Hospice of the Comforter

Each person’s journey through the dying process is unique. However, there are some common signs that usually appear to prepare the body for this transition. This process can take days to weeks unless death comes suddenly from an event such as heart attack or stroke. Your hospice team members will review what may be expected to happen. It is important to call with any questions and report any changes in the patient’s condition.

Common Signs and Changes

Increasing Weakness
This is often the earliest sign the patient is nearing the dying phase. The person’s legs will become weak and he may be unable to rise from a chair, get out of bed or walk to the toilet or bedside commode. Someone will need to be nearby at all times. It helps to think ahead and plan for how you will provide this increased care.

What you can do:

• Notify the nursing staff when you notice this change. Equipment such as a hospital bed, wheelchair or bedside commode can be ordered. Certified Nursing Aide visits may be started or increased.
• Ask for help from your family and friends if they are available.
• Discuss the changing situation with the social worker to review options for care when the patient is bed-bound.

Increased Sleep
Sleeping increases until the person sleeps more than he is awake. He is usually able to be wakened and may have short periods of being alert.

What you can do:

• Let the patient sleep as much as he wants.
• Make the most of the time when he is awake and give personal care and medications at this time.
• Make sure to wake the patient to give regularly scheduled pain medications so pain control is maintained.

Decreasing Appetite
The person no longer feels hungry; therefore, food and fluid intake will decrease.

What you can do:

• Take cues from the patient. Offer soft food and liquids, but do not force the patient to eat.
• Foc us on comfort, not on the amount of food that is eaten.
• Keep the patient’s mouth clean and moist. Give mouth care several times a day.

Difficulty Swallowing
The patient may begin to hold food or liquid in the mouth before swallowing. Gradually, it will become more difficult for him to swallow.

What you can do:

• Let the nurse know when the patient is having difficulty swallowing. The medications will need to be changed from pills to liquid.
• Place liquid medication inside the cheek pocket and gently massage.

Change in Bowel/Bladder Function
Bowel movements become less frequent and the amount of urine decreases. Darker urine is expected as the patient drinks less. The patient may become incontinent.

What you can do:

• Use disposable bed pads and disposable briefs.
• As long as the patient can swallow, it is important to continue medications to prevent constipation.
• Clean the skin thoroughly after each passage of urine or stool and apply a moisture barrier to protect the skin.
• Discuss a urinary catheter with the nurse.

Confusion
The patient may have periods of confusion, often worse at night or upon awakening.

What you can do:

• Gently remind the patient who you are and where he is.
• Speak in a calm, reassuring manner.
• Keep the lights on and the surroundings quiet.
• Stay with the patient.

Restlessness
Restlessness may occur. It may be due to the changes in the body, lower oxygen levels to the brain, or emotional/spiritual issues. The patient may toss and turn, try to get out of bed, talk rapidly or pull at the bed covers.

What you can do:

• Speak quietly.
• Keep the lights dim.
• Try soft music, giving a back rub or reading aloud.
• Notify the nursing staff. Medications can be started to calm and relax the patient.

Emotional and Spiritual Signs
When the patient gets close to the final stage of dying, he may give hints in behavior or words that the time is close.

The patient may:

• Become less interested in what is going on around him.
• Use expressions of speech that indicate he realizes the end is close, such as, ‘I am not going to win this ball game’ or ‘I am going home soon’.
• ‘See’ or ‘talk’ with people who have already died.
• Reach out for things that cannot be seen.

What you can do:

• Be accepting of what the patient says or does. Do not try to correct him. Ask gently what the patient is doing or seeing, and listen carefully.
• Listen for unspoken needs – does the patient need to be reassured that you will be ok without him? Does he need your forgiveness for anything? Do you need to forgive him for anything? Is there someone he would like to see for the last time?
• Express your love and appreciation for the patient.