Fatigue is the most common symptom at the end of life, but little is known about its pathophysiology and specific treatment.
Every person is different and symptoms experienced at end of life vary. Some common symptoms are pain, constipation, nausea, tiredness, breathlessness, fatigue and delirium. In most cases symptoms can be controlled to a comfortable level, but some symptoms may not disappear completely.
State of mind is different for every person approaching death. Hallucinations, confusion, and reduced responsiveness are common near the end of life.
This article provides a summary of symptom assessment tools and reviews the management of four common and distressing symptoms frequently experienced by patients with advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue.
Depression, anxiety, and delirium are common phenomena associated with terminal and irreversible illness.
Fear – It's common to feel scared after a terminal diagnosis, either because of a specific fear you have or simply the unknown. Anger or resentment – You may think 'Why me?' , 'Why this illness?' and feel anger towards the impact it's having on your life and plans.
Based on her observations and interviews with hundreds of people with terminal illnesses, she identified the five stages that a person is likely to experience as they near death: denial, anger, bargaining, depression and acceptance.
Secondary issues such as a terminal tumor placing pressure on the brain or even simple fear, anger, or emotional turmoil can also contribute to the type of mental agitation that can lead to confusion. Other times, however, it is because a human brain near the end is simply unable to function as it once did.
Signs of deterioration may include symptoms such as declining function, increasing fatigue, declining or fluctuating oral intake, declining or fluctuating conscious state, increasing pain, etc.
changes in their normal breathing pattern. noisy chest secretions. mottled skin and feeling cold to the touch. the person telling you they feel like they're dying.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
The end-of-life period—when body systems shut down and death is imminent—typically lasts from a matter of days to a couple of weeks. Some patients die gently and tranquilly, while others seem to fight the inevitable.
Increased need for medication due to uncontrolled pain or symptoms. Shortness of breath. Difficulties performing the tasks of daily living: bathing, getting out of bed, getting dressed, walking, or preparing and eating meals. Increased number of trips to the ER and multiple hospitalizations.
The early signs of deterioration include changes in respiratory rate, oxygen saturation, blood pressure, heart rate, temperature and conscious/mental status which may go unrecognised.
Some of these signs include: A prolonged state of excessive fatigue, sleep, perhaps being comatose-like. Confusion and/or disorientation; Hearing or seeing people and events not visible and not present to you. Social withdrawal and detachment.
Mental changes
As death nears, you may start to see or hear things that no one else does. You may also become agitated, or be more or less alert at different times. This is known as delirium. Your caregiver will tell a doctor or hospice palliative care worker if you're having delirium.
Terminally ill cancer patients near the end of life can experience refractory symptoms, which require palliative sedation. Midazolam is the most common benzodiazepine used for palliative sedation therapy.
Just before death some people become restless, agitated and confused. This is known as terminal restlessness. It often occurs within the last few days of life. Terminal restlessness can be caused by a range of things and sometimes calming drugs are needed.
Depending on your needs, you may use palliative care from time to time or you may use it regularly for a few weeks or months. Some people receive palliative care for several years.
Some people live comfortably for months or years after a diagnosis of advanced cancer, and can be supported by palliative care as needed. For others, the cancer advances quickly so that their care is focused on end-of-life needs soon after their referral to a palliative care service.