Emotional Care

People who are at the end of life are adjusting to physical limitations, discomfort, loss of independence, and ultimately, the knowledge that they will die. It is common for people at the end of life to experience a range of emotional reactions including anxiety, fear, sadness, anger, guilt, and hopelessness. Sometimes they will lash out in anger towards those around them or act in ways that are out of character. Sometimes people will withdraw and not want to talk at all. It can be for many different reasons. It could be related to their symptoms, to a fear of death or worry about what will happen to their loved ones once they die.

It is difficult to know how to respond to these expressions of emotion but you are not expected to have all the answers. Try to gently encourage the person to talk about how they are feeling. This may be with yourself, other family or friends or a health care professional. Reassure them that you are there for them and that their feelings matter, and suggest that they also talk to their doctor about their feelings if you are concerned.

It can be helpful to:

• Provide them with some time alone each day, if desired
• Ask if there is anything you can do to help
• Suggest some enjoyable things to do together
• Remember that it is normal to feel down or worried sometimes
• Encourage their involvement in day to day activities and social visits

It can also be useful to remember to use good communications skills when responding to emotions:

• Recognise and name the feeling (“You seem angry with me”)
• Ask them to talk about their feeling (“Can you tell me more about why you feel angry”)
• Listen to what they are saying. The less you talk, the more space there is for them to express themselves
• Allow silences. Sometimes people need silences to reflect
• Gently encourage them to continue (“Go on”, “Tell me more about that”)
• Acknowledge what they have told you and thank them for sharing
• Respond with any ideas to improve the situation (“I will try and remember not to talk to you in such a way. Perhaps you can help remind me when I do that.”)

In some instances patients become depressed or anxious. This means that they are having intense feelings for longer periods of time. If you are concerned about the person you are caring for, talk to a health professional. Further useful information on depression and anxiety can be found on the beyondblue website

Emotional care in the last few days

It is quite normal for people in the last days of life to withdraw and stop talking. This is part of the normal dying process. It can be helpful to reduce visitors at this time, keep visits short, and explain to visitors that the person may not wish to talk.