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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological

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    Back to Module 12: Last Hours of Living
    Part I: Physiological Changes and Symptom Management During the Dying Process

    Weakness/Fatigue
    Decreasing Appetite/Food Intake, Wasting Decreasing Fluid Intake, Dehydration
    Decreasing Blood Perfusion, Renal Failure
    Neurological Dysfunction: An Overview
    Pain
    Loss of Ability to Close Eyes
    Changes in Medication Needs

    Decreasing Appetite/Food Intake, Wasting

    Signs and Symptoms

    • Most patients lose their appetite and reduce food intake long before they reach the last hours of their lives
    • Families and professional caregivers often:
      • Interpret cessation of eating as "giving in"

      • Worry that the patient will "starve to death"
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    Management of Family Concerns

    • Physicians can help families understand that loss of appetite is normal at this stage. Remind them that:
      • The patient is not hungry

      • Food either is not appealing or may be nauseating

      • The patient would likely eat if he or she could

      • Clenching of teeth may be the only way for the patient to express desires
    • Educate families about the studies that demonstrate that parenteral or enteral feeding of patients at the end of their lives neither improves symptom control or lengthens life
    • Help them to understand that anorexia may be protective, as the resulting ketosis can lead to a greater sense of well being and diminish pain
    • Whatever the degree of acceptance of these facts, it is important for physicians to help families and caregivers realize that food pushed upon the unwilling patient may cause problems (e.g., aspiration) and increase tensions (see Module 11: Withholding, Withdrawing Therapy)
    • Above all, help them to find alternate ways to provide appropriate physical care and emotional support to the patient so that they can continue to participate and feel valued during the dying process
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