General care and comfort in the last days of life

A key aspect of care in the last days of life is to monitor and maintain or enhance patient comfort.

Treatments that moisten the mouth (eg moistened swabs, artificial saliva), lips and eyes (eg eye drops or ointment) can be beneficial.

Good skincare is essential to maintain or improve skin condition and manage skin symptoms—see General skincare measures in palliative care. Use pressure redistribution mattresses and reposition the patient when required for comfort. To minimise distress, reduce the frequency of dressing changes and care of pressure areas or wounds.

Patients may develop urinary or faecal incontinence. Continence pads, uridome draining (in males), or indwelling catheters may be used to maintain dignity and skin integrity.

If urinary retention causes distress, manage with catheterisation.

If constipation causes distress, treat with a rectally administered laxative—for drug regimens, see:

• Constipation with hard faeces in the rectum in palliative care
• Constipation with soft faeces in the rectum in palliative care
• Constipation with an empty rectum in palliative care
• Faecal impaction in palliative care.

For management of constipation in patients with a stoma, see Stomal constipation and obstruction of stomas in palliative care. For management of constipation in patients with spinal cord compression or injury, see Constipation in patients with spinal cord compression or injury.

Family members and carers may wish to participate in the general care and comfort of the patient, and can be taught how to provide interventions.