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

The CareSearch website has a section on Planning for a Home Death which includes a checklist for planning an expected home death. Main topics covered are:

• clarify expectations and support
• assess the home situation
• plan for symptom management
• information that families need

There also is a resource tab for clients and family caregivers.

Talking about death and dying can be difficult. The Residential Aged Care Palliative Approach Toolkit (PA Toolkit) has a webinar “Someone is dying. What do I say?”

CareSearch provides an End-of-Life Essentials factsheet on discussing the process of death and dying (127kb pdf). Even though the End-of-Life Essentials resources were designed for use in hospital settings, the factsheet provides useful phrases for discussing the process of death and dying.

Assessment and management of symptoms is critical for dying clients. Information around medication is available in the Guide to the Pharmacological Management of End of Life (Terminal) Symptoms in Residential Aged Care Residents (375kb pdf). This guide provides a list of eight medications, their indications and suggested dose.

The caring@home project has resources to support people to be cared for and to die at home, if that is their choice.

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.

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 GP. 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 client has died including:

• After a Death at Home
• Care of the Body
• Religious and Cultural Considerations
• Tissue Donation