surround the patient with the people, children, pets, objects, music, and sounds that he or she would like. Include the patient in everyday conversations. Encourage family members to say the things they need to say.

Many experts assert that the time spent with the body immediately after death will help people deal with acute grief.  Those present, including caregivers, may need the clinician’s permission to spend the time to come to terms with the event and say their good-byes. There is no need to rush, even in the hospital or other care facility. Encourage those who need to touch, hold, and even kiss the person’s body as they feel most comfortable (while maintaining universal body fluid precautions).

Introduction to the Last Hours of Living [Medscape]

Advertisements

Sorry, the comment form is closed at this time.

 
%d bloggers like this: