Manage Dying

While individuals may differ in their signs and symptoms of dying there are some common indicators that a person may be in the final days of life. These include:

• Signs and symptoms associated with the terminal phase
• Experiencing rapid day-to-day deterioration that is not reversible
• Requiring more frequent interventions
• Becoming semi-conscious with lapses into unconsciousness
• Increasing loss of ability to swallow
• Refusing or unable to take food, fluids or oral medications
• Irreversible weight loss
• An acute event has occurred requiring revision of treatment goals
• Profound weakness
• Changes in breathing patterns

The CareSearch website has a section on Planning for a Home Death which includes a checklist for planning an expected home death. Main topics covered are:

• clarify expectations and support
• assess the home situation
• plan for symptom management
• information that families need

There also is a resource tab for clients and family caregivers.

Talking about death and dying can be difficult.

CareSearch provides an extensive list of resources for discussing the process of death and dying.

palliAGED has a downloadable Practice Tip on Talking About Dying for Nurses (pdf 315kb) and Careworkers (pdf 454kb)

Assessment and management of symptoms is critical for dying residents. Information about medication is available on the CareSearch GP Hub - End of Life Symptoms webpage including:

1. An overview of key points guiding quality pharmacological management of end of life (terminal) symptoms.

2. Prescribing information for managing common end of life symptoms: Pain; anxiety and emotional distress; delirium that is causing distress; excessive secretions; nausea and vomiting; and shortness of breath.

The caring@home project has resources to support people to be cared for and to die at home, if that is their choice. This factsheet (pdf 209kb) provides information about caring@home and outlines the resources the project has available to support Home Care Package providers.

A syringe driver are commonly used for symptom management and are used to provide continuous medications subcutaneously when a person is no longer able to swallow.  More information and resources about syringe drivers can be found at this CareSearch webpage.

palliAGED also has information on Subcutaneous Medication Administration.

There are legal regulations and laws concerning death certification and coronial procedures. Death is to be verified and depending on which state or territory you are in this may be done by a nurse or doctor. Certification of death must occur which is usually by the GP. In some instances deaths must be reported to the coroner.

palliAGED has a downloadable Practice Tip on After-Death Choices for Nurses (pdf 220kb) and Careworkers (pdf 442kb)

The After Death Care section of the CareSearch website has information on things to be done after the client has died including:

• After a Death at Home
• Care of the Body
• Religious and Cultural Considerations
• Tissue Donation

Watch the ELDAC Home Care Toolkit educational video on After Death Care and Bereavement.