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

Some organisations have a specific care plan for residents in the final days or weeks of life. The use of an end of life care pathway or terminal care plan may help to focus the care required for residents in the last days or weeks of life. palliAGED has a downloadable Practice Tip for End-of-Life Care Pathways for Nurses (pdf 330kb) and Careworkers (pdf 451kb)

The Residential Aged Care End-of-Life Care Pathway (RAC EoLCP) is available for download from Metro South Health in Queensland and the document is licensed under a Creative Commons licence. There is no cost associated with downloading or using the RAC EoLCP document. However, you must agree to the terms of the licence. The website also offers further information and guidance on using the RAC EoLCP.

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.

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 General Practitioner. 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)