COMFORT CARE FOR HOSPICE, PALLIATIVE CARE, & DEMENTIA
According to the National Institute on Aging (NIA), “Comfort care is an essential part of medical care at the end of life. It is care that helps or soothes a person who is dying.” Comfort care for hospice and palliative care not only relieves suffering but improves quality of life by boosting sense of self and self-worth.
Hospice workers, in particular, are well aware of this, as they probably agree with the above quote from Elisabeth Kübler-Ross’s groundbreaking book, On Death and Dying. Whereas palliative care treats people with serious illnesses, and not necessarily those who are in the end stage of their life, palliative care workers also understand the importance of providing comfort to those in their care. Whether hospice or palliative care, one of the primary goals is to improve patient quality of life. Providing comfort care is essential to this end.
Our friend, Bernice, died in 2011. Holly arranged for a hospice organization to aid in her transition—to provide the comfort care and the dignity she deserved at the end of her life. We were impressed by and thankful for the thoroughness with which those hospice workers tended to her needs. Now we know, first-hand, just how important the service is that hospice provides to people who are in the final stages of their lives. Read more about Bernice affected our lives.
Possible Causes of Discomfort
- Breathing problems
- Skin irritation
- Digestive problems
- Temperature sensitivity
Drugs and other treatments can be very helpful in alleviating some of these conditions. Opioids relieve pain. Salves and balms can treat skin irritation. There are medications that can help alleviate breathing and lung problems.
Unfortunately, in an attempt to increase quality of living, modern medicine often sacrifices quality of dying. That may seem like a strange notion, but a dying person who is full of morphine, for example, is deprived of the time to be with friends and family in any meaningful way. They can be deprived of their dignity.
Admitted, drugs are a necessary evil. On the other hand, we encourage non-drug interventions whenever possible. We have always advocated for non-pharmaceutical means to ease and comfort people with dementia.
So, how do we provide comfort without drugs?
There is a host of published evidence that music and music therapy provide relief from pain and anxiety, both by itself and in combination with medical therapies. For example, a study1 by Kathy JoGutgsell, MarkSchluchter, et. al. reported that, “A single music therapy intervention incorporating therapist-guided autogenic relaxation and live music was effective in lowering pain in palliative care patients.” This is just one of many such examples from medical literature.
Music also has power to stimulate reminiscing, even in people with dementia. Nothing triggers fond memories like an old and favorite song. Reminiscence therapy is a powerful way to reinforce feeling of dignity and self-worth. Old photo albums and general personal memorabilia are also excellent tools for reminiscing. This alternative to medical intervention is a way to improve a person’s quality of dying.
More Alternative Therapies for Comfort Care for Hospice
Aromatherapy is another non-drug intervention that is showing some promise for pain relief. The evidence is not conclusive, but studies do support the use of certain essential oils for pain.² Lavender is an aromatherapy oil that is used in many of the pain studies. Lavender has many other benefits for the hospice and palliative setting. Included are its ability to calm anxiety and depression, and improve sleep. It is also anti-inflammatory, anti-viral, and bactericidal. Mixed with a carrier oil and applied directly to the skin, lavender can ease skin irritations and sores.
Sensory Stimulation, mostly in the form of massage is being studied as a non-pharmacological intervention in the hospice and palliative care setting.3 Gentle back, hand or foot massage results in the release of oxytocin in the brain. The ultimate effect of the oxytocin is a reduction in stress levels and increased feelings of wellbeing. The oxytocin release results from the stimulation of cutaneous sensory nerves, so any tactile stimulation will provide similar release and similar benefit.
The addition of aromatherapy to sensory treatment will have an additive affect at the very least. A few drops of lavender oil in a tablespoon of a carrier oil like almond oil, sesame oil, or coconut oil (organic) makes a terrific massage oil.
Recreational Activity including social contact is important to the wellbeing of us all. Reading to a patient is the most common “recreational activity” provided in hospice. The level and type of activity will, of course, depend on the individual. Being outdoors, even if just relaxing on the patio, is wonderful therapy. Participation in a hobby is another. And include music in the care environment whenever practical.
1Music Therapy Reduces Pain in Palliative Care Patients: A Randomized Controlled Trial, Journal of Pain and Symptom Management ; Volume 45, Issue 5, May 2013, Pages 822-831
² The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis, Shaheen E. Lakhan, Heather Sheafer, and Deborah Tepper; Pain Res Treat. 2016; 2016: 8158693. REVIEW ARTICLE
3Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation, Kerstin Uvnäs-Moberg, Linda Handlin, and Maria Petersson; Frontiers in Psychology, 12 January 2015 | https://doi.org/10.3389/fpsyg.2014.01529