Primary Care - Manage Dying
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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:

  • 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,
  • an acute event has occurred requiring revision of treatment goals,
  • profound weakness,
  • changes in breathing patterns.

At this time it is important to consider the costs and benefits of interventions and medicines. Priority should be given to maintaining comfort and dignity through adequate symptom control. Active treatment for long term conditions may be simplified or ceased, for example discontinuing medicines where comfort is not affected, such as anti-hypertensives, prophylactic anticoagulants, etc. It is also important to consider the route of delivery for medicines as the ability to receive medication orally may deteriorate.

Prescribing information: for managing common end of life symptoms
CareSearch
This webpage provides prescribing information for common symptoms when death is likely in days, including anxiety and emotional distress, delirium, excessive secretions, nausea and vomiting, pain and shortness of breath. This information is based on the PalliAGED – ‘Prescribing in the terminal phase’.

 
End of Life (Terminal) Symptom Management Medications for Older Australians Living in the Community (146kb pdf)
Australian and New Zealand Society of Palliative Medicine Inc. (ANZSPM)
A summary of prescribing advice for medicines suitable for use in community aged care for the management of symptoms in the last days of life.

There are legal regulations and laws concerning death certification and coronial procedures, these vary between states and territories. Life is to be declared extinct 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.

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

Checklist - Planning for an expected home death
CareSearch

A checklist for GPs when planning for an expected home death. Main topics include:

  • clarifying expectations and support,
  • assessing the home situation,
  • planning for symptom management, and
  • information that families need.
The dying process
Palliative Care Australia
This leaflet asks the question what does dying look like? What are the changes that happen and what should you do?
 
Considerations for a home death
Canadian Virtual Hospice
The purpose of this article is to outline some of the potential challenges and rewards that come with a home death. That way, both patients and caregivers can have a better idea of what might be expected.
Podcast Episode 29: Drug interactions and deprescribing
Royal Australian College of Physicians (RACP)
This episode features interviews with Prof Richard Day and Prof Sarah Hilmer discussing some of the systems that have led to current rates of polypharmacy, and some strategies for deprescribing.
 
Recognising death
Royal Australian College of Physicians (RACP)
This episode features interviews with Dr Amanda Walker, Dr Charlie Corke and Dr Peter Saul discussing recognising dying and discussing dying with patients, families and carers.

Page updated 15 August 2018