Many patients and families want to be able to prepare as best they can for the end of life. While no two end-of-life experiences are the same, there is a similar pathway traveled by most patients in the final stretch of life with similar symptoms experienced. Gaining an understanding of what may occur can help with setting appropriate expectations and goals for these moments.
COMMON OCCURRENCES SEEN WHEN PREPARING FOR THE END
It is common for the patient to become less concerned/engaged with others and the surrounding environment. Initially, interest in news events or television programming may decrease followed by decreased interest in social interactions with friends, and finally a decreased acknowledgement of family and loved ones.
Lower energy requirements and diminished appetite and thirst are common at the end of life. This is often more difficult for those closest to the patient due to concerns the patient is starving and experiencing distress. Often, a gradually decreased interest in eating, even favorite foods, is experienced by the patient. It is important to follow the patient's lead, and not force food, drink, or create increased stress by attempting to do so.
The patient will spend more and more time sleeping; it may be difficult for them to keep their eyes open. This is a result of a change in the body’s metabolism as a result of the disease. Tell the family to spend more time with the patient during those times when he/she is most alert; this might be the middle of the night.
The patient may become confused about time, place, and the identity of people around him/her. He/she may see people who are not there, such as family members who have already died. Sometimes patients describe welcoming or beckoning. While the patient may not be distressed, it is frequently distressing to family or healthcare professionals. Gently orient the patient if he or she asks. There is no need to ‘correct’ the patient if he or she is not distressed.
To be continued...