Care in the last few days of life in hospital
Read our guide below on how to care for a loved one in their last few days in hospital.
You can also download a PDF version of this patient information by following the link on the right.
Caring for a loved one in their last days
Many people worry about what changes to expect when someone is close to death, having more detailed information may help to reduce anxiety and allow for planning of care.
If you still have questions or want to be able to talk this through in person, speak to a healthcare professional who will support you during this time.
Changes that can occur before death
As people approach the end of their life and become weaker the desire to eat and drink reduces. Often they can only manage small, easily, digested meals. For others it may only be sips of fluids. However, there will come a time when the desire and need for food and drink stops altogether and the person may be unable to swallow.
This can be difficult for families and carers as providing food for our loved one is an important part of caring and there may be a concern about the person becoming dehydrated.
When a person is close to death, though it is possible to give fluids by a drip into the veins (IV) or under the skin (subcutaneous), it’s uncertain that this will prolong their life or help them feel better. The risks and potential benefits of fluids given at the end of life will vary from person to person and the team looking after your loved one will assess regularly.
At this time your loved one may get a dry mouth, and this can be relieved by gently moistening their mouth with a small sponge on a stick. Your healthcare professional can provide these and will show you how to use them.
If the person still needs to take medicines at this time then these can be given either as an injections or via a syringe pump.
Over time, dying people become more drowsy and may spend more time asleep than awake. They will have little energy, and may take less interest in what is going on around them.
Eventually, the person may be unable to communicate and may become unconscious. We believe, at this time, that people can still hear, so talking to them or playing their favourite music may be comforting to them.
People who are short of breath are naturally very worried so the knowledge that a loved one is close at hand can be comforting. If needed, medicines are available which can help with the anxiety.
In the last few days or hours of life, the breathing patterns may change and sometimes long gaps between breaths can occur. You may hear a noisy rattle when the person breathes. This is the moisture in our lungs which we need to be able to absorb oxygen.
When we become immobile and weak, we are unable to cough effectively and so moisture or mucus can build up and it is this which causes the “rattling” sound. When needed, medication can help reduce the amount of mucus produced and changing the person’s position may also help.
Sometimes however, once the mucus has built up, these measures do not relieve the problem completely. Usually, noisy breathing does not distress the dying person, but it can be upsetting for loved ones.
When people are dying they often breathe through their mouth, causing their mouth and lips to become dry. Moistening the mouth with a small sponge on a stick and applying lip balm or Vaseline can help to soothe the dry lips.
Oxygen requirements may be reassessed and whilst it may be useful for some patients, for others, it may no longer be needed.
There may also be changes which occur to the person’s skin near the end of life. It can become pale, moist and slightly cool before death. There may also be colour changes apparent, especially on the arms and legs.
Sometimes, in the last few days of life, people may become muddled and confused. This is a normal part of the dying process.
If necessary, they can be given some medication to help with this. However, most people become increasingly sleepy and die very peacefully.
Giving medicines using a syringe pump
Often in the last days of life a syringe driver will be used. This syringe pump is used to deliver a constant dose of medicines usually over 24 hours. A small needle will be inserted just under the skin in the arm or tummy which the pump will be connected to.
A syringe pump means that the person can have the medicines they need and do not need a lot of injections.
Common medicines used to relieve symptoms in the last days of life include:
- Morphine for pain or breathlessness (alternatives include Oxycodone and Alfentanil)
- Midazolam for agitation and restlessness
- Haloperidol for nausea and vomiting
- Hyoscine for chest secretions (these may continue after medication).
End of life comfort measures
It’s important to us to try and ensure that we meet you and your family’s needs please let the staff in the ward know if there is something that is very important to you.
If possible a side room may be offered for privacy. We’ll also place a purple rose on the door or curtain to protect your privacy as this will indicate to other staff to check before entering your space. Loved ones can stay by the bedside and the ward staff will discuss with you about food and drink, parking etc.
Please feel free to bring in your loved one’s own nightclothes, a special blanket for the bed, photos to help to make the space more homely.
Some families may want to be involved in assisting with their loved ones care, if you do please tell the nurses. If you want to have a keepsake the nursing staff will be able to help you with this.
Spiritual, pastoral and religious care
While support during this time can come from families and friends, sometimes it helps to talk to someone who is independent.
The spiritual and pastoral team are very approachable and provide support to patients and their families. Speak to a member of staff who will contact them for you.
Questions you may have
For lots of relatives there is a worry about whether their loved one has pain. Lots of patients can make a moaning or sighing noise when unconscious which is probably due to their breathing as a lot of people do when they are asleep.
An indication that someone may have some pain is a furrowing of the brow. If concerned call a member of staff who can assess them and reassure you or give analgesia if needed.
Lots of people are unsure about what they can donate. We have specialist nurses who can talk with you. If you think this is something you’d like to discuss, let the doctor or nurse know and they can contact the specialist nurse for you.
If you are not around the nurses in the ward will call you to tell you so you can come in if you wish.
Care after death
Everyone reacts differently to a death of a loved one. You’ll be given time to say goodbye.
After death, a doctor or nurse will verify that death has occurred. We continue to care for the person until they’re taken to the mortuary.
When you’re ready to leave, the nursing staff will explain to you about collection of the medical certificate. If there’s a need for urgent release for burial due to spiritual, cultural or practical wishes, we can discuss this with you.