Our previous column reviewed some of the mental/emotional and spiritual needs which individuals at the end of life may experience, how others can help meet these needs, and provide comfort to a dying individual.  This column examines two additional areas of need identified by the National Institute on Aging; practical tasks and physical condition. 

Providing comfort for the mental/emotional and spiritual needs of a dying individual often focuses on what others say to the individual and family.  Addressing practical tasks and physical condition will focus on what others can do to help meet these needs. 

Practical tasks are those everyday responsibilities which keep a home and family running smoothly.  These tasks may become a source of worry for a dying individual, especially tasks that the individual was accustomed to performing.  Questions may arise about who will take care of these tasks now, or when and how the tasks will be taken care of.  Determining what the individual’s concerns are, and helping develop a plan to meet these responsibilities, can be reassuring to the individual. 

Family members may feel overwhelmed by even simple tasks when they are experiencing feelings of grief and loss.  Assistance with daily chores can be a significant source of comfort for both the individual and family.  It is most effective, however, to be specific when offering help.  A specific suggestion allows the family to say yes or no quickly, and avoids time and energy spent finding a task which is “suitable” for the volunteer.  Examples of practical tasks are running errands, washing or folding laundry, preparing a meal, or making telephone calls.  If you are the caregiver, don’t be afraid to ask others for help, or to assign a specific task when someone offers assistance.

Physical condition is perhaps the most common factor which is thought of in relation to comfort for dying individuals. The experience of pain is at the top of the list.  Keep in mind that pain is easier to prevent than to treat, and treatment measures are more effective at the beginning stages of pain rather than once pain has become more severe.  A variety of medications and doses may need to be tried before the most effective one (with the fewest side effects) is discovered.   

Increased muscle tension may be an indication of pain for someone who is unable to verbalize their needs. Muscle tension may also be a sign of discomfort related to room temperature.  Temperature sensitivity may increase in a dying individual, and simply adding or removing a blanket can improve comfort. 

Breathing patterns may also change at the end of life. The use of oxygen or a cool mist humidifier can promote easier breathing.  A fan may be needed to ensure good ventilation, and the individual’s position will also affect breathing patterns.

Skin irritation can easily occur in an individual who cannot change position independently.  Keeping the skin clean and dry, using extra cushioning, and regular mouth care are effective ways of preventing skin irritation. 

The expectation and management of increased fatigue will be important for those trying to live as “normally” as possible.   To reduce physical and emotional stress, allow extra time for the completion of activities, plan for rest periods between them, and find creative ways to perform activities while expending less energy.  Food and fluid intake are also directly related to physical condition, and comfort related to these factors will be considered in another column.

Living and dying involves many physical, social, emotional, financial, and legal issues.  Pre-planning for some of these issues is possible, but individuals and families must be willing to discuss sensitive topics in order for goals and desires to be understood and pursued.

Karen Kaslow, RN, BSN

Care Coordinator, Keystone Elder Law

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Long Term Care Guide