End of your Life

Transitional Support

 

 

 

For some people nearing the end of life, spiritual needs may be as important as their physical concerns.

Spiritual needs may include finding meaning in one's life, ending disagreements with others, or making peace with life circumstances.

The dying person might find comfort in resolving unsettled issues with friends or family. Visits from a social worker or a counselor may help.

 

 

Providing Care and Comfort at the End of Life

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Not all end-of-life experiences are alike.

Death can come suddenly, or a person may linger in a near-death state for days.

For some older adults at the end of life, the body weakens while the mind stays clear.

Others remain physically strong while cognitive function declines.

It's common to wonder what happens when someone is dying. You may want to know how to provide comfort, what to say, or what to do.

 

In this article, you will read about ways to help provide care and comfort to someone who is dying. Such care often involves a team: Always remember to check with the person’s health care team to make sure these suggestions are appropriate for the situation.

 

What is end-of-life care?

End-of-life care is the term used to describe the support and medical care given during the time surrounding death.

This type of care does not happen only in the moments before breathing ceases and the heart stops beating.

Older people often live with one or more chronic illnesses and need significant care for days, weeks, and even months before death.

 

The end of life may look different depending on the person’s preferences, needs, or choices.

Some people may want to be at home when they die, while others may prefer to seek treatment in a hospital or facility until the very end.

Many want to be surrounded by family and friends, but it’s common for some to slip away while their loved ones aren’t in the room.

When possible, there are steps you can take to increase the likelihood of a peaceful death for your loved one, follow their end-of-life wishes, and treat them with respect while they are dying.

 

 

Generally speaking, people who are dying need care in four areas: physical comfort, mental and emotional needs, spiritual needs, and practical tasks. Of course, the family of the dying person needs support as well, with practical tasks and emotional distress.

 

End of life: Providing physical comfort

Discomfort during the dying process can come from a variety of sources. Depending on the cause of the discomfort, there are things you or a healthcare provider can do to help make the dying person more comfortable. For example, the person may be uncomfortable because of:

• Pain
• Breathing problems
• Skin irritation, including itching
• Digestive problems
• Temperature sensitivity
• Fatigue

Pain. Not everyone who is dying experiences pain.

For those who do, experts believe that care should focus on relieving pain without worrying about possible long-term problems of drug dependence or abuse.

Struggling with severe pain can be draining and make the dying person understandably angry or short-tempered.

This can make it even harder for families and other loved ones to communicate with the person in a meaningful way.

 

Caregivers and other family members can play significant roles in managing a dying person’s pain. But knowing how much pain someone is in can be difficult.

Watch for clues, such as trouble sleeping, showing increased agitation, or crying. Don’t be afraid of giving as much pain medicine as is prescribed by the doctor.

 

Pain is easier to prevent than to relieve, and severe pain is hard to manage.

Try to make sure that the level of pain does not get ahead of pain-relieving medicines

Tell the health care professionals if the pain is not controlled because medicines can be increased or changed

Palliative medical specialists are experienced in pain management for seriously ill patients; consider consulting with one if they’re not already involved (see What Are Palliative Care and Hospice Care?).

 

 

There may be times when a dying person has an abnormal breathing pattern, known as Cheyne-Stokes breathing.

The person’s breathing may alternate between deep, heavy breaths and shallow or even no breaths. Some people very near death might have noisy breathing, sometimes called a death rattle

In most cases, this noisy breathing does not upset the dying person, though it may be alarming to family and friends.

You may try turning the person to rest on one side or elevating their head. Prescription medicine may also help.

 

Skin irritation. Skin problems can be very uncomfortable for someone when they are dying. Keep the person’s skin clean and moisturized. Gently apply alcohol-free lotion to relieve itching and dryness.

Dryness on parts of the face, such as the lips and eyes, can be a common cause of discomfort near death.

 

These tips may help:

• Apply a balm or petroleum jelly to the lips.
• Gently dab an eye cream or gel around the eyes.
• Try placing a damp cloth over the person’s closed eyes.
• If the inside of the mouth seems dry, giving ice chips (if the person is conscious) or wiping the inside of the person’s mouth with a damp cloth, cotton ball, or specially treated swab might help.

Sitting or lying in one position can put constant pressure on sensitive skin, which can lead to painful bed sores (sometimes called pressure ulcers).

When a bed sore first forms, the skin gets discolored or darker.

Watch carefully for these discolored spots, especially on the heels, hips, lower back, and back of the head.

 

Turning the person in bed every few hours may help prevent bed sores and stiffness.

Try putting a foam pad under the person’s heel or elbow to raise it off the bed and reduce pressure. Ask a member of your healthcare team if a special mattress or chair cushion might also help.

 

Digestive problems. Nausea, vomiting, constipation, and loss of appetite are common issues at the end of life.

Swallowing may also be a problem.

The causes and treatments for these symptoms vary, so talk to a doctor or nurse about what you’re seeing.

Medicines can control nausea or vomiting or relieve constipation, all of which are common side effects of strong pain medications.

 

If the person loses their appetite, try gently offering favorite foods in small amounts.

Serve frequent, smaller meals rather than three larger ones.

Help with feeding if the person wants to eat but is too tired or weak.

But don’t force a dying person to eat.

Losing one’s appetite is a common and normal part of dying.

Going without food and/or water is generally not painful, and eating and drinking can add to a dying person’s discomfort.

A conscious decision to give up food can be part of a person’s acceptance that death is near.

 

Temperature sensitivity. When a person is closer to death, their hands, arms, feet, or legs may be cool to the touch.

Some parts of the body may become darker or blueish.

People who are dying may not be able to tell you that they are too hot or too cold, so watch for clues. For example, someone who is too warm might repeatedly try to remove a blanket.

You can remove the blanket and place a cool cloth on the person’s head.

Hunching their shoulders, pulling the covers up, and shivering can be signs the person is cold.

Make sure there is no draft, raise the heat, and add another blanket.

Avoid electric blankets because they can get too hot.

 

Fatigue. It is common for people nearing the end of life to feel tired and have little or no energy. Keep things simple.

For example, a bedside commode can be used instead of walking to the bathroom.

Providing a stool so the person can sit in the shower, or sponge baths in bed can also help.

 

End of life: Managing mental and emotional needs

End-of-life care can also include helping the dying person manage mental and emotional distress. Someone who is alert near the end of life might understandably feel depressed or anxious.

It is important to treat emotional pain and suffering.

You might want to contact a counselor, possibly one familiar with end-of-life issues, to encourage conversations about feelings.

Medicine may help if the depression or anxiety is severe.

 

The dying person may also have some specific fears and concerns.

He or she may fear the unknown, or worry about those left behind.

Some people are afraid of being alone at the very end.

These feelings can be made worse by the reactions of family, friends, and even the medical team.

 

For example, family and friends may not know how to help or what to say, so they stop visiting, or they may withdraw because they are already grieving.

Doctors may feel helpless and avoid dying patients because they cannot help them further.

 

And some people may experience mental confusion and may have strange or unusual behavior, making it harder to connect with their loved ones.

This can add to a dying person's sense of isolation.

 

Here are a few tips that may help manage mental and emotional needs:

• Provide physical contact. Try holding hands or a gentle massage.
• Set a comforting mood. Some people prefer quiet moments with less people. Use soft lighting in the room.
• Play music at a low volume. This can help with relaxation and lessen pain.
• Involve the dying person. If the person can still communicate, ask them what they need.
• Be present. Visit with the person. Talk or read to them, even if they can’t talk back. If they can talk, listen attentively to what they have to say without worrying about what you will say next. Your presence can be the greatest gift you can give to a dying person.

Spiritual needs at the end of life

For people nearing the end of life, spiritual needs may be as important as their physical concerns.

 

Spiritual needs may include finding meaning in one's life, ending disagreements with others, or making peace with life circumstances.

 

The dying person might find comfort in resolving unsettled issues with friends or family.

Visits from a social worker or a counselor may help.

 

Many people find solace in their faith.

 

Others may struggle with their faith or spiritual beliefs.

Praying, reading religious texts, or listening to religious music may help.

The person can also talk with someone from their religious community, such as a minister, priest, rabbi, or imam.

 

Family and friends can talk to the dying person about the importance of their relationship.

For example, adult children may share how their father has influenced the course of their lives. Grandchildren can let their grandfather know how much he has meant to them.

Friends can share how they value years of support and companionship.

Family and friends who can't be present in person can send a video or audio recording of what they would like to say or a letter to be read out loud.

 

Sharing memories of good times is another way some people find peace near death.

This can be comforting for everyone.

Some doctors think that dying people can still hear even if they are not conscious.

Always talk to, not about, the person who is dying.

When you come into the room, identify yourself to the person.

You may want to ask someone to write down some of the things said at this time — both by and to the person who is dying.

In time, these words might serve as a source of comfort to family and friends.

 

There may come a time when a dying person who has been confused suddenly seems to be thinking clearly.

Take advantage of these moments but understand that they are likely temporary and not necessarily a sign of getting better.

Sometimes, a dying person may appear to see or talk to someone who is not there.

Resist the temptation to interrupt or correct them, or say they are imagining things.

 

Give the dying person the space to experience their own reality.

 

Sometimes dying people will report having dreams of meeting deceased relatives, friends, or religious figures.

The dying person may have various reactions to such dreams, but often, they are quite comforting to them.

 

Providing support for practical tasks

Many practical jobs need to be done at the end of life — both to relieve the person who is dying and to support the caregiver.

A person who is dying might be worried about who will take care of things when they are gone.

A family member or friend can offer reassurance — "I'll make sure your African violets are watered," "Jessica has promised to take care of Bandit," or "Dad, we want Mom to live with us from now on" — which may help provide a measure of peace.

You also may remind the dying person that their personal affairs are in good hands.

 

Everyday tasks can also be a source of worry for someone who is dying and can overwhelm a caregiver.

A family member or friend can provide the caregiver with a much-needed break by helping with small daily chores around the house such as picking up the mail, writing down phone messages, doing a load of laundry, feeding the family pet, or picking up medicine from the pharmacy.

 

Caregivers may also feel overwhelmed keeping close friends and family informed.

A family member or friend can help set up an outgoing voicemail message, a blog, an email list, a private Facebook page, or even a phone tree to help reduce the number of calls the caregiver must make

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Providing comfort and care for someone at the end of life can be physically and emotionally exhausting.

If you are a primary caregiver, ask for help when you need it and accept help when it's offered.

Don't hesitate to suggest a specific task to someone who offers to help.

Friends and family are usually eager to do something for you and the person who is dying, but they may not know what to do.

 

In the end, consider that there may be no “perfect” death so just do the best you can for your loved one.

The deep pain of losing someone close to you may be softened a little by knowing that, when you were needed, you did what you could.

 

Read NIA’s article What To Do After Someone Dies for information on making arrangements after death.

 

 

10 Painfully Clear Truths About Life We All Forget Too Often

Written by Angel Chernoff

 

Great conversational points when talking to the sick and dying.

 

1. The average human life is relatively short.

We know deep down that life is short, and that death will happen to all of us eventually, and yet we are infinitely surprised when it happens to someone we know.

It’s like walking up a flight of stairs with a distracted mind and misjudging the final step.

You expected there to be one more stair than there is, and so you find yourself off balance for a moment, before your mind shifts back to the present moment and how the world really is.

 

Let that reminder be your wake-up call to live your life today!

Don’t ignore death, but don’t be afraid of it either.

Be afraid of a life you never lived because you were too afraid to take action.

Death is not the greatest loss in life.

 

The greatest loss is what dies inside you while you’re still alive.

And in life, you can be comfortable or courageous, but not both at once.

 

So be bold, be courageous… be scared to death, and then give yourself a chance to take the next step anyway.

 

2. To a great extent, you live the life you create for yourself.

Your life is yours alone.

Others can try to persuade you, but they can’t decide for you.

They can walk with you, but not in your shoes.

 

Remember, it’s always better to be at the bottom of the ladder you want to climb than the top of the one you don’t.

Be productive and patient.

And realize that patience is not about waiting; it’s the ability to keep a good attitude while working hard for what you believe in.

 

Yes, at the end of the day, this is your life, and to a great extent, it’s made up of your little recurring habits and choices.

 

May your daily actions speak louder than your words.

May your life preach louder than your lips

May your success be your noise in the end. 

 

3. Being busy does not mean being productive.

Busyness isn’t a virtue, nor is it something to respect.

Though we all have seasons of crazy schedules, very few of us have a legitimate need to be busy all the time.

We simply don’t know how to set boundaries, prioritize properly, and say no when we should.

Being busy rarely equates to productivity these days.

Just take a quick look around.

Busy people outnumber productive people by a wide margin.

Busy people are rushing all over the place, and running late half of the time.

They’re heading to work, conferences, meetings, social engagements, looking at their phones, creating TikToks, etc.

They barely have enough free time for exercise and they rarely get enough sleep.

Yet, text messages, emails, and social media updates are blasting out of their smartphones like rockets, and their day planners are jammed to the brim with obligations.

Their busy schedule gives them an elevated sense of importance.

But it’s all an illusion.

They’re like hamsters running on a wheel.

Though being busy can make us feel more alive than anything else for a moment, the sensation is not sustainable long term.

 

We will inevitably, whether tomorrow or on our deathbed, come to wish that we spent less time in the buzz of busyness and more time actually living a purposeful life.

 

4. Some kind of failure always occurs before success.

Most mistakes are unavoidable. Learn to forgive yourself

It’s not a problem to make them; it’s only a problem if you never learn from them.

 

If you’re too afraid of failure, you can’t possibly do what needs to be done to be successful.

The solution to this problem is making friends with failure.

Do you want to know the difference between a master and a beginner?

The master has failed more times than the beginner has even tried

 

Behind every great piece of art, there are dozens of failed attempts to make it, but these attempts are simply never shown to us.

Bottom line: Just because it’s not happening now, doesn’t mean it never will.

Learning the way on the way is key. Sometimes things have to go very wrong before they can be right. (Read The Success Principles.)

 

5. Thinking and doing are two very different things.

Success never comes to look for you while you wait around thinking about it.

You are what you do, not what you say you will do.

Knowledge is basically useless without action.

Good things don’t come to those who wait; they come to those who work on meaningful goals.

 

Ask yourself what’s really important and then have the courage and determination to build your daily life around your answer.

 

And remember, if you wait until you feel 100% ready to begin, you will likely be waiting for the rest of your life.

 

6. You don’t have to wait for an apology to forgive.

Life gets much easier when you learn to accept the apologies you never received.

 

The key is to find some level of peace with every experience — positive or negative

In a way, it’s like taking a step back, letting go a little, and navigating each life experience with an open mind. It’s realizing that grudges from the past are a perfect waste of today’s growth and potential and that holding one is like letting unwanted companies live rent-free in your head.

 

Ultimately, forgiveness is a promise — one you want to keep. When you forgive you are making a promise not to hold the unchangeable past against your present self. It has nothing to do with freeing a past criminal of his or her crime, and everything to do with freeing yourself of the burden of being an eternal victim.

 

7. Some people are simply the wrong match for you.

You will only ever be as great as the people you surround yourself with, so be brave enough to let go of those who keep bringing you down. 

You shouldn’t force connections with people who constantly make you feel less than worthy.

 

 

If someone makes you feel uncomfortable and insecure every time you’re with them, for whatever reason, they’re probably not close friend material.

If they make you feel like you can’t be yourself, or if they make you “less than” in any way, don’t pursue a daily connection with them.

you feel emotionally drained after hanging out with them or get a small hit of anxiety when you are reminded of them, listen to your intuition.

You don’t have to exile them from your life, but you can give yourself space.

 

Set boundaries. Make yourself a priority.

 

There are so many “right people” for you — those who energize you and inspire you to be your best self.

It makes no sense to constantly force it with people who are the wrong match for you. (Note: Marc and I discuss this in more detail in the Relationships chapter of “1,000 Little Things Happy, Successful People Do Differently”.)

 

8. It’s not other people’s job to love and respect you, it’s yours.

It’s important to be nice to others, but it’s even more important to be nice to yourself.

You really have to love and respect yourself to get anything done in the long run.

So make sure you don’t start seeing yourself through the eyes of those who don’t value you

Know your worth, even if they don’t.

 

Today, let someone love you just the way you are — as flawed as you might be, as unattractive as you sometimes feel, and as incomplete as you think you are.

Yes, let someone love you despite all of this, and let that someone be YOU.

 

9. What you own is not who YOU are.

Stuff really is just stuff, and it has absolutely no bearing on who you are as a person.

 

Most of us can make a great life with much less than we think we need.

 

That’s a valuable reminder, especially in a hugely consumer-driven culture that focuses more on material things than meaningful connections and experiences.

To paraphrase Terence McKenna, you have to create your own culture.

 

Don’t watch too much TV or YouTube, don’t read every fashion tip online and don’t consume too much of the evening news.

 

Find the strength to fill your time with meaningful experiences. The space and time you are occupying at this very moment is LIFE,

 

And if you’re worrying about Kim Kardashian or Lebron James or some other famous face, then you are disempowered.

You’re giving your life away to marketing and media trickery, which is created by big companies to ultimately motivate you to want to dress a certain way, look a certain way, and be a certain way.

This is tragic, this kind of thinking. It’s all just Hollywood brainwashing.

 

What is real is YOU and your friends and your family, your loves, your highs, your hopes, your plans, your fears, etc.

 

Too often we’re told that we’re not important, we’re just peripheral to what is.

“Get a degree, get a job, get a car, get a house, and keep on getting.”

And it’s sad because someday you’ll wake up and realize you’ve been tricked.

And all you’ll want then is to reclaim your mind by getting it out of the hands of the brainwashers who want to turn you into a drone that buys everything that isn’t needed to impress everyone that isn’t important.

 

10. Everything changes, every day.

Embrace change, and realize it happens and it can be managed. It won’t always be easy at first, but in the end, it will be worth it.

 

Acceptance is the first step forward.

 

What you have today may become what you have by tomorrow.

You never know

Things change, often spontaneously.

People and circumstances come and go.

Life doesn’t stop for anybody.

It moves rapidly and rushes from calm to chaos in a matter of seconds, and happens like this to people every day.

It’s likely happening to someone relatively nearby right now.

Sometimes the shortest split second in time changes the direction of our lives.

A seemingly innocuous decision rattles our whole world like a meteorite striking Earth.

Entire lives have been swiveled and flipped upside down, for better or worse, on the strength of an unpredictable event.

And these events are always happening.

However good or bad a situation is now, it will change. That’s the one thing you can count on.

So when life is good, enjoy it. Don’t go looking for something better every second

Happiness never comes to those who don’t appreciate what they have while they have it.

 

Yes, it’s your turn to forgive yourself if you’ve recently mishandled or forgotten one or more of the points above.

Forgive yourself for the mistakes you’ve made, for the times you lacked clarity, for the missteps that created needless stress.

Forgive yourself now, for being human!

These are all vital lessons.

And what matters most right now is your willingness to start growing or have learned from them.