Resources for the Comprehensive Geriatric Assessment based

Proactive and Personalised Primary Care of the Elderly

Advance Care Planning :

Providing support and comfort during advancing illness is an essential part of medical care.

The goal is to respect wishes while preventing or relieving discomfort.

Various needs for comfort at this time of life and disease progression include: Physical, Emotional, Spiritual, Mental, and Practical.

 

 

Physical Discomfort

 

One need that most families and caregivers are aware of and are very concerned about is physical comfort.

Causes of physical discomfort include:

 

• Pain

  • Breathing problems

  • Skin irritations

  • Digestive problems

  • Fatigue

 

• Pain

People are concerned about good pain control when nearing the End of Life.

Unless the individual abides by spiritual beliefs that masking pain is not desirable.

• It is important to focus on pain relief not addiction or abuse

• It is easier to maintain control instead of playing catch up

• Analgesic medication needs review when pain is no longer being relieved, or changes

 

• Breathing problems

Shortness of air, or feeling that breathing is difficult, is a concern in the final stages of life.

Assistance to help provide comfort include:

• Oxygen by mask or cannula

• Fan circulating cool air

• Raising head of bed

• Medication

 

• Skin Dryness/Discomfort

  • Alcohol free lotion can be gently applied.

  • Lips can become very dry which can be relieved with a lip balm.

 

 

• Digestive Discomfort

Loss of appetite, nausea/vomiting, constipation and diarrhea may occur in the final stages of a disease.

• Constipation can be caused by pain medication.

• A person’s body may be unable to use the nutrition that is being provided, appetite may decrease.

• Patients often choose not to eat in the final stages of the disease

• Offer favorite foods in smaller portions.

• Assist with feeding

• More frequent meals.

• Change focus of nurturing to touch and talk.

 

• Fatigue

• Keep activities short and simple.

• Make use of appropriate equipment to assist

 

 

Spiritual Concerns

 

Spiritual needs may arise as a person faces the final stages of a disease.

These may include:

• Finding meanings in one’s life

• Resolving issues with families or friends

• Finding peace with self and others

• Fighting disease

• Restlessness can be spiritual

• Many people find strength and peace through their spirituality

• Talk to the person, not about the person

• Hearing is the last sense to leave. Speak  to otherwise non-responsive patients as if they can hear.

• Share memories and fun times—these can be very comforting

• Enlist the help of a social worker, physician, nurse or pastor with these concerns

 

 

Practical Concerns

 

Remember that with progressing illness practical concerns do not stop.

Often knowing their caregiver is taking care of themselves and receiving the support they need can bring a measure of comfort and peace to the patient.

Be honest and specific about the support that can be provided. Knowing how some things can be taken care of – for example, beloved pets or plants, - can  provide great comfort for the patient