Manage Dying

This section reviews resources to assist you in recognising that someone is imminently dying and to provide support for dying residents and their families.

Recognising 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) | Queensland Health is a care plan to provide quality end of life (terminal) care in residential aged care. The RAC EoLCP includes evidence and consensus-based best practice clinical management and care coordination for dying residents.

The RAC EoLCP is free to use under a Creative Commons licence. However users must agree to the terms of the licence.

Talking About Dying

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)

End of Life Medications

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.

Syringe Drivers

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.

After the Resident Has Died

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)

ELDAC Toolkit Educational Video

Watch the ELDAC Manage Dying educational video will help you to recognise deteriorating health; implement the Residential EOL Care Pathway and identify the changes that show death is near.

Assessment Tools
Family Resources

The Residential Aged Care End-of-Life Care Pathway (RAC EoLCP)

The RAC EoLCP is free to use under a Creative Commons licence. However users must agree to the terms of the licence.

CarerHelp

Pathway 4: When the Person is Dying provides information and resources for carers of people with palliative care needs.

Palliative Care Australia

Palliative Care Australia has a webpage and accompanying handout on explaining the Dying Process including changes that family might notice, how to know that death has occurred and what they can do to help.

PalliAGED

PalliAGED has information to support families who are dealing with a loved one dying. There are family resources on the end of life to help explain palliative care and what to expect.

Research Centre for Palliative Care, Death and Dying (RePaDD)

A guide is available from RePADD to support and provide information to family and friends about someone entering Residential Aged Care through to the end of life. The booklet is called When someone dies in residential aged care: Grief and loss for families (pdf 8MB).