Hospice of Southern Illinois

Premiere Local Hospice Provider

Evaluation of Pain in the Cognitively Impaired Individual

Non-verbal male in end of life care whose pain is under control

            At Hospice of Southern Illinois, one of our primary goals is the management of pain in our patients. According to the International Association for the Study of Pain, pain is defined as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” While this formal definition may sound complicated, we all have a general understanding of the concept and have experienced some level of pain in our lifetime. Pain is a very subjective symptom, and pain thresholds vary greatly between individuals. Thus, we cannot apply our own personal experiences with and opinions regarding pain to others.

In an ideal situation, health care providers and familial caregivers could simply ask a patient if they are having pain. However, some patients lack the ability to verbalize altogether or lack the cognitive capacity to reply to the question. This is commonly encountered in patients with an underlying neurological condition, such as dementia, Parkinson’s disease, stroke, or developmental delays. So, what do we do?

First and foremost, we should still ask the question, “Are you experiencing any pain?”

Oftentimes, we may be surprised by an individual’s ability to respond verbally. Many neurological conditions wax and wane. Therefore, we must always give our patients and loved ones the respect of conversation. If a response is not evoked, or if the response is not intelligible, we can also garner information from those caring for the patient daily. They know the patient’s mannerisms and behaviors best and can often point out clues or prior patterns that could indicate pain. Lastly, observational scales are vital to understanding and controlling pain. The American Geriatrics Society suggests observation of six behavioral areas when performing a pain assessment:

  • Facial expressions
  • Verbalizations and vocalizations
  • Body movement
  • Changes in interpersonal interactions
  • Changes in activity patterns and routines
  • Mental status changes

At Hospice of Southern Illinois, we employ a tool called the FLACC Pain Scale. Patients are assessed by a healthcare provider, and this tool can easily be taught to caregivers. A copy of the tool is included below.

Behavior012
FaceNo particular expression or smileOccasional grimace or frown, withdrawn, disinterestedFrequent to constant quivering chin, clenched jaw
LegsNormal position or relaxedUneasy, restless, tenseKicking or legs drawn up
ActivityLying quietly, normal position, moves easilySquirming, shifting, back and forth, tenseArched, rigid or jerking
CryNo cry (awake or asleep)Moans or whimpers; occasional complaintCrying steadily, screams, sobs, frequent complaints
ConsolabilityContent, relaxedReassured by touching, hugging or being talked to, distractibleDifficult to console or comfort

Instructions:

Patients who are awake:

  • Observe for at least 2-5 minutes.
  • Observe legs and body uncovered.
  • Reposition patient or observe activity; assess body for tenseness and tone.
  • Initiate consoling interventions if needed.

Patients who are asleep:

  • Observe for at least 5 minutes or longer.
  • Observe body and legs uncovered.
  • If possible, reposition the patient.
  • Touch the body and assess for tenseness and tone.

Each category is scored on the 0-2 scale which results in a total score of 0-10.

Assessment of Behavioral Score:

0 = Relaxed and comfortable
1-3 = Mild discomfort
4-6 = Moderate pain
7-10 = Severe discomfort/pain

Reference: Merkel S, Voepel-Lewis T, Shayevitz JR, et al:The FLACC: A behavioural scale for scoring postoperative pain in young children. Pediatric nursing 1997; 23:293-797.

In conclusion, after attempting to converse with your patient, interviewing caregivers, and employing an observational scale, you should be able to determine if pain is present. Then, the interdisciplinary team can begin developing a plan to manage the symptom. Moreover, always ensure that all basic comfort needs are met and begin searching for possible causes of the symptom. For a review of common medications used in hospice care to treat pain, please view our app. If you or your loved one is experiencing symptoms due to a terminal illness, please contact our team for an evaluation.

Deprescribing: Why should I stop that medication? Part 2

In the final article of our series on “deprescribing, why should I stop that medication?”, we will continue to review medication classes that warrant a hard look upon transitioning into hospice care. In review, deprescribing is a proactive process to remove medications that have no fruitful indication for use, lack benefit or have the potential to cause adverse effects.

Why Stop That Medication: Diabetes Medication

pharmacist deprescribing, why should I stop that medication with a patient

We will begin the discussion with diabetes medication. The ADA (American Diabetes Association) has released the following guidance, “For patients receiving palliative care and end-of-life care, the focus should be to avoid hypoglycemia and symptomatic hyperglycemia while reducing the burdens of glycemic management.” Contrary to other times in life, the goal blood sugar is safely set at 200-300 mg/dL. Patients at end-of-life are less likely to benefit from reducing the risk of diabetes complications, such as eye and kidney disease.

As oral intake varies and ultimately declines, blood sugar can often become labile. If the patient is asymptomatic, caregivers should heavily weigh the need to check blood sugars, as the process does involve a pinprick and induces mild discomfort. Deprescribing of diabetes medications is often the most emotionally charged of all the deprescribing discussions. Patients have been educated by their medical providers, typically for many years, on the importance of strict glycemic control; however, as hospice providers, we must now educate as well on the very real risk of low blood sugar and the ability to relax the strict standards at this time in their life. The process often begins by eliminating the medications at highest risk to cause hypoglycemia and then continue to reevaluate the lower risk medications over time as the hospice care team-patient relationship develops.

Appetite stimulants

Multiple types of medications are used as appetite stimulants, including steroids, antidepressants, hormonal agents and cannabinoids. All these medications have short-term and long-term side effects, some more serious than others. Thus, this is truly a balancing act of risk versus benefit. Is the patient gaining weight while on the medication? Even if they are gaining weight, is it improving his/her quality of life? Remember, the goal should always be quality of life, not solely a number. The act of eating and sharing a meal with family and friends is a very emotional experience. Loved ones often have the most difficult time with this lost activity. For more information on this topic, please review May’s Medical Director Minute, “Mom’s not eating much anymore”.

Proton pump inhibitors, for example, omeprazole (Prilosec)

Now let us discuss a group of medications called “Proton Pump Inhibitors”. This class includes the common medication, omeprazole (Prilosec). This group of medications is commonly overused and often continued long-term despite the recommendation to use for a discrete amount of time, except in a few special circumstances. These medications are often started while a patient is in the hospital for gastric protection, and then, due to transitions in care, are never discontinued. Prolonged use of these medications can increase the risk of hip fractures, poor vitamin B12 and magnesium absorption and Clostridioides colitis (formerly known as C diff). We certainly do not want our patients to suffer uncontrolled heartburn or gastric upset; therefore, a thorough symptom review must occur, and consideration should be given to other agents also useful for treating these symptoms.

Vitamins

Finally, an encompassing review should be given to all over-the-counter medications, vitamins and supplements. These products often have significant interactions with prescription medications. They also contribute to the overall pill burden. As appetite decreases, taking multiple pills contributes to a feeling of satiety. Pills are often taken with less food and liquid during end-of-life, due to overall decreased oral consumption and/or swallowing difficulties. This contributes to nausea and vomiting. Medical studies on most supplements are minimal regardless, and their use should be strongly reviewed at end-of-life.

Now You Understand Why To Stop That Medication, Especially In End-Of-Life Care

Hospice of Southern Illinois’ care team conducts deprescribing medications. The Hospice Medical Director, Associate Medical Directors and our full-time pharmacist lead the full medication review. We are aware that deprescribing can be an emotional process. Rest assured, we have your goals of care top-of-mind and best interests at heart.    

Deprescribing: Why should I stop that medication? Part 1

Classes of Medications

Deprescribing: Why should I stop that medication?

Last month, we reviewed the reason why deprescribing is important to ensure that a patient’s goals of care are met. This month, we will begin to dive into which classes of medications should be on the hot seat for removal. In other words, what types of medications lose their luster or purpose as we enter end-of-life care. Hospice care is about palliating symptoms and improving quality of life once the patient has opted to discontinue aggressive treatment for his/her life-limiting illness. Thus, medications aimed at prevention, slowing progression or those with concerning current or possible side effects are of utmost priority.

The following classes of medication deserve review in all patients admitted to hospice:

  • Respiratory hand-held inhalers
  • Anticoagulants
  • Cholesterol medications 
  • Dementia medications
  • Diabetes medications
  • Appetite stimulants
  • Proton pump inhibitors, for example omeprazole (Prilosec)
  • Vitamins/ supplements

Respiratory hand-held inhalers

Hand-held respiratory inhalers are a mainstay of treatment for asthma, COPD, chronic bronchitis and emphysema. Patients rely on these inhalers to quickly relieve shortness of breath and wheezing. However, as respiratory disease advances, patients lose their ability to adequately inhale the medication, hold their breath and slowly exhale, all components of successful use. Without this technique, the mediation often sits in the mouth or the back of the throat and does not reach the lower respiratory tract where it is needed. This process also requires hand-mouth coordination and mental acuity. Thus, severe arthritis or cognitive impairment can limit use as well. In addition to medication failure and lack of benefit, inhaled steroid medications can cause thrush (oral yeast infection) if left deposited in the mouth.

To ensure the most adequate response to these medications that open the airways, we often suggest discontinuing hand-held inhalers and transitioning to nebulizer delivery. This method allows the patient to inhale the medication through an aerosolized mist via a face mask. This requires no special coordinated breathing and ensures that the medication reaches the lower airway tract.

Anticoagulants

Anticoagulants, often known as “blood thinners”, are used to treat an actual blood clot. They are prescribed to reduce the chance of a clot forming in response to certain medical conditions, like atrial fibrillation. Inherent in their nature, by thinning the blood, they increase the risk of bleeding. Thus, if a patient is at risk for falling, the risk of a major bleeding event caused by a potential fall must be weighed against the risk of a possible or actual clot.  The patient’s liver and kidney function must also be considered. These comorbidities can increase the risk of bleeding in and of themselves. While complicated, targeted education and discussion help make educated decisions.

Cholesterol Medications 

Cholesterol-lowering medications reduce the long-term risk of cardiovascular and cerebrovascular disease. The most common group of these medications is the “statins”. It is one of the few classes of medications where a randomized clinical trial has been conducted to determine the outcome of describing these medications in a population of patients with a life-limiting illness. Completed in 2014, the study by Abernethy et al, showed that the subset of patients that stopped their “statin” had a better quality of life than those that continued the medication. Common side effects of these medications include muscle pain and weakness and gastrointestinal distress. Therefore, cholesterol medications have very limited utility in end-of-life care.

Dementia Medications

Dementia medications slow the progression of mild to moderate cognitive dysfunction. These medication examples include donepezil (Aricept) and memantine (Namenda). If a patient has entered hospice care due to his/ her dementia, the disease is certainly beyond the moderate stage. The disease has also progressed despite the patient being on these medications; therefore, their usefulness is no longer evident. These medications also increase the risk of falls, gastrointestinal distress, fainting and low heart rate. Thus, typically, these medications lack benefit in end-of-life care.

In summary, for these classes of medications mentioned above, the healthcare provider and the patient/family must consider the desired intention of the medication and the patient’s current physical and mental state. If the two do not align, then a thoughtful deprescribing process should begin.  Please visit our website next month to learn more about deprescribing and the medications we are watching out for.

Deprescribing: What does that mean?

Deprescribing Defined

Throughout our lives, most of us have been prescribed numerous medications from our healthcare providers. Some of those medications are used to treat an acute, or self-limiting, illness or issue. Others are aimed to control and treat long-term conditions, such as high blood pressure, heart disease or diabetes. However, there comes a time when we, as providers and consumers of healthcare, must make informed decisions about which medications should be used at certain times of our lives. This is when the process of deprescribing is employed.  Deprescribing is the systematic process of identifying and discontinuing medications when existing or potential harms outweigh existing or potential benefits.

This process should be performed within the context of the patient’s care goals. Other factors that should be considered include the current level of functioning, life expectancy, values and preferences. The ultimate goal is to reduce polypharmacy and medication burden, all while improving patient outcomes. The process is designed to be proactive, thus preventing an adverse medication event or adverse patient outcome before it occurs.

Understanding Deprescribing in Transitions of Care

Deprescribing can occur at any encounter with a healthcare provider; however, transitions of care are some of the most important times to do a thorough medication assessment, such as a hospital discharge or a hospice admission. There are several patient characteristics to consider that should also trigger a medication review.

[Read more…]

Mom’s not eating much anymore.

Why do we focus on eating, even when our loved ones are at the end-of-life?

patient eating and drinking with Hospice of Southern Illinois nurse nearby.

            The physical aspect of eating is a vital part of our social nature and structure. Whenever friends and families gather to acknowledge birthdays, anniversaries, and special accomplishments, food and drink are often at the center of the celebration. Sharing nourishment with our loved ones is often how we show our gratitude, express our care for each other and praise our achievements. In contrast to the social benefits of breaking bread together, the biological need to eat is solely to promote healthy body function and provide energy for the body’s vital organs and activities.

Eating & Drinking Changes At The End-Of-Life, Here’s How.

            As a physical body ages and is no longer healthy, physical nutritional requirements begin to change. When an individual has a terminal illness, the body slowly begins to shut down; thus, nutritional and caloric needs decrease over time. There are also normal changes in taste and smell as we age that accompany these declining needs. This constellation of issues often promotes a lack of appetite, clinically known as “anorexia”. This use of the word anorexia is quite distinct from the term anorexia nervosa, a separate medical and mental illness.

This gradual, or sometimes even sudden, loss of appetite is often very distressing for the family of the individual dealing with the terminal illness. Families often worry that their loved one will starve to death or suffer from dehydration. This loss of appetite is also a distressing tangible symbol of physical decline. In these situations, clinicians experienced in end-of-life care are crucial to help explain that forced consumption of nutrition, either via natural or artificial means, can be more harmful than helpful.

[Read more…]

Planning for YOU: Important End-of-life Conversation Tips

We plan for everything! Let’s take control of our end-of-life conversations for our own peace, comfort and dignity. While our fears may make this conversation uncomfortable to start, having conversations about healthcare is essential! Remember, talking about your end-of-life wishes and getting your affairs in order doesn’t bring it closer. Here are a few things end-of-life conversations can do:

  1. Leads to improved quality of life
  2. Ensures your wishes are followed
  3. Provides peace of mind knowing there is a plan in place
  4. Relieves family pressure and stress when you cannot speak for yourself
  5. Enables families to focus on caregiving and reflection rather than crisis

An AARP article gathered these insightful statistics, “How we want to die is the most important and costly conversation Americans aren’t having. Consider these facts:

  • Ninety-two percent of people think it is important to talk about end-of-life wishes with their loved ones, but only 32 percent have done so, according to a 2018 survey by the Conversation Project, which works to promote greater discussion of end-of-life-care.
  • One in 5 said they’ve avoided the subject out of worry about upsetting their loved ones.
  • Ninety-six percent of people 65 and older consider it important to put in writing their wishes for medical care in case of serious illness, but only a quarter have shared such a document with a doctor, a 2017 Kaiser Family Foundation study found.
  • A sizable majority of people say they want to die at home, but 60 percent die in hospitals or institutions.”
Caregiver Conversations Guide

Download our free Caregivers Conversations Booklet, a guide for caregivers and their loved ones. We introduce general health, mental wellness, healthcare options, including comfort care, and advance directives talking points. It’s never too soon to start talking with your family about WISHES YOUR WAY!

Planning for you, NOW!

Lastly, here are a few steps and resources you can consider right now no matter what your age or situation is:

  1. Plan Your Advance Directives, Which Include:
  2. Who should have Advance Directives?
  3. Who can speak for you if you cannot?
  4. You are in charge of your decisions!
Caregiver Conversations Guide

Download our free Caregivers Conversations Booklet, a guide for caregivers and their loved ones. We introduce general health, mental wellness, healthcare options, including comfort care, and advance directives talking points. It’s never too soon to start talking with your family about WISHES YOUR WAY!

Hospice of Southern Illinois' social worker reviewing planning for you with family to ensure peace of mind

Having these conversations with family and friends is an invaluable gift to those you love. Further, sharing where these guides and documents are located is equally as important. The more often you have open and honest discussions, the easier it will be to approach changes or challenges that arise. Preparing for your future healthcare wishes before you need it is smart! Planning all your healthcare wishes, including your end-of-life journey, helps to ensure a more positive experience for health changes that may be ahead. Most importantly, it can lead to a better quality of life overall. If you need assistance planning for end-of-life or need more support caring for someone at the end of their life, call our experienced team today, 1-800-233-1708.

Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat.

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Is my dying loved one experiencing depression?

Grief versus Depression in the Hospice Patient

Identifying the difference between normal grief and clinical depression can be a challenging task in the dying patient, but a task that is extremely important. Emotional distress is natural and expected when one is experiencing a serious illness and confronting the end of their life. The differentiation between a normal and appropriate reaction to death and a more serious psychiatric disorder, such as major depression, can be clinically taxing.

patient speaking with social worker about “anticipatory” grief, a normal reaction

When an individual learns that they have received a terminal diagnosis, “preparatory” or “anticipatory” grief is a normal reaction. This is defined as the type of grief that the terminally ill patient has to undergo in order to prepare themselves for their final separation from their world. It is commonly accompanied by withdrawal from family and friends, intermittent sadness, crying, anxiety and deliberating on the past.

This type of grief is a normal, not pathological, life cycle event. These individuals are still able to retain the capacity for pleasure and look forward to items in the near future. They may have passive wishes for death, but there are no intense, persistent suicidal thoughts. Their symptoms often come in waves.

When It’s More Than Grief: Signs of Depression

In contrast to the normal reactions of “preparatory” grief, healthcare professionals categorize major depression differently. For example, there is a persistent flat affect or overwhelming feelings of hopelessness, helplessness, and worthlessness. The patient has little interest in activities that normally brought them pleasure. They often have sleep and appetite disturbances. We do not typically see a disturbed self-esteem and grief together; however, it is quite typical in depression. Individuals with severe major depression may experience an active desire for early death and have persistent, intense suicidal thoughts. They may experience feelings of guilt and have no sense of anything to look forward to in the near future.

Clinically significant depression is likely more common, 25-77% based on the study, in the dying population than in the general public. However, depression is not an inevitable part of the dying process. Therefore, screening for depression should be carried out in all terminally ill patients, as treatment is widely available and typically successful. First and foremost, we must ensure that all uncontrolled symptoms are treated, particularly pain. After these symptoms are addressed properly, supportive psychotherapy and/or pharmacologic therapy for the depression should be initiated based on the clinical scenario. 

At Hospice of Southern Illinois, we have an expert team of social workers and bereavement counselors. They work hand in hand with our interdisciplinary team to ensure that our patients and their families receive the emotional and psychological support that they need. We also have a full-time pharmacist on staff. Our pharmacist tailors medications to patients’ specific needs.

Hospice of Southern Illinois has been your community, not-for-profit hospice for 40 years. We take great pride in partnering with your medical provider. There comes a time when compassionate care is the best care. Please visit hospice.org or call 800-233-1708 for more information.

Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat.

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Hospice of Southern Illinois + Local Schools “Send Love to Seniors”

local students make handmade valentine's day cards for local seniors
send love to seniors in trenton illinois

Does anything warm your heart more than a handmade valentine from a child? There may be a few things, but this idea surely warrants a smile. Hospice of Southern Illinois has coordinated with over 10 local schools to collect handmade Valentine’s Day cards to distribute to long-term care homes and assisted living homes in the Metro East. For 40 years, our goal has been to improve quality of life. Therefore, we took an opportunity to bridge generations together for positivity. The week leading up to Valentine’s Day, hundreds of handmade cards from area schools will land in the hands of seniors. “Send Love to Seniors” is one small gesture Hospice of Southern Illinois is proud to coordinate.

[Read more…]

40 Years of Caring

hospice heroes work here - 40th anniversary graphic

Support, safety, and solicitude lead Hospice of Southern Illinois into the New Year as we continue our service to our patients, their families and our community as we have for the last 40 years. We celebrate 2021 with 40 years of caring. With the challenges of COVID-19 and the rapid evolution of healthcare as we know it, we maintain our reputation for excellent end-of-life care. First, you can expect our caregivers to provide support and education you can trust.  Next, since 1981, we constantly evolve our care model to ensure compassion, dignity and excellence. Finally, we stand by our mission to enhance the quality of life for individuals and their loved ones touched by a terminal illness.

Photo of nursing caring for patient (taken before the 2020 pandemic).

The tradition of living life to the fullest, no matter what time we have left, remains our focus. So, we ask you, as we do every one of our patients, “what is important today?” Find out what that is. Because no matter your age, gender, nationality, race, or diagnosis, quality of life matters.

History of 40 Years of Caring

We started as a grassroots movement in 1981 in Belleville, Illinois. Let’s talk a bit of history before we continue on. After hospice care became widely known from a nurse, Dame Cicely Saunders, in England in 1967, it was recognized in the United States in the late 70’s. Hospice of Southern Illinois was on the forefront in caring for individuals and their families faced with a life-limiting illness. We have heard for 40 years, “I wish I had called hospice sooner.” Hearing these words far too often, we continue to advocate for peace and comfort for all individuals. Don’t delay the unique and individualized care that hospice and palliative care offers to patients and families.

After 40 years of caring, you can count on your local, not-for-profit hospice. Our medical team, caregiver support, and alternative therapies extend our commitment to our end-of-life services and the communities we serve. Further, community engagement and giving back is part of our DNA. It’s a privilege and honor to be available to answer questions when you need us. 

40th Anniversary Message

Take this away from our anniversary message: don’t let the call to Hospice of Southern Illinois wait. The sooner you ask for help, the sooner your loved one receives this special type of care, and the sooner our team of individuals with a hospice heart can focus on the unique needs of your loved one’s end-of-life journey. Everyone deserves a peaceful and comfortable journey. When you think of dignity, ask for us by name. Thank you for trusting 40 years of caring with Hospice of Southern Illinois.

Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat.

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Understanding Signs & Symptoms at the End-of-Life

Medical Director Minute with Dr. Ellen Middendorf

Our goal in hospice care is to improve quality of life. At Hospice of Southern of Illinois, we are experts at managing pain and symptoms related to terminal illnesses.  We utilize an interdisciplinary team, including a physician, nurse practitioner, doctor of pharmacy, nurses, social workers, bereavement counselors and hospice aides to provide care to patients and their families. Patients can experience a variety of symptoms at end of life. For example, symptoms may include pain, dyspnea or shortness of breath, constipation, nausea and vomiting, pharyngeal rales or a rattling noise in the back of the throat and terminal restlessness. In short, these are some of the most common. Next, continue reading more information on these specific symptoms.

Common End-of-Life Symptoms & Management

Pain

Pain is a widely prevalent symptom at end of life. It is experienced in up to 70% of patients with advanced cancer, 75% of heart failure patients and up to 93% of patients dying from HIV/AIDS. Pain is also very common in patients with dementia and neurologic diseases, such as multiple sclerosis and cerebrovascular disease. In hospice care, the class of medications called opioids most commonly treats pain.

Dyspnea

Dyspnea is the uncomfortable awareness of breathing, and this symptom can be seen in all disease states. Its presence and severity cannot be inferred from physical exam or laboratory manifestations. It can occur in the absence of physical signs or abnormal findings on labs or radiographs. Therefore, our team must be very astute in listening to their patients and caregivers to ensure that this symptom is treated promptly. We can attempt nonpharmacologic treatment with oxygen and a bedside fan, but, once again, the mainstay of treatment is opioids.

Constipation

Constipation is a troubling symptom that can be caused by a multitude of issues. Problems within the colon, such as cancer or strictures, can be the culprit. Metabolic issues, including chronic diabetes, hypothyroidism, hypercalcemia and chronic kidney disease can contribute. Neurological conditions that include spinal cord injuries, Parkinson’s disease, multiple sclerosis and paraplegia are often associated with constipation. Many medications have constipation as a common side effect, including opiates, some antidepressants, iron supplements, anti-epileptic drugs and anti-Parkinsonian agents. A low fiber diet and an inactive lifestyle often contribute, in addition. Multiple types of laxatives and stool softeners can be helpful.

Nausea and Vomiting

Nausea and vomiting can be particularly distressing and affect an individual’s ability to eat. Additionally, there are a variety of causes. For instance, medications, including chemotherapy, opioids, anti-inflammatories iron, antibiotics, anticonvulsants and antidepressants, are common agents to blame. Electrolyte disturbances, constipation, inflammation or tumors of the gastrointestinal tract, anxiety and bowel obstructions are other common causes. If intracranial pressure increases, either due to tumor or bleeding, this often leads to nausea and vomiting. There are many pharmaceutical agents available to treat nausea. Many are available to use in combination if needed.

“Death Rattle”

Pharyngeal rales is otherwise known as the “death rattle.” This sound is caused by the airways accumulating oral secretions. As a result, the patient loses the ability to clear their airways by coughing and swallowing, and it often occurs within 48 hours of death. Suctioning is ineffective to treat this symptom and may cause discomfort to the patient and a reactive swelling to the airway. The mainstay of treatment is a class of medications known as anticholinergics. Anticholinergics dry secretions.

Terminal Restlessness

The final grouping of symptoms to discuss is terminal restlessness which is common in patients with advanced illness nearing death. The patient may have day-night reversal and is often anxious, restless and has hallucinations. This complex can be difficult to manage and is often irreversible. Therefore, we focus on symptom control and relief of distress for the patient and the family. Pharmacologic agents are used to treat the symptoms that the patient is experiencing.

The Hospice of Southern Illinois Difference

speak with a nurse about end of life symptoms

We will develop a personalized plan of care for all of our patients that meet their individualized needs. Our interdisciplinary team meets weekly to discuss our patients and their end-of-life symptoms to ensure that we are providing the best care possible. To learn more about our care, please visit hospice.org. Additionally, we are very proud to have a PGY2 Pain and Palliative Care Pharmacy Residency. By having a pharmacist on staff, our patients and their families have the benefit of a doctor of pharmacy reviewing and collaborating on every medication profile. To learn more about the medications mentioned above, please visit our app. As a result, you’ll have access to more medication information and other FREE resources.

Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat.

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