Understanding End-of-Life Concerns for the Elderly

End-of-life care is when someone is caring for another person during the last month or weeks of their life. Understanding end of life care can be helpful for the family to know what to expect. It creates a plan for those who are approaching the end of their life and revolves around the needs of the person as a whole. End-of-life concerns typically focus on making sure there are no tasks that haven’t been taken care of after the individual has passed.

End-of-life concerns revolve around the comfort and physical needs of the person. However, learning to manage the emotions of the family members is also an important aspect of end-of-life care.

Types of Care

There are a few types of care given during times of illness depending on the illness and its prognosis.

End-of-life care focuses on the process a person goes through as they approach the end of their life. This type of care focuses on the whole person, including their mental and spiritual selves.

Palliative care is simply controlling pain to improve a person’s quality of life and can be given at any time during a person’s illness.

Curative care is care given to cure the illness.

Hospice care is for those individuals who are terminally ill and is focused on controlling pain and other symptoms.

Signs of End-of-Life

Just as each individual is unique, so also will their death experiences be. For some, it may be a slow process, while others will experience a quick transition to death. It is important to remember that regardless of how it progresses, each person needs to have comfort and dignity during this time.

End-of-life concerns typically include the presence of someone near them just for soothing conversations and acts of compassion. End of life can come in stages as outlined below.
Months (40-90 days)
Loss of Appetite: As a person nears the end of life, it is normal for them to have a loss of appetite. As a result, there is a weight loss.

Fatigue and Weakness: The body is starting to slow down so this can lead to an increased desire to sleep. Because the body is not getting fuel through food, it will start to become weak. This means that movement is difficult for the person.

Withdrawing from People: When death is becoming a realization, the person may start to withdraw. They will start separating from friends and family. There may also be times of reflection on life and regrets.

Discussions about Death: Individuals will talk openly about end-of-life wishes. Faith and cultural backgrounds play an important role in how a person views death.

Pain: Pain is a common symptom that may vary for each person. It may come from the illness, or it could be a result of emotional distress.

Nausea: Nausea can result from different reasons. Constipation, medications, or emotional stress can contribute to nausea.
Weeks before the End of Life:
Eating may stop It is a normal process for eating to stop due to lack of appetite. This is a normal process and does not speed up the end-of-life process.

Restlessness Medicine and chemical changes in the brain can lead to restlessness and agitation. This may result in senseless movements.

Confusion During this time, the respiratory system provides less oxygen to the brain, and this can cause confusion and delirium.

Hallucinations Seeing or hearing things or people that are not there is common during the last weeks or days of life.

Increased Sleep It is not uncommon for a person to sleep most of the day when nearing the end of life. They may even sleep for a few days before seeming to be awake. They will typically respond if someone attempts to wake them.

Skin Color Change Due to the change in circulation, the person’s hands, feet, and knees may be discolored, purple, or grey. They can also have areas of dark blotchy patches (mottled skin) on their back.

Labored Breathing Being self-active means that a person needs less oxygen. Because of this, a person facing end of life will have breathing that is shallow and less frequent.

Incontinence For individuals facing the end of life, it’s not unusual for them to lose control of their bladder or bowels. Typically, their bathroom needs are reduced as they are not eating and drinking normally.
Days before the End of Life
Unconsciousness and Unresponsive As the end-of-life approaches, the sleep pattern of the person may increase to the point that there is little consciousness. When there is an attempt to wake them, they may be unresponsive.

Irregular Vital Signs It is not uncommon for vital signs to be irregular. This includes blood pressure, heart rate, and body temperature.

Cessation of Eating or Drinking As they are near the end of life, a person may come to a point where they are unable to eat due to gastrointestinal issues or choking.

Restlessness There may be a period of restlessness or agitation for these individuals. As they draw nearer to death, they may not recognize those around them.
Hours before the End of Life
Breathing Changes Most of the time people nearing the end of life will exhibit Cheyne Stokes breathing. This breathing pattern cycles from a gradual increase in breathing followed by a decrease. There is also a period where sleep apnea is present. This cycle will continue because the body is trying to recover from the change in carbon dioxide levels.

Pain There are times when some individuals will show signs of being in pain. They may even grimace or cry out. Pain management can be planned through the healthcare team.

Skin, Body Fluid, and Breath Odor As they near death, there are metabolism changes that cause skin, body fluids, and breath to smell similar to acetone.

Noisy Breathing Eventually, the breathing will become loud and congested. This comes from the inability to reabsorb fluids in the throat or chest.

Cold Extremities (Hands, Feet, Nose, and Ears) Compromised circulation will also cause these areas to feel cold to the touch.

End-of-Life Concerns

To promote a peaceful process for end of life, there must be ground rules in place. Having compassion amid a trying time can ensure that all involved will find the support needed to adjust to the transition and loss.

As humans, we can be harsh during the hard times of losing someone dear to us. Some decisions need to be made but are not well thought out because of the emotional and mental distress of death. For this reason, it is best to make sure there are agreements and rules for behavior to ensure that your loved one isn’t surrounded by arguments during the last days of life.

Talking to other family members can help with navigating fears about death. This should be done before the passing of the loved one. There are many ways to find help with this issue. Christian counselors, books, and pastors are great avenues of support and information.

The most important end-of-life concern is that you honor the wishes that the dying individual has put into place. This will reduce the stress of decision-making and allow you to grieve healthily. Honoring your loved one isn’t just about carrying out their wishes regarding details for services and execution of the will.

Honoring them means you are taking care of yourself, doing good things in their name, starting new chapters in life, remembering to be joyful, and showing others grace in the middle of grief.

Getting Support

It is normal to have end-of-life concerns when facing death. It is terrifying to imagine life without a loved one. You begin to grieve even before the person has passed. Caring for a dying person is also emotionally strenuous. Consider reaching out to a counselor to walk you through the process. Feel free to contact our offices today and we can connect you with a Christian therapist who is skillful at navigating grief, death, and supporting the dying.