Are you reluctant to face the thought of death? Fear, anger, and inadequacy are some common feelings we experience when we must deal with our own or a loved one’s mortality. An understanding of how to help comfort someone who is at the end of life can help us cope with these feelings, and allow us to provide more effective care to those in need of our support. The National Institute on Aging, in its literature about the end of life, discusses four main areas of comfort that should be addressed at the end of life. These four areas are mental/emotional, spiritual, practical, and physical. Last week we reviewed some myths and misperceptions about hospice services. Hospice and palliative care are two types of services that attempt to identify and meet these comfort needs for the individuals and families with whom they interact. But you don’t have to be a professional to learn how to comfort someone who is near death.
Let’s start with mental/emotional comfort. Everyone will have their own experience with death, and there is no right or wrong way to think or feel about it. People are often afraid of talking about death and don’t know what to say to someone who is dying. They try to offer platitudes, which although meant well, usually aren’t helpful. Instead, let the individual know that you are willing to listen, and allow them to guide the conversation. Some people may be willing to share their thoughts, while others may not be ready. Don’t be offended if the individual chooses someone else with whom to talk. Sometimes, sharing thoughts and feelings with family or friends can be more difficult than sharing them with a more “neutral” party, such as a medical professional. Dying people may have specific fears or concerns, such as being alone at the time of death, or leaving others behind. Some fears and concerns (like the two mentioned previously), may be common among those who are dying, while others may be highly individualized. It is important not to assume that you know what someone’s fears are, or impose your own fears on the individual. These situations may lead to misunderstandings and tension instead of comfort. A dying individual will be comforted when his or her own fears and concerns are validated and attempts are made to address them, no matter how trivial they may seem to others. Meeting this need will allow the individual to relax and focus energy and attention on important relationships.
Other mental/emotional needs revolve around the environment. How many visitors does the individual feel comfortable with at one time? What about lighting and noise levels? Absolute quiet is not necessary; the noise of daily activity may be reassuring. Background music may or may not be appreciated. Thinking about your loved one’s personality can help guide routines and activities. Those who are dying but still relatively active will appreciate being treated “normally,” and may have a need for time alone. Respecting the individual’s ability to make choices and retain autonomy for as long as possible also is an important factors in promoting well-being.
Understanding an individual’s spiritual needs will also contribute to their level of comfort. The belief that one’s life has been meaningful provides a sense of peace to many people. This meaning can be reinforced by sharing memories, verbalizing the importance of your relationship with the dying person, discussion about personal beliefs and faith, and prayer. If loved ones are distant and unable to visit in person, these activities can be shared through letters, recordings, and even Skype. When speaking with the dying individual, asking open ended questions about beliefs, meaningful experiences, and regrets can help initiate a discussion of potentially sensitive topics. Sharing tears can be cleansing for everyone. Writing down information that is shared verbally may become a source of comfort to family members and friends after the individual’s death. To achieve a sense of closure, the individual may require assistance to make telephone calls or write letters to others to say thank you, offer an apology, ask for forgiveness, or say goodbye.
Hopefully, these tips will help you feel more empowered to provide comfort to those who are dying, so that you may put your love into action and your remaining time spent together will be honest and meaningful. Next week we will cover the last two areas identified by the National Institute on Aging: practical comfort and physical comfort.
Karen Kaslow, RN
Care Coordinator, Keystone Elder Law