Managing Symptoms at the End of Life

Fatigue
Chronic fatigue, the kind that affects most people who are dying, can stem from:

• An illness.
• Anemia.
• Depression.
• Poor nutrition.
• Deconditioning (becoming out of shape from lack of exercise).
• Side effects from treatments such as chemotherapy and radiation.

Persistent exhaustion impacts every aspect of a person's life: psychological, physical and emotional. Ask your loved one's doctor to adjust medications or try nondrug interventions such as gentle exercise. Even a walk around the block can help. If untreated, fatigue will overwhelm a patient's quality of life. 

Loss of Appetite and Thirst
As the end approaches, the desire to eat and drink ebbs. Because the body either doesn't need as many nutrients or can't absorb them, it stops asking. Weight loss follows. Bear in mind that it's a natural part of the dying process and the patient isn't suffering. Neither family members nor health providers should force terminally ill patients to eat or drink. If they do ask for food or drink, offer small, frequent meals of high-calorie, high-protein foods, or add nutritional supplements. Keep ice chips handy. They relieve two key symptoms: dehydration and dry mouth.

For those who may consider more aggressive measures, such as feeding tubes or intravenous lines, confer first with the doctor, hospice nurse or primary medical professional about the pros and cons.

Skin Breakdown
Anyone confined to a bed for long periods of time will risk bedsores, also known as decubitus ulcers. They usually occur on the arms, legs, feet and back, places where prolonged body weight creates pressure points against the bed. Lack of circulation causes skin to break down at these points. To protect skin and prevent infection, try the following:

• Change your loved one's position every two hours. Ask a medical professional to show you how to do this safely.
• Be sure that your loved one maintains good nutrition as best as possible.
• Talk to your doctor about whether a special bed or mattress can help.
• If your loved one develops bedsores, ask a doctor, home care nurse or other medical professional how to care for them. If you cannot cope with changing the dressing, find someone who can.
  

Cognitive Changes
Up to 85 percent of terminally ill patients suffer from cognitive changes during their final days. The most common afflictions include confusion, delirium and agitation. These symptoms arise from any number of causes, including the disease itself, infection, medications, and kidney and liver dysfunction. The reassurance of family and friends can play a vital role in helping someone who suffers cognitive problems. Discuss these cognitive changes with your health care team. Some medications long in use, such as haloperidol, can help with agitation and confusion.

Digestive Problems
For those who are terminally ill, digestive issues are a frequent problem. The most common issues are:

• Constipation: Patients who are bedbound and not eating a regular diet are often affected by constipation. Many medications worsen it, so talk to your loved one's doctor or nurse about preventions and solutions.
• Bowel obstructions: A cause of great discomfort, obstructions prevent patients from eliminating stool. An obstruction needs to be diagnosed by a health professional and treated as soon as possible.
• Nausea/vomiting: Nausea torments 60 percent of terminally ill patients, and episodes of vomiting harass another 30 percent. Again, various medicines complicate it, so talk to the doctor about changing medications or having an anti-nausea drug prescribed.

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