living your best to the end

Comfort care

medical decisions

What a lovely thought: comfort care.

Comfort is found in many forms for physical, emotional and spiritual needs:

  • comfort food
  • comfortable shoes
  • getting or giving a hug
  • patting a cat or dog
  • a familiar place or soothing space
  • peace of mind
  • a spiritual or religious connection
  • the comfort of having resolved issues and emotions.

We all need comfort throughout life and there’s lots of comfort to be considered at the end of life. Whatever choice and decision about medical interventions, every part of your body and brain can use comforting.

While pain is most often the most feared, being aware of what else can become uncomfortable – and can be made more comfortable – as life winds down may save future anguish knowing there are many ways to minimize the discomfort pain and suffering.

Common Physical Needs

  • Breathing problems – shortness of breath, gasping for breath
  • Skin irritation – thinner skin is more sensitive and can easily ‘break’ and less easily heal – bed sores are a common, painful result
  • Serious Itchiness – often the result of kidney or liver failure or a side effect of medications
  • Digestive problems – upset or bloated stomach, heartburn, reflux
  • Constipation – often the result of pain medication and not being able to move
  • Diarrhea – in addition to being uncomfortable, this can also cause deydration
  • Nausea
  • Dry mouth – the mouth seems sadly neglected in end of life care – teeth still need brushing, gums flossing.
  • Temperature sensitivity
  • Fatigue: as the body winds down, there’s less energy to be found. Sleeping more is normal, but can add to problems with skin, digestion, constipation and breathing problems.
  • Agitation and delirium

“Comfort care is an essential part of medical care at the end of life. It is a care that helps or soothes a person who is dying.  The goal is to prevent or relieve suffering as much as possible while respecting the dying person’s wishes. “National Institutes on Aging;Providing Comfort at the End of Life

Common Emotional Needs

It can seem that take second place to physical issues but those old emotions cause turmoil: Depression, anxiety, denial, anger, confusion, conflict, a troubled mind, unresolved issues and regrets. Fear is common. Will I be abandoned? How long will it be? What will it be like?

For many, having lived a life of productivity, winding down can bring on a feeling of not be useful, needed or important to anyone else’s life.

Life winding down can feel isolating. Sometimes just ‘being’ with a person – sitting in the same room – or a gentle touch – can ease emotional distress.

Common Spiritual Needs

Spiritual needs – which aren’t necessarily tied to organized religion – often involve questions about fate, the purpose of life and the existence of a higher power or being. Spiritual needs may change with time.

Many religions have end of life, death and bereavement customs and traditions that can be a source of comfort to all.

The comfort of a conversation

Often having the opportunity to talking about your emotions, whether to a Social Worker, Psychologist, Chaplain or other trained health care professional, can be as helpful as it is comforting.

Dr Robert Arnold, Palliative Care physican shares patient stories:

The Ithaca, N.Y., resident, who had heart bypass surgery eight days earlier, is unhappy with her slow recovery on the fifth floor. The doctor wants to hear about it. He doesn’t examine her. He’s just eager to listen.

With her two daughters in the room, Ms. Tsapis lets fly a chattily cantankerous tale of woes about her setbacks. She’s been in pain. She’s had trouble with her breathing. She’s still weak.

After patiently listening, the doctor asks questions about her background, her family, her interests, her pleasures in life. With droll references to the hospital, the medical profession, her hometown and her daughters, he gets her to laugh.

He then issues his professional opinion: She has leeway to whine to her daughters two hours a day without them rebuking her, but otherwise she should be taking walks in the hospital, playing games that she enjoys and avoid sitting around preoccupied by her health troubles. This is how she can assist her own recovery.

When another patient complains about the nasty aftertaste of her liquid pain medication, Dr. Arnold sends her nurse scurrying to find a chocolate bar that will get rid of the taste.” The-human-touch-of-palliative-care-Dr-Robert-Arnold

When you complete your Advance Directives such as BestEndings, you can include instructions to ensure you get comfort care

 

Interesting Reading:A PATH to coordinated care for the frail elderly

Palliative Care: What it is and what it isn’t 

Mouth care: Important to Quality of Life