Late-Stage Caregiving: Care for the Skin and Body in General
When patients are in a terminal stage of illness, they experience a lot of physical and emotional pain, and caring for them becomes extra challenging for the caregiver. The changes in the patient's body take a turn for the worse, and it becomes more apparent that the end of life is near. Because procedures aimed to treat the person's illness are usually discontinued when there is no longer hope of a cure, the goal is to provide comfort and preserve the quality of life and dignity in their final days.
Among the many physical declines that a patient undergoes, two of the most apparent changes are on the skin and body in general.
At the terminal stage of a disease, such as cancer, normal skin cells cannot multiply to replace dead cells. Blood supply to the skin becomes so poor that repair is too difficult or impossible. Overall, the skin becomes weak. A patient easily develops pressure ulcers on bony areas that support prolonged sitting and lying down. These pressure areas are the tailbone, hips, shoulder blades, ankles, and heels.
Because the patient is too weak or in pain, they usually can barely move around. Most are already chair bound or bedridden. Immobility results in poor circulation, which makes the patient’s skin condition worse. The inability to move can cause pressure sores and stiffness of joints.
To help keep the patient's skin and body healthy, the caregiver can do the following:
1. Relieve pressure on bony areas by turning the patient at least every 2 hours. Keep the body in the right alignment and use pillows to support the head, neck, arms, and legs.
2. When moving the patient in bed, lift instead of pull. Weak skin easily breaks when it rubs against surfaces such as the bedsheet. To move the patient safely, use draw sheets. Ask someone for help if lifting the patient is too difficult to do alone. Never lift the patient under the arms or pull their arms to position them—move them as a whole.
3. If a bony area is paler or darker in color than the surrounding area, do not massage over the bony places. Doing so will cause skin breakdown.
4. Use a special mattress intended for patients with pressure ulcers, if possible.
5. Keep the skin clean and dry. Change their incontinence pads as soon as they are soiled and use a mild soap to wash the genital area and buttocks. Dab to dry and do not wipe, as wiping may cause skin breakdown.
6. When the skin is intact but too dry, apply moisturizers or lotion.
7. Avoid elevating the head of the bed more than 45 degrees. Doing so will cause the patient to slide down the bed and tear skin.
8. Lips may also be cracked and dry. Give water if they are able to drink. If they are breathing through the mouth or unconscious, you may use coconut oil or water-based gels to relieve dryness.
9. For stiff joints, do range-of-motion exercises, but do not stretch or bend beyond resistance.
10. Because of poor circulation, the arms and legs may feel cold to touch, so cover them with blankets. You may also gently massage the hands and feet if there are no visible wounds.
11. Respect the patient’s dying wishes and follow doctor’s orders and recommendations.
Late-stage caregiving is very challenging, but it is a special act of kindness to someone who has lost their battle against disease. Recognize that, although the patient may have a hard time moving about or communicating, caregivers can still connect with them through the senses. As you touch them during care procedures, give an extra ounce of TLC (tender loving care) by telling them, “I am here for you.”
