The purpose of my talk today is to talk about characteristic problems that occur in the elderly and show how they affect us caregivers.

First, let's define the main concept. Dementia– this is acquired dementia. That is, when the human brain has already formed, and then something happened to it. We still use the word "oligophrenia" to this day. Oligophrenia- this is dementia that arose in the early stages of brain formation, and everything that a person “acquired” later is called dementia. It usually happens after 60-70 years.

Rating of typical misconceptions. "What do you want, he's old..."

1. Old age is not treated.

For 14 years I worked as a district geriatric psychiatrist in Korolev in a regular dispensary. Once upon a time there was perhaps the only person who regularly went door-to-door with people with dementia.

Of course, a lot of interesting experience has accumulated. Often the patient's relatives are faced with the position of doctors: “What do you want? He's old..." The most brilliant answer, in my opinion, was given by one relative of an elderly grandmother, who said: “What do I want? I wish that when she died, I had less guilt. I want to do what I could do for her!”

The doctor always wants to be efficient, he wants to cure the patient. And old age cannot be cured. And the illusion is created that there is nothing to do with old people at all. It is with this illusion that we must fight today.

There is no diagnosis of "old age", there are diseases that need to be treated, like any disease at any age.

2. Dementia does not need to be treated because it is incurable.

In such a case, any chronic diseases does not need to be treated, and yet about 5% of dementias are potentially reversible. What does "potentially reversible" mean? If on early stage For certain types of dementias, prescribe the correct treatment, then dementia can be cured. Even with irreversible processes, at an early stage, dementia can recede for a while, and symptoms can decrease. If treated appropriately.

Is 5% a little? A lot on a general scale, since according to official data in Russia there are about 20 million people suffering from dementia. In fact, I think this figure is underestimated by one and a half to two times, since dementia is usually diagnosed late.

3. "Why torture him with" chemistry "?".

Also a violation of ethics: it's not for us to decide all this. When you yourself get sick, do you not need to be “tormented” with medicines? Why old man can't get the same help as the young one? Some amazing hypocrisy, relatives say: “Let's not torture our grandfather with chemistry”, and then. When grandfather infuriates them, and brings them to a "white heat", they can hit him, tie him up.
That is, you don’t need to “torment with chemistry”, but can you beat? An elderly person cannot go to the doctor himself, and we must take on this function.

4. “Doctor, just let him sleep…!”.

People endure for weeks, sometimes months, terrible behavioral disorders and sleep disturbances due to the dementia of their relatives, and then, staggering, they come to a psychiatrist and say: “Doctor, we don’t need anything, let him just sleep.” Of course, sleep is very important, it needs to be organized, but sleep is the tip of the iceberg, if you just improve sleep, this will not help a person with dementia much.

Insomnia is a symptom. And therefore, it is possible to put a grandfather to sleep, but it is impossible to help him from dementia in this way.

For some reason, the environment of the patient - close people, nurses, average medical staff, some neuropathologists and therapists - they think that it is very difficult to improve sleep, remove aggression, remove crazy ideas. In fact, this is a real challenge. We cannot cure a person, but to make sure that he is comfortable for us in care and at the same time he feels more or less good himself is a real task.

Outcome of delusions: Unnecessary suffering of the patient and his environment.

Aggression, delusions, behavioral and sleep disturbances, and much more can be stopped, and the development of dementia can be stopped for a while or slowed down.

3 D: depression, delirium, dementia

There are three main themes that caregivers and physicians face in geriatric psychiatry:

1. Depression

• Depression is a chronically low mood and inability to enjoy.
• Common in old age
• At this age, it can be perceived as the norm by the patient and others
• Strongly affects everything somatic diseases and worsen their prognosis

If a person, no matter what age, is chronically unable to experience joy, it is depression. Everyone has their own experience of old age. I would very much like that with my help we will form an image of old age a la Japan, when we save up money in retirement and go somewhere, and not sit on a stool straight.

In the meantime, the image of old age in our society is rather depressing. Who do we represent when we say "old man"? Usually a bent grandfather who wanders somewhere, or an angry, restless grandmother. And therefore, when an elderly person Bad mood, it is accepted as normal. It is all the more normal when old people who have lived to be 80–90 years old say: “We are tired, we don’t want to live.” It is not right!

As long as a person is alive, he should want to live, this is the norm. If a person, in any situation, does not want to live, this is depression, regardless of age. What's wrong with depression? It negatively affects somatic diseases and worsens the prognosis. We know what is common in older people a whole bouquet diseases: diabetes the second type, angina pectoris, hypertension, knee pain, back pain and so on. Even sometimes you come to a call, you ask an elderly person what hurts, he says: “Everything hurts!”. And I understand what he means.

Both old people and children suffer from depression in the body. That is, in fact, the answer “everything hurts” can be translated into our language like this: “My soul hurts, first of all, and everything else comes from that.” If a person is depressed, sad, his pressure jumps, sugar, until we remove this sadness and depression, it seems unlikely to normalize other indicators.

Bottom line: Depression is rarely diagnosed and treated. As a result: the duration and quality of life is less, and others are worse off.

2. Delirium (confusion)

1) Clouding of consciousness: loss of contact with reality, disorientation, with chaotic speech and motor activity, aggression.

2) Occurs often after injuries, moving, diseases

3) Often occurs acutely in the evening or at night, may pass and resume again

4) A person often does not remember or vaguely remember what he did in a state of confusion

5) Worsened by wrong treatment

We encounter the topic of delirium in people at a young age, mainly when long-term use alcohol. This is "delirious tremens" - hallucinations, acute delusions of persecution, and so on. In an older person, delirium may occur after physical or psychological trauma, moving to another place, bodily diseases.

Just the day before yesterday, I was on a call to a woman who is already under a hundred years old. She always lived almost independently - with a visiting social worker, relatives bought food. She had dementia, but mild, until some point it was not critical.

And so she falls at night, breaks her femoral neck, and on the very first night after the fracture, confusion begins in her. She doesn’t recognize anyone, she screams: “Where did you put my furniture, my things?” She starts to panic, get angry, get up with her broken leg, and run somewhere.

A common reason for the start of confusion is moving. Here an old man lives alone, serves himself in the city or in the countryside. The environment helps him - neighbors buy groceries, grandmothers come to visit. And suddenly they call relatives and say: “Your grandfather is weird.” He gave to the pigs what he gave to the chickens, to the chickens what he gave to the pigs, he wandered somewhere at night, barely caught, and so on, he talks. Relatives come and take grandfather away.

And here a problem arises, because grandfather, although he did not cope well with his chickens and pigs, at least knew where the toilet was, where the matches were, where his bed was, that is, he somehow oriented himself in the usual place. And after the move, he does not orient himself at all. And against this background, usually at night, confusion begins - grandfather is torn "home".

Sometimes relatives, stunned by such perseverance, really take him home so that he calms down about the chickens ... But this does not lead to anything, because in the next entrance the same grandfather is eager to “go home”, although he lived in this apartment all his life .

People, at the moment of confusion, do not understand where they are and what is happening around. The confusion often comes on acutely, in the evening or at night, and may go away by itself in the morning after sleep. That is, at night they call an ambulance, the doctor gives an injection, says: call a psychiatrist, and in the morning the patient wakes up calm and does not remember anything. Because confusion is forgotten (amnesic), the person does not remember, or very vaguely remembers what he did in a state of confusion.

Confusion is most often accompanied psychomotor agitation: speech, motor, usually occurs at night, and, which is especially unpleasant, is aggravated by incorrect treatment.

When sleep is disturbed in the elderly, what drug is usually advised by a therapist, a neuropathologist? Phenazepam is a benzodiazepine tranquilizer. This drug can treat anxiety and insomnia. He soothes and soothes.

But with confusion (due to organic disorders brain) phenazepam acts on the contrary - it does not calm, but excites. We often hear such stories: an ambulance came, gave phenazepam or made relanium intramuscularly, grandfather forgot for an hour, and then began to “run along the ceiling”. This whole group of benzodiazepine tranquilizers often works the other way around (paradoxically) in old people.

And about phenazepam: even if your grandparents use it within reasonable limits, keep in mind that, firstly, it is addictive and addictive, and secondly, it is a muscle relaxant, that is, it relaxes muscles. Elderly people, when they increase their dose of phenazepam, getting up, for example, at night to go to the toilet, fall, break their hips, and that's it.

Sometimes they also begin to treat insomnia or confusion in grandmothers with phenobarbital, that is, Valocordin or Corvalol, which contain it. But phenobarbital, although indeed a very strong sleeping pill, anti-anxiety and anticonvulsant It is also addictive and addictive. That is, in principle, we can equate it to narcotic drugs.

Therefore, in Russia we have such a specific phenomenon as korvalolshchik grandmothers. These are grandmothers who buy a huge number of bottles of Valocordin or Corvalol in a pharmacy and drink several of them a day. In fact, they are drug addicts, and if they don't drink it, they a) won't fall asleep; b) they will develop behavioral disorders resembling delirium tremens at an alcoholic. Often they have slurred speech like "porridge in the mouth" and wobbly gait. If you see that your close person regularly drinks these over-the-counter drugs - please take note of this. They must be replaced by other drugs without such side effects.

Bottom line: when confusion is not addressed in the early stages, they do not look for causes, they are not treated in the same way, as a result - the suffering of the patient and the whole family, the flight of nurses.

3. Dementia

Dementia is acquired dementia: disorders of memory, attention, orientation, recognition, planning, criticism. Violation and loss of professional and everyday skills.

• Relatives, and sometimes even doctors, “notice” dementia only at advanced stages
• Mild and sometimes moderate disorders are considered normal in the elderly and old age
• Dementia can start with personality disorders
• Often the wrong treatment is used

What do you think, if you bring an average elderly person in their 70s with a memory impairment and an orientation to an appointment with a neurologist, what diagnosis is most likely to be received? He will receive a diagnosis of "dyscirculatory encephalopathy" (DEP), which, translated into Russian, means "a disorder of brain functions due to impaired blood circulation through its vessels." More often than not, the diagnosis is wrong and the treatment is wrong. Non-stroke, but a pronounced form of the course of cerebrovascular disease (DEP), it is severe and relatively rare disease. Such patients do not walk, their speech is impaired, although there may not be asymmetry in tone (differences in the work of the muscles of the left and right half bodies).

There is a traditional problem in Russia - overdiagnosis vascular problems brain and underdiagnosis of so-called atrophic problems, which includes Alzheimer's, Parkinson's and many others. For some reason, neuropathologists everywhere see problems with blood vessels. But if the disease develops smoothly, gradually, slowly, most likely it is not connected with the vessels.

But if the disease develops abruptly or abruptly, this vascular dementia. Quite often, these two conditions are combined. That is, on the one hand, there is a smooth process of dying off of brain cells, as in Alzheimer's disease, and on the other hand, vascular "catastrophes" also occur against this background. These two processes mutually "feed" each other, so that even yesterday a well-kept old man can "break into a tailspin".

Relatives and doctors do not always notice dementia, or notice it only in advanced stages. There is a stereotype that dementia is when a person lies in a diaper and “blows bubbles”, and when, for example, he loses some household skill, this is still normal. In fact, dementia, if it develops very slowly, most often begins with memory disorders.

The classic case is dementia of the Alzheimer's type. What does this mean? A person remembers events from his life well, but he does not remember what happened just now. For example, at the reception I ask an elderly person, he recognizes everyone, knows everything, remembers the address, and then I say: “Did you have breakfast today?”. - "Yes", - "What did you have for breakfast?" - Silence, he does not remember.

There is also such a stereotype that dementia is something about memory, attention, orientation. In fact, there are types of dementias that begin with character and behavioral disorders. For example, frontotemporal dementia, or Pick's disease as it used to be called, can begin with a personality disorder. A person in the first stages of dementia becomes either complacently relieved - "the sea is knee-deep", or vice versa, very closed, self-absorbed, apathetic and sloppy.

You probably want to ask me: where, in fact, does that conditional border lie, between the still normal and already the onset of dementia? There are different criteria for this boundary. ICD (International Classification of Diseases) indicates that dementia is a violation of higher cortical functions with violation of domestic and professional skills. The definition is correct, but it is too vague. That is, we can apply it both at advanced and at early stages. Why is it so important to define the boundary? This moment is not only medical. Legal issues often arise: problems of inheritance, legal capacity, and so on.

Two criteria will help determine the boundary:

1) Dementia is characterized by criticism disorder. That is, a person no longer treats his problems with criticism - to memory disorders, basically. He does not notice them, or downplays the scale of his problems.

2) Loss of self-service. As long as a person takes care of himself, we can assume by default that there is no dementia.

But here, too, there is a subtle point - what does “serves itself” mean? If a person already exists in your care, but functions in an apartment, this does not mean that there is no dementia. It may very well be that it is already gently developing, it's just that a person in his usual environment does not detect it. But, for example, he cannot go and pay himself according to the receipt: he gets confused, does not understand what and where to pay for, is not able to count the change, etc.

Here is the mistake: mild and slow disorders are considered the norm in the elderly and senile age. This is very bad, because it is mild and slow disorders that can be effectively treated. If you bring your relative at an early stage of dementia, it can be managed with medications that don't cure dementia but are great at containing it. Sometimes for many, many years.

Bottom line: Dementia is diagnosed late, treated incorrectly. As a result, close people live less, worse, suffer themselves and cause suffering to others.

Where should you start if a loved one has dementia? A very unusual answer: taking care of the caregiver!

Having normalized state of mind caregiver, we:

– Improving the quality of care;

– We carry out the prevention of “burnout syndrome” among relatives and carers. If you explain "on the fingers", those who are nearby go through the stages of aggression, depression and somatization;

– We keep good carers and health for our loved ones who bear the burden of care;

– If the caregiver works, we improve his performance and sometimes keep his job.

Does anyone have a version of why you need to start with yourself when caring for a loved one with dementia? Recall 3D, where depression comes first. The caregiver is actually much more vulnerable than the dementia patient.

A dementia patient may no longer understand anything, consider you a granddaughter, a neighbor, a nurse instead of a daughter. And you still need to provide for the patient - socially, legally, medically. If you put the patient in the center, or rather, his illness, over time you will lie next to the patient. Only by normalizing the condition of the caregiver, we improve the quality of care and help the patient himself.

Burnout Syndrome has three conditional stages: aggression, depression, somatization. Aggression - often as irritability, the classic version is asthenia (weakness, fatigue).

Depression follows aggression if the caregiver does not have the opportunity to rest. This is the phase of apathy, when a person no longer needs anything at all, he walks like a “zombie”, is silent, tearful, automatically cares and is no longer with us. This is a more severe stage of burnout.

If at this stage we do not take care of ourselves, somatization occurs. Simply put, a person can simply die. The caregiver develops own illnesses and he himself becomes disabled.

It is impossible to cheat reality. If you care without taking care of yourself, then after a while you yourself will die. .

What can be done when proper treatment and caring for a demented relative?

– Identify and treat “potentially reversible dementias” and depressive pseudo-dementias;

– Extend the life and quality of life of a loved one if dementia is incurable;

– Eliminate the suffering of an elderly person, behavioral disorders, psychotic disorders;

In 5% of cases, dementia can be cured. There are dementias with hypothyroidism, with hyperthyroidism, with a lack of vitamin B-12, folic acid, normotensive hydrocephalus and so on.

If we cannot cure dementia, we must understand that it takes, on average, four to seven years from the time of diagnosis to the death of our loved one. Why should we turn these years into hell? Let's eliminate the suffering of an elderly person, and save ourselves health and work.

Questions:

– If I notice some behavioral deviations in a relative, but she does not recognize this and does not want to be treated?

- IN medical law eat the federal law"ABOUT psychiatric care and guarantees of the rights of citizens in its provision. I believe that all people who care for dementia patients, due to the difficult social and medical and legal situation, need to read and know this law. Especially about observation by a psychiatrist: how can a psychiatrist be invited, in what cases can a psychiatrist involuntarily refer a patient to a hospital, and when to refuse, etc.

But in practice, if we see dementia, we try to start treating it as soon as possible. Since getting permission from the court for an examination is a very long time, and the disease progresses, relatives go crazy. Here it should be remembered that psychotropic drugs for dementia patients cannot be left on their hands. You need tight control. They forget to take them, or they forget that they took them, and they take more. Or they don't take it on purpose. Why?

1. Ideas of damage, which is formed against the background of memory impairment. That is, an elderly person, already overwhelmed by paranoid anxiety, takes his documents, money and hides them, and then cannot remember where he put them. And who stole? Either relatives or neighbours.
2. Ideas of poisoning. This problem can be solved if you start treatment with drugs in solution. Then, when this idea disappears in a person, he agrees to take drugs for memory voluntarily.
3. Inappropriate sexual demands. I tried to talk a little about this at the Conference. A very difficult topic. We are used to the fact that caregivers can sexually abuse helpless caregivers. But it also happens the other way around: deprived of criticism and “brakes”, the ward commits depraved acts towards minors, etc. This happens much more often than many people think.

– What can be associated with a complete refusal of food and water for late stages dementia?

- First of all, it is necessary to find and treat depression.

1. Depression (no appetite);
2. Ideas of poisoning (changes in taste, poison was added);
3. Concomitant somatic diseases with intoxication.

1. If you have a replacement, the most The best way when you are tired - leave a post for a while. A replacement can be found if you set such a goal.
2. If it is impossible to leave and rest, we treat the “burnout syndrome” with medicines.

It must be borne in mind that caring for an elderly person is hard physical and moral work, which, for us, relatives, is not paid. Why else is burnout syndrome so relevant? If you were paid money for care, you would not burn out so quickly. Adequately paid care is the prevention of burnout syndrome.

But it’s even harder to rebuild inside, admit that your loved one is sick, take control of the situation into your own hands, and, despite fatigue and troubles, try to enjoy this life. Because there won't be another.

If you are dying or caring for a dying person, you may have questions about how the process of dying will be physically and emotionally. The following information will help you answer some questions.

Signs of approaching death

The process of dying is as diverse (individual) as the process of birth. Impossible to predict exact time death, and how the person will die. But people who are on the verge of death experience a lot similar symptoms regardless of the type of disease.

As death approaches, a person may experience some physical and emotional changes, such as:

• Excessive drowsiness and weakness, at the same time periods of wakefulness decrease, energy fades.

• Breathing changes, periods of rapid breathing are replaced by respiratory arrests.

• Hearing and vision change, for example, a person hears and sees things that others do not notice.

• The appetite worsens, the person drinks and eats less than usual.

• Changes in the urinary and gastrointestinal systems. Your urine may turn dark brown or dark red, and you may also have bad (hard) stools.

• Body temperature fluctuates from very high to very low.

• Emotional changes, the person is not interested in the outside world and individual details of everyday life, such as time and date .

A dying person may experience other symptoms, depending on the disease. Talk to your doctor about what to expect. You can also contact the Terminally Ill Assistance Program, where they will answer all your questions regarding the process of dying. The more you and your loved ones know, the more prepared you will be for this moment.
Excessive sleepiness and weakness associated with approaching death

As death approaches, a person sleeps more, and it becomes more and more difficult to wake up. The periods of wakefulness become shorter and shorter.

As death approaches, the people who care for you will notice that you are unresponsive and that you are in a very deep sleep. This state is called a coma. If you are in a coma, then you will be tied to the bed, and all your physiological needs(bathing, turning, eating and urinating) will need to be controlled by someone else.

General weakness is a very common occurrence as death approaches. It is normal for a person to need help with walking, bathing, and going to the toilet. Over time, you may need help to roll over in bed. Medical equipment, such as wheelchairs, a walker or a hospital bed can be very helpful during this period. This equipment can be rented from a hospital or terminally ill center

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Respiratory changes as death approaches
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With the approach of death periods rapid breathing may be interspersed with periods of restlessness.

Your breath may become wet and stagnant. It is called " death rattle". Changes in breathing usually happen when you are weak and normal discharge from your respiratory tract and the lungs cannot come out.

Although noisy breathing may be a signal to your loved ones, you will most likely not feel pain and notice congestion. Since the fluid is deep in the lungs, it is difficult to remove it from there. Your doctor may prescribe oral tablets (atropines) or patches (scopolamine) to relieve congestion.

Your loved ones may turn you on the other side so that the discharge comes out of the mouth. They can also wipe these secretions with a damp cloth or special swabs (you can ask at the help center for the terminally ill or buy them at pharmacies).

Your doctor may prescribe oxygen therapy to help relieve your shortness of breath. Oxygen therapy will make you feel better, but will not prolong your life.

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Changes in vision and hearing as death approaches
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Visual impairment is very common in recent weeks life. You may notice that you have trouble seeing. You may see or hear things that no one else notices (hallucinations). Visual hallucinations are common before death.

If you are caring for a dying person who is hallucinating, you need to cheer him up. Recognize what the person sees. Denial of hallucinations can upset the dying person. Talk to the person, even if he or she is in a coma. It is known that dying people can hear even when they are in a deep coma. People who came out of a coma said that they could hear all the time while they were in a coma.

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hallucinations
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Hallucinations are the perception of something that is not really there. Hallucinations can involve all of the senses: hearing, sight, smell, taste, or touch.

The most common hallucinations are visual and auditory. For example, a person may hear voices or see objects that the other person cannot see.

Other types of hallucinations include gustatory, olfactory, and tactile hallucinations.

Treatment for hallucinations depends on their cause.

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Appetite changes as death approaches

As death approaches, you are likely to eat and drink less. It's connected with general feeling weakness and slow metabolism.

Since nutrition is so important in society, it will be difficult for your family and friends to watch you not eat anything. However, metabolic changes mean you don't need the same amount of food and fluids as you used to.

You can eat small meals and liquids while you are active and able to swallow. If swallowing is a problem for you, thirst can be prevented by moistening your mouth with a damp cloth or a special swab (available at a pharmacy) dipped in water.
Changes in urinary and gastrointestinal systems with the approach of death

Often the kidneys gradually stop producing urine as death approaches. As a result, your urine turns dark brown or dark red. This is due to the inability of the kidneys to properly filter urine. As a result, urine becomes very concentrated. Also, its number is decreasing.

As appetite decreases, some changes also occur in the intestines. The stool becomes harder and more difficult to pass (constipation) as the person takes in less fluid and becomes weaker.

You should tell your doctor if you have bowel movements less than once every three days, or if bowel movements are uncomfortable. Stool softeners may be recommended to prevent constipation. You can also use an enema to cleanse the colon.

As you become more and more weak, it is natural that you find it difficult to control bladder and intestines. Your bladder may be placed urinary catheter as a means of prolonged drainage of urine. The terminally ill program can also provide toilet paper or underwear (these can also be purchased at a pharmacy).
Changes in body temperature as death approaches

As death approaches, the part of the brain responsible for regulating body temperature begins to malfunction. You may have a high temperature, and in a minute you will be cold. Your hands and feet may feel very cold to the touch and may even turn pale and blotchy. Changes in skin color are called patchy skin lesions and are very common in last days or hours of life.

Your caregiver can control your temperature by wiping your skin with a damp, slightly warm washcloth or by giving you medications such as:
Acetaminophen (Tylenol)
Ibuprofen (Advil)
Naproxen (Alev).
Aspirin.

Many of these medicines are available in the form rectal suppository if you have difficulty swallowing.
Emotional changes as death approaches

Just as your body prepares physically for death, you must also prepare emotionally and mentally for it.

With the approach of death, you may lose interest in the world around you and individual details. Everyday life, such as date or time. You can close in on yourself and communicate less with people. You may want to communicate with only a few people. This introspection can be a way of saying goodbye to everything you knew.

In the days leading up to death, you may enter a state of unique conscious awareness and communication that may be misinterpreted by your loved ones. You can talk about the fact that you need to go somewhere - "go home" or "go somewhere". The meaning of such conversations is unknown, but some people think that such conversations help prepare for death.

Events from your recent past can mix with distant events. You can remember very old events in great detail, but not remember what happened an hour ago.

You can think of people who have already died. You may say that you have heard or seen someone who has already died. Your loved ones can hear you talking to the deceased person.

If you are caring for a dying person, you may be upset or frightened by this strange behavior. You may want to bring your loved one back to reality. If this kind of communication is bothering you, talk to your doctor to better understand what's going on. Your loved one may fall into a state of psychosis, and it may be scary for you to watch it. Psychosis occurs in many people before death. It may have a single cause or be the result of several factors. Reasons may include:
Medications such as morphine, sedatives and pain relievers, or taking too many medications that don't work well together.
metabolic changes associated with high temperature or dehydration.
Metastasis.
Deep depression.

Symptoms may include:
Revival.
hallucinations.
Unconscious state, which is replaced by revival.

Sometimes delirium tremens can be prevented by alternative medicine, such as relaxation and breathing techniques, and other methods that reduce the need for sedatives.

Pain

Palliative care can help you relieve physical symptoms associated with your condition, such as nausea or difficulty breathing. Controlling pain and other symptoms is an important part of your treatment and improving your quality of life.

How often a person feels pain depends on their condition. Some deadly diseases, such as bone cancer or pancreatic cancer, can be accompanied by severe physical pain.

A person may be so afraid of pain and other physical symptoms that they may consider suicide with the assistance of a physician. But death pain can be effectively dealt with. You should tell your doctor and loved ones about any pain. There are many medications and alternative methods (such as massage) that can help you deal with the pain of death. Be sure to ask for help. Ask a loved one to report your pain to the doctor if you are unable to do so yourself.

You may want your family not to see you suffer. But it is very important to tell them about your pain, if you cannot stand it, so that they immediately consult a doctor.

Spirituality

Spirituality means a person's awareness of the purpose and meaning of his life. It also denotes the relationship of a person with higher powers or the energy that gives meaning to life.

Some people don't often think about spirituality. For others, it's part of everyday life. As you approach the end of your life, you may be faced with your own spiritual questions and challenges. Being associated with religion often helps some people achieve comfort before death. Other people find solace in nature, in social work, strengthening relationships with loved ones or in creating new relationships. Think of things that can give you peace and support. What questions concern you? Seek support from friends, family, relevant programs, and spiritual guides.

Caring for a dying relative

Physician-assisted suicide

Physician-assisted suicide refers to the practice of medical assistance to a person who voluntarily wishes to die. This is usually done with the assignment lethal dose medicines. Although the doctor in an indirect way participates in the death of a person, he is not its direct cause. On the this moment Oregon is the only state to legalize physician-assisted suicide.

A person with a terminal illness may consider suicide with the assistance of a doctor. Among the factors that can cause such a decision are severe pain, depression and fear of dependence on other people. A dying person may consider himself a burden for his loved ones and not understand that his relatives want to provide him with their help, as an expression of love and sympathy.

Often a person with a terminal illness contemplates physician-assisted suicide when their physical or emotional symptoms don't get effective treatment. Symptoms associated with the dying process (such as pain, depression, or nausea) can be controlled. Talk to your doctor and family about your symptoms, especially if these symptoms bother you so much that you think about death.

Pain and symptom control at the end of life

At the end of life, pain and other symptoms can be effectively managed. Talk to your doctor and loved ones about the symptoms you are experiencing. The family is an important link between you and your doctor. If you yourself cannot communicate with the doctor, your loved one can do this for you. There is always something you can do to ease your pain and symptoms so that you feel comfortable.

physical pain

There are many pain relievers available. Your doctor will choose the easiest and most non-traumatic drug for pain relief. Oral medications are usually used first because they are easier to take and less expensive. If your pain is not acute, pain medications can be bought without a doctor's prescription. These are drugs such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. It is important to stay ahead of your pain and take your medications on schedule. Irregular application medication is often the cause of ineffective treatment.

Sometimes pain cannot be controlled with over-the-counter medications. In this case, more effective forms treatment. The doctor may prescribe pain medications such as codeine, morphine, or fentanyl. These drugs can be combined with others, such as antidepressants, to help you get rid of the pain.

If you cannot take pills, there are other forms of treatment. If you have trouble swallowing, you can use liquid medicines. Also, drugs can be in the form of:

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Rectal suppository. Suppositories can be taken if you have trouble swallowing or feel sick.
Drops under the tongue. As well as nitroglycerin tablets or heartache sprays, liquid forms some substances, such as morphine or fentanyl, may be absorbed blood vessels under the tongue. These drugs are given in very small amounts - usually just a few drops - and are effective way pain management for people with swallowing problems.

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Plasters applied to the skin (transdermal patches). These patches allow pain medications, such as fentanyl, to pass through the skin. The advantage of patches is that you instantly receive the required dose of medication. These patches are better at controlling pain than pills. In addition, a new patch must be applied every 48-72 hours, and tablets must be taken several times a day.

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Intravenous injections (droppers). Your doctor may prescribe treatment with a needle inserted into a vein in your arm or chest if you have very severe pain that cannot be controlled by oral, rectal, or transdermal means. The drugs may be given as a single injection several times a day, or continuously in small amounts. Just because you're hooked up to a drip doesn't mean your activity will be restricted. Some people carry small portable pumps that provide them with small doses of medication throughout the day.

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Injections into the area spinal nerves(epidural) or under the tissue of the spine (intrathecal). At acute pain strong painkillers such as morphine or fentanyl are injected into the spinal area.
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Many people who suffer from severe pain fear that they will become addicted to pain medications. However, addiction rarely occurs in terminally ill people. If your condition improves, you can slowly stop taking the medicine so that dependence does not develop.

Painkillers can be used to manage the pain and help keep it tolerable. But sometimes painkillers cause drowsiness. You can only take a small amount of medicine and tolerate it accordingly a little pain to stay active. On the other hand, maybe weakness doesn't matter to you of great importance and you are not disturbed by drowsiness caused by certain medications.

The main thing is to take medicines on a certain schedule, and not just when the need arises. But even if you take medication regularly, sometimes you may feel severe pain. This is called "pain breakouts". Talk to your doctor about what medications should be on hand to help manage breakouts. And always tell your doctor if you stop taking a medicine. Sudden termination may cause serious side effects and severe pain. Talk to your doctor about ways to manage pain without medication. Alternative medical therapy may help some people relax and relieve pain. You can combine traditional treatment from alternative methods, such as:

*
Acupuncture
aromatherapy
Biofeedback
Chiropractic
Pointing images
Healing Touch
Homeopathy
Hydrotherapy
Hypnosis
Magnetotherapy
Massage
Meditation
Yoga

For more information, see the Chronic Pain section.

emotional stress

During the period when you are learning to cope with your illness, a short emotional stress is an normal. Non-depression that lasts more than 2 weeks is no longer normal and should be reported to your doctor. Depression can be cured, even if you have a terminal illness. Antidepressants combined with psychological counseling will help you cope with emotional distress.

Talk to your doctor and family about your emotional stress. While grief is a natural part of the process of dying, it doesn't mean you have to endure severe emotional pain. Emotional suffering can intensify physical pain. They can also reflect badly on your relationships with loved ones and prevent you from saying goodbye to them properly.

Other symptoms

As death approaches, you may experience other symptoms as well. Talk to your doctor about any symptoms you may have. Symptoms such as nausea, fatigue, constipation or shortness of breath can be managed with medication, special diets and oxygen therapy. Have a friend or family member describe all of your symptoms to a doctor or terminally ill worker. It is helpful to keep a journal and write down all your symptoms there.

We all live in this world by pure chance, and we die "when our hour strikes," to put it in poetic language. However, we cannot die just like that - everything happens according to plan, has symptoms, or signs. What are these signs and is it really possible to predict that a person will die soon? Medicine claims - yes, it is possible, and offers the following signs approaching death.

1. Lack of appetite

This natural sign the approach of death, because your body no longer needs energy - why do you need it if you die tomorrow? You may not want to eat at all, or you may only want very “harmless”, light meals or foods, such as porridge, sandwich, compote, yogurt. It is unlikely that you will want to eat meat before your death - you simply will not have time to digest it when you die. Your body itself feels when you die, and simply refuses food. In such a situation, you may have very little strength, and it’s good if someone takes care of you and is nearby, because the lack of appetite does not mean that you do not need anything: sometimes you need a little water - just to moisten dry lips.

2. Immeasurable sleepiness

Before going to another world, a person begins a period of “borderline”: he sleeps more and more, it is more difficult for him to move and even talk, he is more and more immersed in that reality invisible to the living. He must not be forbidden, and relatives should act wisely, allowing the dying man to sleep as much as he wants, and talk to him as if he were alive, because he has not died yet, and his sleep is not a deep sleep, but rather a slumber through which he hears and understands what is happening in the world.

3. Weakness and fatigue

Before the threshold of death, a person has little energy, he eats little or no food, constantly sleeps, speaks little, it can be difficult for him to roll over in bed on his side or drink water. He needs help, because his weakness and fatigue indicate that death is already near.

4. Loss of orientation and consciousness

Sometimes, before death, a person ceases to understand where he is and what is happening. He is in this world, but the other world seems to be calling him. The organs begin to "jump", the brain can turn off, and then turn on, but not work as usual. In such a situation, a person behaves strangely, sometimes he does not recognize his loved ones. Those close to you need to show patience and endurance, caring for the dying.

5. Heavy breathing

The dying man breathes heavily at death. Breathing quickens and then becomes very deep. Breathing is hoarse, uneven, the dying person seems to be suffocating. It helps him to sit down with a pillow behind him - sitting he can breathe easier than lying down.

6. Introspection

The natural process of death includes a loss of attention to what is happening around, to the life of the people around. The dying man is preparing for death - he is no longer interested in what the living think and say. At the same time, he cannot be left alone with himself - he must feel the support of loved ones, who are desirable to be near and support the dying.

7. Urine color changes

The urine of the dying person becomes darker - sometimes almost brown, sometimes reddish. Organs, as already mentioned, "jump", and the same applies to the kidneys. Sometimes kidney failure before death leads to the immersion of the dying person in a coma and subsequent silent death.

8. Edema

This symptom is a consequence of kidney failure. You can no longer go to the toilet, so the fluid accumulates in the body, leading to swelling of parts of the body.

9. Cold extremities

Before plunging into death, the hands and feet of the dying person become cold, especially the palsy. The blood simply flows to the most important organs, leaving the limbs almost without blood, and therefore without heat. In such a situation, loved ones should cover the dying person with a blanket to warm their frozen hands and feet.

10. Walking spots

The dying person is pale, but as a result of circulatory disorders, it seems that spots or patterns “walk” on his body. Usually such spots or patterns appear first on the feet, and then on other parts of the body.

Not all of these signs are “necessary”: some of them may be absent, but it is these signs that most often say, from the point of view of medical observations, that death is not just nearby - it has already almost taken possession of a person.

If you are dying or caring for a dying person, you may have questions about how the process of dying will be physically and emotionally. The following information will help you answer some questions.

Signs of approaching death

The process of dying is as diverse (individual) as the process of birth. It is impossible to predict the exact time of death, and how exactly a person will die. But people who are on the verge of death experience many of the same symptoms, regardless of the type of disease.

As death approaches, a person may experience some physical and emotional changes, such as:

Excessive drowsiness and weakness, at the same time periods of wakefulness decrease, energy fades.

Breathing changes, periods of rapid breathing are replaced by respiratory arrests.

Hearing and vision change, for example, a person hears and sees things that others do not notice.

The appetite worsens, the person drinks and eats less than usual.

Changes in the urinary and gastrointestinal systems. Your urine may turn dark brown or dark red, and you may also have bad (hard) stools.

Body temperature fluctuates from very high to very low.

Emotional changes, the person is not interested in the outside world and individual details of everyday life, such as time and date.

A dying person may experience other symptoms, depending on the disease. Talk to your doctor about what to expect. You can also contact the Terminally Ill Assistance Program, where they will answer all your questions regarding the process of dying. The more you and your loved ones know, the more prepared you will be for this moment.

Excessive sleepiness and weakness associated with approaching death

As death approaches, a person sleeps more, and it becomes more and more difficult to wake up. The periods of wakefulness become shorter and shorter.

As death approaches, the people who care for you will notice that you are unresponsive and that you are in a very deep sleep. This state is called a coma. If you are in a coma, then you will be bed-bound and all your physiological needs (bathing, turning, feeding and urinating) will have to be controlled by someone else.

General weakness is a very common phenomenon with the approach of death. It is normal for a person to need help with walking, bathing, and going to the toilet. Over time, you may need help to roll over in bed. Medical equipment such as wheelchairs, walkers or a hospital bed can be very helpful during this period. This equipment can be rented from a hospital or terminally ill center.

Respiratory changes as death approaches

As death approaches, periods of rapid breathing may be replaced by periods of breathlessness.

Your breath may become wet and stagnant. This is called "death rattle". Changes in breathing usually happen when you are weak and the normal secretions from your airways and lungs cannot get out.

Although noisy breathing may be a signal to your loved ones, you will most likely not feel pain and notice congestion. Since the fluid is deep in the lungs, it is difficult to remove it from there. Your doctor may prescribe oral tablets (atropines) or patches (scopolamine) to relieve congestion.

Your loved ones may turn you on the other side so that the discharge comes out of the mouth. They can also wipe these secretions with a damp cloth or special swabs (you can ask at the help center for the terminally ill or buy them at pharmacies).

Your doctor may prescribe oxygen therapy to help relieve your shortness of breath. Oxygen therapy will make you feel better, but will not prolong your life.

Changes in vision and hearing as death approaches

Visual impairment is very common in the last weeks of life. You may notice that you have trouble seeing. You may see or hear things that no one else notices (hallucinations). Visual hallucinations are common before death.

If you are caring for a dying person who is hallucinating, you need to cheer him up. Recognize what the person sees. Denial of hallucinations can upset the dying person. Talk to the person, even if he or she is in a coma. It is known that dying people can hear even when they are in a deep coma. People who came out of a coma said that they could hear all the time while they were in a coma.

hallucinations

Hallucinations are the perception of something that is not really there. Hallucinations can involve all of the senses: hearing, sight, smell, taste, or touch.

The most common hallucinations are visual and auditory. For example, a person may hear voices or see objects that the other person cannot see.

Other types of hallucinations include gustatory, olfactory, and tactile hallucinations.

Treatment for hallucinations depends on their cause.

Changesappetitefromapproachof death

As death approaches, you are likely to eat and drink less. This is due to a general feeling of weakness and a slower metabolism.

Since nutrition is so important in society, it will be difficult for your family and friends to watch you not eat anything. However, metabolic changes mean you don't need the same amount of food and fluids as you used to.

You can eat small meals and liquids while you are active and able to swallow. If swallowing is a problem for you, thirst can be prevented by moistening your mouth with a damp cloth or a special swab (available at a pharmacy) dipped in water.

Changes in the urinary and gastrointestinal systems as death approaches

Often the kidneys gradually stop producing urine as death approaches. As a result, your urine turns dark brown or dark red. This is due to the inability of the kidneys to properly filter urine. As a result, urine becomes very concentrated. Also, its number is decreasing.

As appetite decreases, some changes also occur in the intestines. The stool becomes harder and more difficult to pass (constipation) as the person takes in less fluid and becomes weaker.

You should tell your doctor if you have bowel movements less than once every three days, or if bowel movements are uncomfortable. Stool softeners may be recommended to prevent constipation. You can also use an enema to cleanse the colon.

As you become more and more weak, it is natural that you find it difficult to control your bladder and bowels. A urinary catheter may be placed in your bladder as a means of continuous drainage of urine. Also, the terminally ill program can provide toilet paper or underwear (these are also available at the pharmacy).

Changes in body temperature as death approaches

As death approaches, the part of the brain responsible for regulating body temperature begins to malfunction. You may have a high temperature, and in a minute you will be cold. Your hands and feet may feel very cold to the touch and may even turn pale and blotchy. Changes in skin color are called patchy skin lesions and are very common in the last days or hours of life.

Your caregiver can control your temperature by wiping your skin with a damp, slightly warm washcloth or by giving you medications such as:

Acetaminophen (Tylenol)

Ibuprofen (Advil)

Naproxen (Alev).

Many of these medicines are available as rectal suppositories if you have difficulty swallowing.

Emotional changes as death approaches

Just as your body prepares physically for death, you must also prepare emotionally and mentally for it.

As death approaches, you may lose interest in the world around you and certain details of everyday life, such as the date or time. You can close in on yourself and communicate less with people. You may want to communicate with only a few people. This introspection can be a way of saying goodbye to everything you knew.

In the days leading up to death, you may enter a state of unique conscious awareness and communication that may be misinterpreted by your loved ones. You can say that you need to go somewhere - "go home" or "go somewhere". The meaning of such conversations is unknown, but some people think that such conversations help prepare for death.

Events from your recent past can mix with distant events. You can remember very old events in great detail, but not remember what happened an hour ago.

You can think of people who have already died. You may say that you have heard or seen someone who has already died. Your loved ones can hear you talking to the deceased person.

If you are caring for a dying person, you may be upset or frightened by this strange behavior. You may want to bring your loved one back to reality. If this kind of communication is bothering you, talk to your doctor to better understand what's going on. Your loved one may fall into a state of psychosis, and it may be scary for you to watch it. Psychosis occurs in many people before death. It may have a single cause or be the result of several factors. Reasons may include:

Medications such as morphine, sedatives and pain relievers, or taking too many medications that don't work well together.

Metabolic changes associated with high temperature or dehydration.

Metastasis.

Deep depression.

Symptoms may include:

Revival.

hallucinations.

Unconscious state, which is replaced by revival.

Sometimes delirium tremens can be prevented with alternative medicine, such as relaxation and breathing techniques, and other methods that reduce the need for sedatives.

Pain

Palliative care can help you relieve physical symptoms associated with your condition, such as nausea or difficulty breathing. Controlling pain and other symptoms is an important part of your treatment and improving your quality of life.

How often a person feels pain depends on their condition. Some deadly diseases, such as bone cancer or pancreatic cancer, can be accompanied by severe physical pain.

A person may be so afraid of pain and other physical symptoms that they may consider suicide with the assistance of a physician. But death pain can be effectively dealt with. You should tell your doctor and loved ones about any pain. There are many medications and alternative methods (such as massage) that can help you deal with the pain of death. Be sure to ask for help. Ask a loved one to report your pain to the doctor if you are unable to do so yourself.

You may want your family not to see you suffer. But it is very important to tell them about your pain, if you cannot stand it, so that they immediately consult a doctor.

Spirituality

Spirituality means a person's awareness of the purpose and meaning of his life. It also denotes a person's relationship with higher forces or energy, which gives meaning to life.

Some people don't often think about spirituality. For others, it's part of everyday life. As you approach the end of your life, you may be faced with your own spiritual questions and challenges. Being associated with religion often helps some people achieve comfort before death. Other people find solace in nature, in social work, strengthening relationships with loved ones, or in creating new relationships. Think of things that can give you peace and support. What questions concern you? Seek support from friends, family, relevant programs, and spiritual guides.

Caring for a dying relative

Physician-assisted suicide Physician-assisted suicide refers to the practice of medical assistance to a person who voluntarily wishes to die. This is usually done by prescribing a lethal dose of medication. Although the doctor is indirectly involved in the death of a person, he is not a direct cause of it. Oregon is currently the only state to legalize physician-assisted suicide. A person with a terminal illness may consider suicide with the assistance of a doctor. Among the factors that can cause such a decision are severe pain, depression and fear of dependence on other people. A dying person may consider himself a burden for his loved ones and not understand that his relatives want to provide him with their help, as an expression of love and sympathy. Often, a person with a terminal illness contemplates physician-assisted suicide when their physical or emotional symptoms do not receive effective treatment. Symptoms associated with the dying process (such as pain, depression, or nausea) can be controlled. Talk to your doctor and family about your symptoms, especially if these symptoms bother you so much that you think about death.

Pain and symptom control at the end of life

At the end of life, pain and other symptoms can be effectively managed. Talk to your doctor and loved ones about the symptoms you are experiencing. The family is an important link between you and your doctor. If you yourself cannot communicate with the doctor, your loved one can do this for you. There is always something you can do to ease your pain and symptoms so that you feel comfortable.

physical pain

There are many pain relievers available. Your doctor will choose the easiest and most non-traumatic drug for pain relief. Oral medications are usually used first because they are easier to take and less expensive. If your pain is not acute, pain medications can be bought without a doctor's prescription. These are drugs such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. It is important to stay ahead of your pain and take your medications on schedule. Irregular use of medications is often the cause of ineffective treatment.

Sometimes pain cannot be controlled with over-the-counter medications. In this case, more effective forms of treatment are needed. The doctor may prescribe pain medications such as codeine, morphine, or fentanyl. These drugs can be combined with others, such as antidepressants, to help you get rid of the pain.

If you cannot take pills, there are other forms of treatment. If you have trouble swallowing, you can use liquid medicines. Also, drugs can be in the form of:

Rectal suppositories. Suppositories can be taken if you have trouble swallowing or feel sick.

Drops under the tongue. Just like nitroglycerin tablets or heart pain sprays, liquid forms of certain substances, such as morphine or fentanyl, can be absorbed by the blood vessels under the tongue. These drugs are given in very small amounts - usually just a few drops - and are an effective way to manage pain for people who have trouble swallowing.

Patches applied to the skin (transdermal patches). These patches allow pain medications, such as fentanyl, to pass through the skin. The advantage of patches is that you instantly receive the required dose of medication. These patches are better at controlling pain than pills. In addition, a new patch must be applied every 48-72 hours, and tablets must be taken several times a day.

Intravenous injections (droppers). Your doctor may prescribe treatment with a needle inserted into a vein in your arm or chest if you have very severe pain that cannot be controlled by oral, rectal, or transdermal means. The drugs may be given as a single injection several times a day, or continuously in small amounts. Just because you're hooked up to a drip doesn't mean your activity will be restricted. Some people carry small portable pumps that provide them with small doses of medication throughout the day.

Injections into the region of the spinal nerves (epidural) or under the tissue of the spine (intrathecal). For acute pain, strong pain medications such as morphine or fentanyl are injected into the spine.

Many people who suffer from severe pain fear that they will become addicted to pain medications. However, addiction rarely occurs in terminally ill people. If your condition improves, you can slowly stop taking the medicine so that dependence does not develop.

Painkillers can be used to manage the pain and help keep it tolerable. But sometimes painkillers cause drowsiness. You can only take a small amount of medication and endure a little pain and still be active. On the other hand, weakness may not matter much to you and you are not bothered by drowsiness caused by certain medications.

The main thing is to take medicines on a certain schedule, and not just when the need arises. But even if you take medication regularly, sometimes you may feel severe pain. This is called "pain breakouts". Talk to your doctor about what medications should be on hand to help manage breakouts. And always tell your doctor if you stop taking a medicine. Sudden cessation can cause serious side effects and severe pain. Talk to your doctor about ways to manage pain without medication. Alternative medical therapies can help some people relax and relieve pain. You can combine traditional treatment with alternative methods such as:

Acupuncture

aromatherapy

Biofeedback

Chiropractic

Pointing images

Healing Touch

Homeopathy

Hydrotherapy

• Magnetotherapy

• Meditation

For more information, see the Chronic Pain section.

emotional stress

During the period when you learn to cope with your illness, a short emotional stress is normal. Non-depression that lasts more than 2 weeks is no longer normal and should be reported to your doctor. Depression can be cured, even if you have a terminal illness. Antidepressants combined with psychological counseling will help you cope with emotional distress.

Talk to your doctor and family about your emotional stress. While grief is a natural part of the process of dying, it doesn't mean you have to endure serious emotional pain. Emotional suffering can exacerbate physical pain. They can also reflect badly on your relationships with loved ones and prevent you from saying goodbye to them properly.

Other symptoms

As death approaches, you may experience other symptoms as well. Talk to your doctor about any symptoms you may have. Symptoms such as nausea, fatigue, constipation, or shortness of breath can be managed with medication, special diets, and oxygen therapy. Have a friend or family member describe all of your symptoms to a doctor or terminally ill worker. It is helpful to keep a journal and write down all your symptoms there.

Why, before death, people's noses are pointed, they see the dead, they empty themselves - especially for the readers of "Popular about Health" I will consider this information in more detail. life path of any person, whatever he may be, ends in death and it is worth reconciling with this, for some this state comes early, and for someone after many years of life. You should be prepared for this if there is a bed patient in the family.

The signs before death are different for everyone, however, many see the dead before death, which is explained by the fact that a person is gradually preparing to leave for another world and he often sees already dead people. Immediately at the moment of dying, all physiological sphincters relax, in particular, the urinary and intestinal ones, which leads to emptying.

A bedridden patient before death may experience mental anguish and fear of death. In his right mind, he understands what he will have to go through and he becomes scared. The body undergoes physical and mental level, the emotional background changes, interest in life gets. Some ask for euthanasia to alleviate the agony before death, while the relatives should consider the opinion of the dying person and help him to easily leave, either through the use of painkillers, or through euthanasia.

With the approach of death, the patient often spends time in a dream, he is apathetic, and interest in the world around him disappears. The activity of all physiological systems gradually decreases, irreversible changes develop. A person loses energy, he feels tired. A dying person can sometimes feel non-existent things and sounds in reality. In order not to upset a person, this should not be denied. There may also be a loss of orientation, confusion is not ruled out.

Already in the last moments before death, it can be noted that the limbs of the dying person grow cold, as the blood flows to more important organs, which in the end still refuse to provide life support. A person loses his appetite, work is disrupted digestive tract he stops drinking. When weakening the sphincters, it is important to provide the patient with the necessary hygiene conditions using special absorbent underwear, disposable diapers or diapers.

With severe exhaustion, the patient may sink eyeballs, the man hardly opens his eyes. It happens that the eyes, on the contrary, are open, so they should be moistened special solutions, including saline. A weakened person may experience terminal tachypnea with wheezing. Most patients die quietly, they gradually lose consciousness and are in a coma.

In the last days before death, the patient should be left with only painkillers, antiemetics, diuretics, vitamins, antihypertensive drugs and other medicines that will no longer be tender can be canceled. If a person has a desire to talk with loved ones about the last moments of his life, it is better to satisfy his request calmly than to hush up such a topic.

The dying person wants to understand that he is not alone, that he will definitely be taken care of, that suffering will not touch him, since painkillers will be given in time. Relatives should provide comprehensive assistance to the dying. Before death, a person's facial features may be somewhat sharpened, including the nose. This can occur as a result of dehydration of the body.

Sometimes, before death, a person is given palliative care, which is aimed at anesthetizing a person if he has pain syndrome, such help helps to improve the last days of the patient, alleviate his suffering. A dying patient needs not only help and attention, but also complete care and normal living conditions. For him, psychological unloading is important, in addition, relief of experiences.

One of the signs of a person's near departure from life can be a cold and pointed nose. In the old days, there was a belief that death holds a person by the nose in his last days, which is why he sharpens. The ancestors believed that if a dying person turns away from the light and spends a lot of time facing the wall, he is already on the threshold of another world.

If suddenly he suddenly felt some relief and asked him to shift to his left side, then this indicates a sure sign of his imminent death. Such a person leaves the earthly world without torment, if the windows and the door in the room are opened in a timely manner. Relatives should be prepared for the death of the patient. It is impossible to predict with accuracy the moment of death of a person and how it will all happen. You need to be ready to help him in the last minutes, you may need to make an anesthetic drug.

Conclusion

The stages of dying are individual for everyone, as well as the process of the birth of life. You must always remember that it is the most difficult for a dying person, and not for his relatives, so you need to help the patient in every possible way, giving him attention and being close to him. Close people need to be patient and show increased concern for a relative, provide him with moral support and invaluable attention. Death is the inevitable outcome of human life cycle, and this moment is impossible not to cancel, not to change. Perhaps there are cycles of lives, but no one has yet proven this, there are only such assumptions.