Physical needs can include:

• Loss of appetite and nutritional needs
• Shortness of breath
• Body odour
• Skin breakdown or pressure sores
• Changes in appearance (fluid retention, muscle waste, hair loss, skin discolouration)
• Incontinence
• Constipation
• Unable to get out of bed to make the bed
• Moving from bed to chair
• Mouth problems
• Confusion
• Inability to feed oneself

Information is provided below to help you with these physical needs.

Note: For more information on How to Give a Bed Bath and take care of a person’s personal hygiene issues See Topic 9.

Loss of appetite and nutritional needs

What you can expect? The body isn’t digesting food as it once did. The person’s metabolism may be slowing down and a decreased appetite will therefore be normal. The person may refuse solids altogether and prefer only liquids. Weight loss may occur no matter how much is eaten. A changing sense of taste, including making some foods taste too bitter or too sweet, will also alter a person’s appetite. Certain food textures and certain food smells may cause nausea. The need for liquids will also decrease towards end of life. This is normal. Forcing foods or fluids can lead to distress, choking or aspiration which means inhaling food or fluid into the lungs.

How can you help with changes in appetite?

• It is perfectly fine if the person doesn’t want to eat as long as they continue to drink fluids (although at some point swallowing liquids may become difficult). Try adding fruit and juice to milkshakes or smoothies. Avoid giving orange, pineapple or tomato juice on its own as these juices can aggravate mouth ulcers or cause indigestion.
• Try serving water, tea or soft drinks to take a strange taste away. Sometimes adding lemon juice to foods can make food taste more normal.
• Try new spices and flavourings for food avoiding too salty or too seasoned foods.
• Add sauces or gravies and experiment with adding a little sugar, basil, lemon juice or mint.
• Marinate meat in soya sauce, sweet juices or sweet wines.
• For people who do not want meat try high protein foods like eggs, chicken or fish.
• Choose foods that are soft and easy to eat.
• Smaller portions served five or six times a day or when the person requests may be more palatable than a full meal. Only offer what a person feels like eating.
• Sometimes a glass of beer or wine (if permitted by the doctor) will stimulate appetite.
• Offer cold plates of cottage cheese and fruit if the smell of food is a problem.
• Nutritional supplements can be found at the pharmacy.
• Don’t worry that a person is starving or thirsty. The body has learned to shut down and prepare for the end and eliminates the need for fluids and food naturally.

Shortness of breath, breathing difficulties

Breathing problems can be very frightening for caregivers. Anxiety can cause shortness of breath; shortness of breath can cause anxiety. Call the doctor when a sudden onset of breathing difficulties occurs.

Signs that a person is experiencing breathing difficulties:

• Depth of breathing changes
• Rate of breathing changes
• Breathing becomes more irregular
• A blue tinge appears around the mouth and nailbeds
• Thick mucus can’t be coughed up
• Breathing sounds moist and gurgling

Note: Not all of these signs have to be present for a person to be having breathing difficulties.

How to help with breathing difficulties

• The goal is to make the person comfortable and minimize their feeling of distress.
• Plan for frequent rest periods between events where some exertion is needed.
• Remain close by, be calm, and coach the person into relaxing and breathing more slowly.
• Create a breeze by opening a window or using a fan.
• Avoid fragrances or scented products which can trigger a coughing or sneezing attack or cause shortness of breath.
• Use a humidifier to moisten the air and loosen secretions so a person can cough them up.
• Serve warm drinks with lemon and honey to reduce mucous.
• Reposition the person by having them sit up with arms over a pillow or bed table or elevate the head of the bed to raise the upper body.
• Loosen clothing and bedding.
• If secretions cannot be cleared with a mouth swab, then ask the doctor for a medication that will dry up the secretions.
• A cold compress placed on the forehead or cheeks will help to lessen the feeling of breathlessness.

Managing Oxygen Therapy

Be careful! Any spark could ignite a flame or explosion. Do not use Vaseline as it contains petroleum which is flammable.

• Be sure that the face mask is properly adjusted and in the correct position.
• Turn oxygen off when not in use.
• If the tubing is reddening the skin use a self-adhesive padding under the tubing.
• Oxygen is not recommended at end of life unless the person has used it throughout their illness. If so, it can provide comfort.
• If the tubing is irritating the back of the ears, talk to your oxygen provider about ear protectors.

Body Odour Problems

If the body is dealing with a serious health condition and the body’s liver and/or kidneys are struggling to process toxins then a body odour may result. In those cases, no amount of personal hygiene will take away the smell. Similarly, diabetes creates a condition called ketoacidosis which gives the breath a fruity smell and can cause a distinct body odour. IF the person is diabetic, consider it a medical emergency and call for help immediately. However, if someone is dying naturally there is no need to call 911.

Caregivers may need to wear a mask to help cope with the strong smells. However, doing so may upset the person. Instead try one of these easy ways to mask odours:

• Place coffee grounds in the room
• Place a bowl of baking soda in the room
• Use an essential oil diffuser
• Open the window and let in some fresh air

Ensure the person receives frequent skin and oral care and clean bedding as often as needed.

Aromatherapy

Aromatherapy is the use of essential oils of plants by inhalation using a diffuser or by applying to the skin. It may be helpful:

• To promote relaxation
• To alleviate anxiety
• To reduce depression
• To reduce pain
• To reduce nausea
• To alleviate physical symptoms
• To alleviate side effects of chemotherapy
• To improve sleep patterns
• To reduce stress and tension
• To alleviate psychological distress/provide emotional support
• To improve well-being and quality of life
• To live with altered body image

Ask at your local pharmacy where you could purchase essential oils and a diffuser.

Skin breakdown or pressure sores

When you see red, tender skin over pressure points or in skin folds, dry itchy skin, rashes, open weeping sores or tears in the skin then you know that skin is breaking down. Skin problems and skin breakdown can occur for a number of reasons including:

• Immobility
• Decreased nutritional intake
• Changes in metabolism and a lack of repositioning
• Sliding on the sheets which can cause tiny skin tears making people predisposed to infection
• Old age which can lead to thin, fragile skin that is easily torn
• Lack of oxygen to the tissue at pressure points leading to pressure sores
• Yeast infections such as thrush in the groin area or under the breasts

How to help with skin difficulties

• Establish a schedule so you can remember to reposition the person every 1 to 2 hours by lifting them with a turn sheet or slider sheet.
• Add a foam pad on top of the mattress.
• Use pillows or sheets to pad bony prominences. Put a pillow between the knees and ankles when the person is lying on their side.
• Gently massage hips, heels, and the person’s tailbone with a moisturizing lotion.
• Keep all linen wrinkle-free and dry.
• Give a gentle bed bath. (See Topic# 9)
• Use flannel towels as they are softer than terrycloth towels.
• Wear gloves so your own rough skin isn’t hurting the person.
• Report skin changes to health care providers.

Changes in Appearance

Swelling is caused by extra fluid in the tissues or abdomen which will cause feet, lower legs and hands to swell. How to help with swelling

• Elevate the feet when the person is sitting in a chair or lying in bed.
• Massage the swollen areas to help fluid to be absorbed.

How to help with muscle loss Loss of muscle strength can occur as a result of illness and/or from prolonged time spent in bed which will require that you provide extra help with walking, dressing, and getting in and out of bed.

• Reassure the person that you don’t mind helping them
• Recognize that the person may feel frustrated at how weak and tired they feel
• Use a bell or baby monitor so you can come quickly if needed
• Rent a walker or wheelchair if needed

Incontinence

Loss of control of the bowel and bladder is so common that there are several products on the market now that can help.

How to help with incontinence

Incontinence garments like Stayfree^TM, DryPlus, ^TM Attends^TM, Poise^TM, will help keep sheets clean and dry. Change the garment often. Use a zinc oxide cream to help prevent sore skin.

Note: Be sure to wear gloves or wash your hands with warm soapy water each time you assist with incontinence garments.

Constipation

Constipation is caused by not drinking enough, not eating enough, not eating enough fibre, not getting enough physical exercise, and gut slow-down due to opioid-based pain medication.

How to help with constipation difficulties: Note that most of these suggestions are inappropriate in the final days of a person’s life.

• Have the person drink several (8-10) glasses of water each day. However, at end of life this intake becomes unrealistic and could cause distress. Often people take only ½ cup per day in the final days of life. Consult your doctor or nurse about the right amount of water if your loved one is on a fluid restriction.
• Gradually add more whole grains to the diet
• Offer a hot drink in the morning
• Encourage walking, exercising in bed
• Avoid chocolate, cheese, eggs
• Monitor bowel movements and observe for abdominal swelling and pain due to constipation. Have a nurse give a suppository.

Mouth problems

Mouth problems can have several causes including:

• Dehydration
• Fungal infections such as thrush (bad breath, white patches on the tongue, sore mouth and throat) Note: Thrush can spread to others. Avoid kissing the person on the lips or sharing utensils if you suspect thrush.
• Open sores
• Cracked lips
• Poor-fitting dentures (refusal to wear dentures)
• Decaying teeth (tooth pain)

How to help with mouth difficulties

• Keep the mouth clean and moist
• Remove dentures before cleaning the mouth and clean the dentures using a denture cleaning product; the doctor may prescribe a medicated cream to rub on the gums under dentures
• Treat cracked dry lips
• Provide frequent sips of water as tolerated or use a spray bottle
• Provide oral care as frequently as every two hours and certainly after waking, after each meal, at bedtime
• Have the doctor prescribe a medication that is swished in the mouth then swallowed if needed for thrush
• Use an alcohol free, gentle mouthwash

Comfort Measures for Thrush Infections

• Medication obtained from a health care provider, i.e. Mycostatin
• Clean the mouth by rinsing with mouth wash or plain water after eating
• White patches can be gently removed with a soft toothbrush when they become loose
• Soak dentures overnight in full strength Listerine, rinsing before they are put back in the mouth

Signs that Mouth Care is Helping

• Mucous membranes are pink and moist
• Mouth is clean
• Thrush patches decrease in size and number
• Mouth discomfort subsides

 Three Easy Recipes for Mouthwash to Make at Home

“Caring for the Terminally Ill: Honouring the Choices of the People Person/Family/Community 3^rd Edition August 2014

Confusion

Confusion may start slowly and progressively worsen leading to short term memory loss, poor concentration, decision-making difficulties, seeing and hearing things at night that aren’t happening. Similarly, the person may demonstrate anger and become fearful for no obvious reason.

How to deal with confusion

• Start with them and where they are at.
• Remind the person who you are frequently.
• While talking to the person position yourself so that you are face to face turning off the background noise from the television or radio.
• Keep the calendar and clock in view of the person so they can feel oriented.
• Do not leave the person alone for prolonged periods of time.
• Talk slowly and quietly using short statements.
• Be sure to keep the medication out of reach and bring it to the person yourself rather than having the person self-administer their own medication.

Ask for help if:

• Confusion occurs very suddenly or becomes worse.
• The person becomes violent or agitated.
• You or the person themselves are hurt physically because of the confusion.
• You are tired and need relief.

 

1. Read this scenario.

Joe is an 85 year old man who is recovering from heart surgery. Prior to the surgery and to the few months leading up to the surgery, he was extremely active and social. His recovery is taxing to him and his caregiver because he isn’t sleeping well at all. Joe is an avid reader and has a few books on the go at one time. He is having difficulty concentrating on his reading which he thought going into the surgery would be the one thing that he could manage to make the time pass. When Joe awakens at night he often feels disoriented which causes anxiety.

2. You would like to change up the bedtime routine to see if Joe can get a better night’s rest. What would you suggest? Jot down some strategies before checking the sample response.

Sample answer:

Try reading to Joe in the evening before he falls asleep. Try suggesting to Joe that there be three sleep breaks in a 24 hr. period rather than just one long one. Establish times for those sleep breaks. Keep a light on at night nearby if Joe does week so anxiety and disorientation may be lessened.

 

Use these additional resources to learn more about the topic of helping someone with their physical needs.

The Relationship between Mental Health, Mental Illness and Chronic Physical Conditions
https://ontario.cmha.ca/documents/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/

Back Pain Exercises and Stretches for Caregivers
https://www.spineuniverse.com/conditions/back-pain/back-pain-exercises-stretches

Helping You Understand Weight Loss and Changes in Appetite in Advanced Illness