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Physiological Changes

Changes in Eating:
As the body begins to slow down, it no longer digests food the same way. Weightloss is common. Keep in mind this does not mean that the person is hungry or being starved.
It's natural for a person to no longer want food at the end of life. Often nothing tastes good. Cravings will come and go. Changes in eating can be one of the heardest things for caregivers to accept. Food is a way we feed the body. Meals are a normal way we share time together with loved ones.
What can you do:
  • Let the person be the guide. They will let you know if food or drinks (liquids) are needed or wanted.
  • Liquids are better than solid foods because they are easier to swallow.
  • Small chips of ice or frozen juice may be refreshing and assist with hydration.
  • If the person has difficultly swallowing, liquids may be given in small amounts by dropper (ask the hospice nurse for help).
  • Familiar food can be given in small amounts. There maybe times when the taste or smell is comforting.
  • People who can't speak will let you know they don't want to eat in their own way. They may cough, bite the spoon, clamp their teeth closed, turn their heads, or spit the food out.
  • Respect the person's wishes by trying not to force food or drinks.
  • Often a person near death may appear thirsty, but won't be able to drink water. Use moistened swabs to keep the mouth and lips moist.
Changes in Breathing:
Breathing patterns often change for people at the end of life. Breathing may slow down. Or there may be fast, short breaths followed by periods of no breathing. These periods can last 5 to 30 seconds, or up to a full minute.
Breathing this way is not uncomfortable for the person. It's because the body is getting weaker. Your hospice nurse and doctor will see if oxygen would be appropriate at this time.
When people get really weak, they can't swallow. Saliva can sit in the back of their throat and make a "rattling" sound. Suctioning it out will produce more saliva. You may be trying to help, but this may only cause more discomfort. The sound may be scary to hear, but it does not mean the person is suffering.
What you can do:
  • Your nurse may teach you about medicine used to dry the saliva.
  • Gently turn the person on their side. This may help to drain the saliva. Raising the head of the bed may also help.
  • At this point, the person usually breathes with their mouth open. This can make the mouth very dry. Frequent mouth care is important.
  • The person might struggle to breathe. If so, your doctor can use morphine or similar medicine to provide comfort.
Changes in Bowel Movement:
"Incontinence" is the loss of bladder and bowel control. This can happen as muscles in the lower body start to relax. However, the amount of urine or stool will less as people get weaker.
The color of urine may also be darker than normal. It may be cloudy or have a strong smell. This is the normal reaction to drinking less liquids. The kidneys are no longer working properly.
Incontinence can be embarrassing. Always keep the person clean, dry, and comfortable. THe overall goal is to protect the person's dignity.
What can help:
  • Adult diapers and underpads on the bed may help. The nurse or CNA can show you how to change these for someone in bed.
  • The nurse might suggest placing a tube (called a "catheter") into the bladder. This will keep the person's skin from being wet all the time there may be a few seconds of discomfort as the tube is put in. After that, the person is usually not aware of it.
  • The nurse may suggest using certain lotions or creams.
  • Allow for privacy during personal care. Check the person often to make sure that they are kept dry and comfortable.
  • Our CNA will assist with personal care if needed.
Changes in Body Temperature:
Fever: The brain loses control of the body temperature when the body is weak. This can cause a fever or make the person feel cold. Some they may get sweaty with or without a fever.
What can help:
  • Let the hospice nurse know if the person has a fever immediately.
  • Put a cool wash cloth on the forehead or remove blankets to help.
  • The nurse may use an over-the-counter pain medicine (like Tylenol) if the fever is high.
  • As the fever drops, the person might sweat a lot. Change the gown/pajamas and sheets to provide comfort.
  • A fan may be used or open a window.
  • The person may throw the covers off. Remember that they me be warm even if you feel cool.
Coolness: As your loved one becomes weaker, blood flow slows down. Legs and arms might feel cool to the touch. Skin color may change. The hands and feet may look a little purple. The knees, ankles, and elbows may look spotty.
What can help:
  • Use a warm blanket (not an electric blanket).
  • Gently rearrange the person in bed.
  • Gently massage arms, legs, hands, and feet.
Overall, the person may look very pale. The lips and skin under the fingernails may look a little blue. None of this causes any discomfort for the person. These changes are a natural part of the dying process.
"We'll walk with you along the way..."