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While abundant resources and products
are available to guide caregivers of dependent newborns, precious
little exists to guide caregivers of those at the other end
of life's journey. Old or young, healthy or not, basic personal-care
needs are the same: good skin care, adequate bowel and bladder
function, and good oral hygiene. Persons approaching the end
of life often have problems in one or more of these areas. Caregivers
need knowledge and support to understand and tend to their loved
ones' needs.
Bowel care
Constipation is common. It may
be due to narcotic pain medications (such as morphine, which
slows the bowel). Constipation also can be caused by decreased
fluids or fiber or decreased physical activity. Patients need
to drink as much fluid as possible (hot liquids in the morning
are helpful) and focus on high-fiber foods such as prunes,
dates, raisins, and dried fruit. Getting the patient up and
walking around helps. As the amount of pain medicine increases,
so should the medicine(s) to treat constipation. Check with
your nurse or physician regarding use of over-the-counter
stool softeners, senna, MOM, fiber, or enemas.
If diarrhea is the problem,
stop the laxatives and high-fiber foods. Avoid caffeine, milk
products, and greasy or spicy foods. Treat with over-the-counter
medications for diarrhea. Remember to increase the patient’s
fluids (to replace the fluids lost with diarrhea) and gradually
resume a bland diet (potatoes, rice, oatmeal, bananas, toast).
(Return to list)
Bladder care
Most patients, at some point,
will lose control of their bladders due to weakness. If it
is acceptable to the patient, a tube (called a "Foley
catheter" or "Foley") may be placed in the
bladder by a home care or hospice nurse. The catheter will
drain into a bag that is hooked to the bed or a chair. If
preferred, an adult "diaper" can be worn. To maintain
the patient’s dignity, caregivers might refer to the
diaper as protective panties or undergarments. Your loved
one should be kept clean and dry so that this sensitive area
does not become irritated.
As the end of life approaches,
organs begin to shut down. This process includes the kidneys,
which produce the urine. Caregivers will notice a decrease
in the amount of urine. It will be darker in color and have
a stronger odor. (Return to list)
Skin care
Frequent skin care accomplishes
several goals: it can allow loving, caring touch between caregiver
and patient; it can refresh and improve patient self-image;
and it can promote circulation through gentle massage. Patients
who are bedbound are at high risk for skin breakdown. Pressure
is applied not only externally from the mattress, bed sheets,
and other body parts, but also internally from bony prominences
such as the hipbones or shoulder blades. Skin breakdown (bedsores)
can occur in a period of hours. Caregivers can reduce the
occurrence of skin problems by having the patient change position
every two hours, taking care to cushion bony prominences.
Lotions and oils are helpful tools in the prevention of skin
breakdown as well. Lastly, if arms or legs are swollen, this
can be reduced by keeping the affected limb(s) elevated on
pillows. (Return to list)
Oral care
What a difference a toothbrush
can make! Persons approaching the end of life often cannot
brush due to weakness or tender, ulcerated gums. Mouth care
for these people is extremely important to promote comfort.
For patients who are eating or drinking, a clean mouth also
will enhance taste. If a soft toothbrush is too harsh, sponge
"toothettes" or mouth swabs can be used. (They are
available in most pharmacies or medical supply stores.) Some
patients like these dipped in ice water. Avoid mouthwash that
is alcohol-based, as it can be drying and may irritate any
sores in the mouth. Lip balms, olive oil or Vaseline will
keep lips moisturized and prevent cracking. (Return
to list)
For more information
We recommend that you go to
the symptom
management webpages of Beth Israel Hospital in New
York. (Return to list)
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