Nausea
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Nausea

Nausea is an unpleasant sensation of wanting to vomit, which may not always result in vomiting. It is common at the end of life and can cause distress for the person and their family or carers. Other associated symptoms include sweating, feeling cold, paleness, and an increased heart rate.

What I can do

Identify potential causes of nausea in older people. These include:

  • Medications such as strong painkillers (e.g. opioids or NSAIDs) or recent chemotherapy or radiotherapy treatment
  • Gastrointestinal issues such as constipation, gastric stasis, or bowel obstruction
  • Psychological factors including anxiety, fear or pain.

To determine the best course of action, regularly assess:

  • Frequency, severity, duration, and time of occurrence (e.g. morning, night)
  • Triggers that may worsen or relieve symptoms
  • Bowel habits, food and fluid intake, and current medications.

Develop a treatment plan with the older person based on this assessment that brings relief. This might start with simple non-drug approaches such as:

  • Offering small frequent snacks of bland food or clear liquids (e.g. water, broth, or ice chips)
  • Positioning the person comfortably with their head elevated
  • Applying a cold compress to the forehead
  • Encouraging relaxation techniques involving music, gentle massage or acupressure.

Consult the person’s GP if nausea continues or worsens and if vomiting is frequent or excessive. The GP will be able to determine if medicines are needed by considering all other symptoms, medications, and their side effects.

What I can learn

Explore the current research evidence on this topic by reading the Nausea CareSearch Clinical Evidence Summary.

Nurses can read more on assessing and managing nausea in the CareSearch Nurses Hub.

Watch the video on Managing nausea and vomiting (11 min) by Agency for Clinical Innovation

Explore the current research evidence on this topic by reading the CareSearch Dyspnoea Clinical Evidence Summary.

Prescribers can find advice on managing nausea and vomiting with medications in the CareSearchgp and palliMEDs apps.

CareSearchgp app

What I can give

If an older person or their family is concerned about nausea and vomiting at the end of life, these resources may help:

What I can suggest

Teams can become more efficient at optimising nausea care by:

  • Implementing validated assessment tools such as the Edmonton Symptom Assessment Scale (ESAS) or Palliative Care Outcome Scale (POS)
  • Engaging multidisciplinary teams in care discussions, including dietitians, GPs, and pharmacists
  • Consulting palliative care specialists for complex cases.

Providing training and ongoing education for all staff will help improve confidence and competence in:

  • Recognising and assessing nausea and vomiting
  • Medication administration protocols, including subcutaneous and syringe driver techniques
  • Non-drug management approaches such as dietary modifications and environmental adjustments.

Have a systematic approach to educating families and those providing informal care in the home on:

  • What to expect and how to help manage symptoms
  • When to seek additional support
  • Who to contact for after-hours advice and emergency medication.


Page created 26 February 2025