Late stage and end-of-life

Below are some of the physical care issues that are likely to occur in the late stage. The following tips may help provide maximum health and comfort. Consult your health-care professional on specific techniques or if you have any questions.

Difficulty swallowing food and liquids

1. Provide a quiet and calm environment during meals or snacks, away from television and other distractions.
2. Ensure that the person is in a comfortable sitting position during and after a meal or snack.
3. Don’t rush. Allow plenty of time for the person to eat. Several smaller meals or snacks throughout the day may be easier to manage than three bigger meals.
4. Foods that are soft or bite-sized may be easier to handle. Be prepared for possible choking. This is a risk when swallowing becomes more difficult.
5. Encourage the person to feed herself by giving visual cues or gently using hand-over-hand prompting. If she needs help, offer the food and drink slowly. You may have to remind the person to swallow. Finger foods that do not require spoons, forks and/or knives can help the person be independent.  Put one plate and only one utensil at their place to simplify the environment.
6. Encourage drinking fluids. If drinking water is hard, because of choking, try substituting fruit juice, gelatin, sherbet, or thickened liquids.
7. Record the person's weight monthly.

Caring for the skin and body

1. If the person stays in bed or in a chair or wheelchair most of the time, change his position at least every two hours. This eases pressure off the same part of the body (and skin). Ask a health-care professional about the proper technique to lift and turn him.
2. Protect bony areas with pillows and pads.
3. Wash the skin gently and blot dry, using as little force and friction as possible.
4. Prevent "freezing" of the joints by helping her keep her range of motion. A physiotherapist can show you how to do range-of-motion exercises.

Maintaining bladder (urine) and bowel (bowel movement) function

1. Set a toileting schedule.
2. Eliminate caffeinated drinks, which encourage urination.
3. Provide enough fluids during the day, but limit liquids at least two hours before bedtime.
4. Use adult briefs and bed pads as needed.
5. Monitor bowel movements.

Decreasing the risk of infection. Monitoring for pain

1. Pay careful attention to oral hygiene: the teeth and mouth.
2. Treat cuts and scrapes right away.
3. Make sure that she receives an annual flu vaccine.
4. People with late-stage dementia may have trouble telling you that they have pain. Family members and caregivers must learn other ways of recognizing pain and illness. Signs to watch for and report to your health-care professional include:
   • Pale or flushed skin tone; dry, pale gums; mouth sores; vomiting; feverish skin; or swelling of any part of the body
   • Body language and non-verbal signs that may indicate the person is uncomfortable
   • Changes in behaviour (especially anxiety, agitation, shouting and sleep disturbances)

Canadian Virtual Hospice offers caregiving demonstration videos on a number of personal care issues.

In this video, created by Canadian Virtual Hospice, Dr. Romayne Gallager talks about how to assess pain.