One day, your task as a care partner will end.
Of course, you know this. Perhaps, on a day full of appointments and crises and decisions, you long for that day. In a secret place in your heart, you might think, “My elder has suffered enough and I’m tired. I’m ready for the end.”
Then a nurse or doctor pulls you aside and and says, “I think we are approaching end-of-life.” It may be that the finality of that moment will shake you. Your journey together is about to take a turn from which neither of you will return. They are leaving and you won’t be the same.
I can’t help you deal with the emotions of that moment, but knowing the signs of end-of-life can help you prepare.
End-of-life
Each elder and every death is different. It’s important to remember that there are no absolutes other than death itself. You may see all or only a few of these indicators.
Decrease energy
Over the past several years, you’ve probably noticed a slow decline. As end-of-life approaches, this will increase. They will stay in bed some days, and then every day. Activities which they loved can now only be tolerated in short increments.
Decreased hunger and thirst
It may creep up on you, until one day you’ll realize that your elder’s clothes are hanging on their skeletal frame and they barely eat enough to sustain life. You can’t keep them hydrated either as they take only a few sips at a time.
Don’t panic.
Many care partners turn to nagging, cajoling and frantic persuasion. More drastic measures are intravenous fluids and feeding tubes. It’s important to realize that the rules change at this point in life.
- Eating a balanced diet no longer matters
- It isn’t important to get enough vitamins
- Eating is for pleasure and not to sustain life.
Your elder’s organs are starting to shut down. If a small bowl of chocolate ice cream is what they want, make sure they get it. They may only take a mouthful or two, but it will give them pleasure and that’s what matters.
The ability to swallow may become impaired
In the past months, their diet may have been changed to minced or even pureed, and their fluids may have been thickened. All of this is to aid in swallowing as it’s common for the ability to swallow to decrease. The danger of aspiration and resulting pneumonia is real, so these special diets are important. Eating in an upright position, small amounts and slowly also helps. But at some point, swallowing may become impossible.
Don’t panic.
I will talk about feeding tubes in a later blog, but let me say at this point: don’t. Feeding tubes were never intended for elderly people at end-of-life, and they present multiple problems. Your elder’s body is naturally shutting down. Allow the process and make them as comfortable as possible.
Ability or inclination to talk may wane
However, they can still listen. Use this time to say all the important things you need to say. Share precious memories, express love, tell how they have influenced your life. This is your chance.
Bowels and bladder will be less active
This is because of less intake and because their organs are no longer able to function as they used to.
Breathing can become raspy
The heart is pumping slower and isn’t pumping the way it should, causing fluid to build up. This can cause raspy breathing. It can be managed medically, but should only be done to provide comfort.
As the end nears…
- they get bluish, mottled skin on their toe and nail beds, and sometimes knees.
- Their body temperature drops.
- The rattled breathing becomes more pronounced, and they may slip into a coma.
This may be painful to read, especially as you imagine your elder in this state. You may feel helpless. Don’t panic.
Be there. Your presence, your words, your touch will be all they need as they leave this life. This is your final opportunity to care.
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