“What would you like on your tombstone?” is the tagline of the Tombstone Pizza commercials. Menacing men stand over the condemned asking the question, and the one about to meet their end comically replies, “cheese and pepperoni!” It’s funny for the commercial because of the unexpected response. But let’s be honest, “cheese and pepperoni,” is not what the majority of us want inscribed about the sum total of our lives.
Most of us want ourselves and our loved ones to die with dignity. We’d like to meet the end of our lives gracefully and peacefully, so that the end is much like the beginning and middle of life: thoughtful, respectable, and meaningful. Unfortunately, death does not come so easily for everyone. The end of life often comes with the messy details of physical decline, including emotional distress at the thought of parting with loved ones and both physical pain and limitations.
Why Managing Pain is Important
Pain in itself causes distress, but it also substantially affects a number of other circumstances vital to a good life and a good death. First, pain interrupts sleep. As patients approach the end of life, sleep increases both in duration and frequency. A patient in pain may find their sleep patterns interrupted by constant movement out of a painful position. When patients cannot have quality levels of sleep, overall experience of pain increases in a vicious cycle of cause and effect, leading to increased chronic pain levels. Additionally, most of us would like to meet the end of our loved ones lives or our own life with opportunities for final connections.
Whether it’s sharing important memories or family stories, time to say goodbye is vital to a good end of life experience. Pain interrupts those possibilities, as it is difficult to think or recall effectively when the body is in substantial amounts of distress. This results in a lack of desired connections, which increases the possibility of depression and anxiety leading up to the end of life. Effective pain management at the end of life is imperative for the sake of both physical relief and vibrant connections.
Considering Different Options
It should come as good news that the physical pain and increasing limitations the body suffers toward the end of life is manageable. There are care and treatment options that promote dignity and relative comfort as death draws near. When it comes to pain management in the elderly at the end of life, care providers such as a hospice and palliative care team will carefully gauge the needs of your loved one. Questions such as “where does it hurt” and “how much does it hurt” can be gauged using a wide variety of tools.
Pain might be evaluated on a 1-10 scale, where 1 means “nothing hurts” and 10 means “the worst pain I’ve ever experienced.” There are also visual scales available for elderly patience who find verbal communication difficult. Seasoned care providers are also able to look for non-verbal signs of distress. It may be that a senior favors leaning to one side in the bed, indicating a need to look for bedsores or other infections. Food and liquid intake also serves as a helpful cue regarding pain.
Creating a Plan of Care
The best pain management in end of life care is carefully planned pain management. As it is possible, a care team that includes hospice and palliative care physicians, nurses, assistants and aides, loved ones, and the elderly person him or herself should conference openly about what to expect in the time to come. Responsible decision-making comes from informed participants. An effective care team will ask about the patient’s end of life goals, balancing comfort care with desired functions. For example, a person may be willing to reduce the dose of pain alleviating drugs for the sake of more lucid time with his or her grandchildren.
A documented plan that states goals, concerns, and anticipated actions will help everyone on the care team to proceed according to the patient and his or her family’s end of life wishes. According to the plan, most hospice and palliative care providers are able to provide medications and a wide variety of other therapies for pain management in elderly.
Compassionate End-of-life Care
While what we want on our tombstones is not the kind of thought many of us would like to consider for our loved ones or ourselves, the end eventually comes for us all. It is possible to have an end of life experience full of dignity and grace so that whatever is written on the tombstone implies a life lived well – and ended well.
For more information on pain management for the seniors you love who are approaching the end of life, please contact Harbor Light Hospice online or by phone today.
