Caring for someone at the end of their life can mean many things to different people. Often it is referred to as comfort care or palliative care or when someone is palliating. Symptom management is a large component of maintaining a person’s comfort, along with supporting spiritual, emotional and cultural wellbeing of the person and their loved ones. The routine comfort measures often thought about at this time are around pain relief, comfortable positioning, skin care, urinary and bowel care, mouth and eye care. I often say to staff “if they don’t look comfortable, then they probably aren’t.” With all these comfort measures to consider, the comfort of the eyes and mouth can be easy to maintain with some simple techniques, making a huge impact on the quality of the overall comfort during their last days of life.
The non-pharmacological measures used to maintain comfort are just as important as the symptoms we control with medication. “It’s the little comfort things that make all the difference.”
As a person ages, dry eye syndrome is common and the use of lubricating drops during the end of life stage can help to promote and maintain comfort. Maintaining a person’s regular prescribed eye drop regime is a good way of maintaining eye comfort at the end of life.
As a person is dying and becomes unconscious their altered hydration affects the comfort of the eyes and mouth as these are susceptible to drying out. The aim is to maintain comfort in the last few hours or days of a person’s life which is paramount to a person’s overall wellbeing.
As we blink and close our eyes we are constantly lubricating the eyes. As a person loses the ability to blink with decreasing levels of consciousness, the eyes can dry out and become uncomfortable.
Saline eye toilets can be helpful with cleaning the eyes and if any discharge is present the saline can also help with maintaining comfort when eyes are dry.
Simple eye care can make all the difference to a person’s comfort. A warm wet face washer can also be soothing when placed across the eyes.
As with eyes, mouth care is another area of care that has a big impact on a person’s comfort as they are reaching the end of their life. Mouth breathing is common, along with reduced hydration and the inability to swallow and changes in conscious levels. Maintaining a clean and moist mouth can be a challenge and establishing what is comfortable for the person is important. Ensuring the mouth is clean with routine cleaning either with a soft toothbrush or foam swab, followed by frequent moistening of the mouth with plain water and/or saliva substitute gel can maintain comfort and prevent any further discomfort such as cracks, bleeding or ulcers.
The importance of comfort measures continues as a person approaches their end of life and it is pleasing to see that both oral and eye care have been included in the palliAGED Practice Tip Sheets for careworkers and nurses in aged care.
Karen Gregory, Palliative Care Clinical Nurse, Resthaven Inc. SA