Typical death trajectory
The most common cause of death in UK is frailty. This can be a protracted period of time with a fluctuating level of function. The appearance of physical deterioration can be difficult for families and gentle explanation of this helps them to accept changes as they occur. These conversations are very difficult but so beneficial for families. The lack of this explanation features highly in complaints and may make the grieving process even more difficult.
Trajectories of dying
Major medical conditions before death
Diagnosing dying is highly complex and this should be acknowledged and reflected in sensitive communications – e.g. having conversations which discuss planning for the worst whilst hoping for the best can be very effective in exploring hopes and fears.
Questions like “if we could not help you get any better and in fact you became worse, where would you like to be cared for/ what would be important to do now..?” – use of tools is helpful in prognostication.
Not many people can accurately diagnose imminent death, which means dying within days or hours. You may find that clinicians focus on medical rather than emotional and quality of life issues.
Most people find the decreased ability of the individual to communicate extremely distressing and the last hours of life is the time when they most want to communicate with their loved one. Planning ahead and preparing the individual and loved ones may help to alleviate some of their distress.
Facilitate the continuity of care and ensure that preparations have been identified within the care plan to avoid any abrupt changes in setting and care, as these can be disruptive and distressing to everyone (for instance moving a patient from a care home to hospital).
You need to recognise that individuals would prefer to remain with those who have cared for them and who they know, rather than people who they do not know. This is also true of any healthcare professionals who are responsible for their care.
Final minutes of life
Remember the dying process is draining on those around the patient and you will need to help relatives and loved ones as death approaches. They will need to hear gentle and sometimes repetitive clarification on:
- what care is being given and why
- the futility of any treatment, nutrition and hydration attempts
- the irreversibility of the events.
All those present at the time of death, will experience the loss in a different way. And that includes you.
In those final minutes, remind people that touch is a form of communication too and encourage everyone to say good bye.
Once death has occurred then care needs to be focused on those in the room. There is no need to hurry.
Allow people to spend time with the body, within the limits allowed culturally and clinically. This allows them to make sense of what has happened.