#71 Dying at home, what you need to know and how to be prepared - Symptom control and medication as someone approaches the end of life at home

This is the fourth in a series of seven podcasts about End of Life Care, specifically towards the last days of life and when someone wishes to die at home. Rachel kindly agreed to make these with me and recreate some of the conversations I have had over so many years about dying at home, what you need to know and how to be prepared.

In this episode we talk about symptom control in the last days of life when someone is dying at home.

Dying at home, what you need to know and how to be prepared

1.Recognising when someone might be approaching the last stages of life and why this matter

2. What support is available to help look after a person who is dying at home

3. What equipment might be needed to help look after a person who is dying at home

4. Symptom control and medication as someone approaches the end of life at home

5. What changes are there as someone approaches the end of life?

6. What we need to do after a person has died at home

7. Changing plans, anticipatory grief and being prepared

Key messages from guest

• Treatment at the end of life focuses on palliation or control of symptoms

• Medication can be rationalised or revised towards the end of life to ensure medication focuses on easing symptoms and removing the burden of taking medications that are no longer needed. 

• Conversations about stopping or changing medications should happen to explain to clearly explain the reasons

• Tests should also be reviewed to consider if they are still appropriate

• A syringe pump can be used at a time when a person may no longer be able to swallow tablets

• Syringe Pumps can be used for pain, sickness, agitation or breathing symptoms

• Medication is only one way of controlling symptoms, it is always appropriate to consider the cause of a symptom and how they may be managed without medication

• Some areas have a policy for informal carers to administer medication for symptoms, finad out what happens in your area

Episode takeaways

• Morphine does not hasten death when given in appropriate, incremental doses

• Syringe pumps do not hasten or cause death when medication is titrated to need

• Symptom control should always be personalised

• All prescribed medications should be written on a chart for medication administration

• Be prepared, think ahead to ensure medications for the end of life are in place

Resource

• Hear  Anticipatory Prescribing: what it is, what research tells us and what we can do better with Dr Ben Bowers 

• Read Is end-of-life anticipatory prescribing always enough? By Dr Ben Bowers 

• Listen to Dr Kathryn Mannix explain Ordinary Dying in episode 32: Using tender conversations in Advance Care Planning with Dr Kathryn Mannix

• Access Rachel’s work

  • Website:The Magnificent Midlife 

  • Podcast: The Magnificent Midlife Podcast

  • Book:  The Magnificent Midlife book

Bio:

Rachel Lankester, founder of Magnificent Midlife

Rachel Lankester is the founder of Magnificent Midlife, an online hub celebrating and empowering women 40+. She's the author of Magnificent Midlife: Transform Your Middle Years, Menopause and Beyond and host of the Magnificent Midlife podcast. After a shocking early menopause diagnosis at 41, she scratched her own itch and created what she wasn't able to find to help herself. This includes 1-1 and group mentoring, courses and educational resources to help women vibrantly transition through the sometimes messy middle of life. She's also the founder of MenoClarity, an online information hub about menopause.

Clare Fuller, Advance Care Planning Advocate, Educator & Coach

Clare is a Registered Nurse with 30 years’ experience in End-of-Life Care (EoLC). Clare is an advocate for Advance Care Planning and founded www.speakforme.co.uk to help organisations to improve EoLC, provide professional education and raise public awareness about Advance Care Planning. Clare campaigns for proactive Advance Care Planning, hosts the podcast Conversations about Advance Care Planning  and is a Lasting Power of Attorney Consultant.