Symptoms of dying
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Symptoms of Dying: A Comprehensive Overview
Common Physical Symptoms in Terminally Ill Patients
Pain and Dyspnea
Pain and dyspnea (difficulty breathing) are among the most prevalent symptoms experienced by terminally ill patients. Pain affects between 5% to 51% of patients, while dyspnea is reported in 28% of cases. Persistent dyspnea is particularly distressing and is associated with a lower quality of dying and death. In patients with nonmalignant diseases, distressing breathlessness is 34% more likely compared to those with cancer.
Respiratory Symptoms
Respiratory symptoms, including cough and breathlessness, are significant in patients dying from COVID-19, with dyspnea being the most prominent symptom. In general, respiratory failure is a common mode of death, particularly in intensive care settings.
Gastrointestinal Symptoms
Nausea and vomiting are reported in 10% to 14% of terminally ill patients. Poor appetite is also a significant indicator of imminent death, with increased fatigue and poor appetite being associated with the identification of the dying phase.
Neurological and Psychological Symptoms
Confusion and delirium are common, affecting around 10% of patients. Worsened or persistent delirium significantly lowers the quality of dying. Anxiety and depression are also prevalent, with 80% of family members of ICU patients experiencing borderline anxiety and 70% experiencing borderline depression.
Other Symptoms
Other common symptoms include oral and respiratory secretions (25%), myoclonus (12%), and bowel and bladder problems (over 20%). Fatigue and restlessness are also frequently reported, with restlessness being a significant issue in the last hours of life.
Symptom Management and Control
Pharmacological Interventions
Effective symptom management often involves the use of opioids, co-analgesics, anxiolytics, and anticholinergics. Opioids are particularly effective for managing pain and dyspnea, while anticholinergics are used to manage respiratory secretions. In nursing home patients, the administration of opioids, midazolam, and anticholinergics significantly ameliorated symptoms such as pain, anxiety, and depression.
Non-Pharmacological Interventions
Non-invasive clinical evaluations and therapies focused on symptom palliation are crucial. Emotional, spiritual, and social support play a significant role in symptom control, with up to 90% of symptoms being well-controlled with appropriate communication and support.
Impact of Care Setting on Symptom Experience
Home vs. Hospital Care
The place of care significantly impacts the severity of symptoms. Patients dying at home are more likely to experience severe symptoms compared to those in palliative care units or hospitals. However, those dying in acute hospitals are more likely to require further help for breathlessness.
Intensive Care Units
In ICU settings, the symptom burden is high, with significant levels of traumatic stress, anxiety, and depression reported among family members. This highlights the need for improved family-centered care in these settings.
Conclusion
The symptoms of dying are multifaceted and vary widely among patients. Pain, dyspnea, and gastrointestinal issues are common, while psychological symptoms like anxiety and depression also play a significant role. Effective symptom management requires a combination of pharmacological and non-pharmacological interventions, tailored to the individual needs of the patient. The care setting significantly influences the severity and management of symptoms, underscoring the importance of comprehensive, compassionate care across all environments.
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