These pages are a resource to guide evidence-based practice in the care of older people in the last days of their life (terminal phase). On these pages many links direct you to the palliAGEDgp app. Once you have accepted the Terms and Conditions, you will have access to all app content.
If you require other prescribing advice for more long-term palliative care, refer to the Therapeutic Guidelines (subscription required).
Recognising or diagnosing dying is a vital and often the first step to ensuring that appropriate terminal care is in place.
Principles
Identification of the terminal phase requires the clinician to recognise when a person is actively dying. Signs of active dying include: bed-bound, unable to swallow, poor responsiveness with limited response to verbal or physical stimuli, reduced or no urine output, changes in breathing pattern and signs of peripheral shutdown. Clinicians need to consider the needs of the person and the inappropriateness of ongoing investigations. When a person has been diagnosed as dying, the goals of care have changed to the management of the terminal phase.
This diagnosis is the opportunity to support shared decision-making and to design care through conversations with the person their family and carers. It can help the avoidance of unnecessary and futile options of care, including hospital transfers and resuscitation. If a person dies peacefully without needless suffering, the family and carers have the best opportunity to see the death as a good death and have fewer difficulties as they grieve.
The identification that someone is in the terminal phase should trigger several considerations from the clinical team.
The clinical priorities of terminal care are:
- talking to the person, the family and carers
- managing symptoms
- ensuring medicines are available for symptom management
- withdrawing non-essential medicines
- advising other health professionals involved in the person’s care.
For many healthcare providers, care for older people in the terminal phase will represent a small component of their workload. These pages recommend a suite of resources to help healthcare providers with issues about symptoms or medicines in older Australians entering the terminal phase.
All care of a person in the terminal phase should take into consideration the Advance Care Directive and End-of-Life discussions.
In the terminal phase, changes in physiology as the body shuts down and changes in the underlying illness contribute to some expected symptoms, including: