Hospice And Palliative Care - Physical Ailments

Hospice and palliative care: treating physical ailments

Physical complaints are treated holistically in palliative medicine. In addition to physical causes, psychological, social and spiritual factors also influence their development and course. Physical symptoms such as pain, shortness of breath, nausea and vomiting, constipation and diarrhea can be relieved satisfactorily in most cases. The emergence of physical complaints or their deterioration are treated as precautionary as possible.

During the treatment, it is precisely discussed or assessed how high the individual benefit of the therapy is for the patient. The focus is always on the patient's desired quality of life.

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• How is pain treated?
• Eating and drinking: How can complaints be treated?
• How can nausea and vomiting be treated?
• How can constipation and diarrhea be treated?
• How can breathlessness be treated?
• Rattle breathing: what is it?
• Whom can I ask?
• How are the costs going to be covered?

How is pain treated?

Pain is perceived very differently from person to person. To determine the pain intensity (pain intensity), the patient can indicate the severity of the pain on a scale (eg from zero to ten) (no pain to unbearable pain). This form of pain measurement is especially important when starting or changing therapy to check the effectiveness of pain therapy. If a patient can no longer communicate adequately, the pain level is assessed by medical staff and relatives or relatives (e.g. friends).

As far as possible, the cause of the pain and the pain itself are treated.

Examples of treatment of the causes are radiation therapy for bone metastases, optimal wound care or the administration of glucocorticoids for brain tumors.

Pain is treated with analgesics (painkillers) according to the WHO level scheme:

1. Level: non-opiate (opioid) analgesics
2. Level: low potency (weak) opiates (opioids)
3. Level: highly potent (strong) opiates (opioids)

As a rule, first-stage drugs are prescribed first. In the event of a loss of effectiveness, drugs of the second or third stage are chosen. If the pain persists, therapy can be started with a low or high potency opioid from the start. In addition, co-analgesics (accompanying medication) can be prescribed depending on the cause of the pain.

Note If opiates (opioids) are used correctly in palliative medicine pain therapy, the development of addiction is usually not a problem.

Tablets, capsules, syringes, infusions, plasters and drugs that are absorbed through the mucous membrane can be used to treat pain. The treatment takes place with a basic pain therapy. Retarded pain medication (drugs with a twelve-hour effect) are taken or administered regularly. Acute worsening of pain (breakthrough pain) can also be treated with reliever medication. In special cases, epidural or spinal anesthesia can be performed.

Antidepressants and certain anticonvulsants (e.g., carbamazepine) may be prescribed as supportive therapy. These drugs also act as pain relievers by changing the way the brain processes pain.

Muscle relaxants (muscle relaxants) can be used for pain caused by increased muscle tension.

Further information on the subject can be found here.

Note Pain does not have to be endured and should be treated as early as possible in order to improve the quality of life. However, it is not always possible to completely suppress pain. However, they can usually be reduced to a level that is tolerable for the patient.

Eating and drinking: How can complaints be treated?

When feeding incurably ill people, the focus should be on enjoyment. Frequent small meals are usually better tolerated. Loss of appetite can be treated with medication if necessary.

Note Individual dietary suggestions can be developed as part of a nutritional consultation.

If necessary, energy-rich food supplements can be used. Nutrition can also take place via a nasogastric tube, for example in the case of swallowing disorders or constrictions in the esophagus. If insertion through the mouth and esophagus is not possible or if feeding via a gastric tube is necessary for a longer period of time, a PEG tube can be inserted. A connection between the abdominal wall and stomach is established as part of an endoscopic procedure. A sealable gastric tube is inserted through this connection. This allows food to be delivered directly into the stomach. It is always essential to obtain comprehensive information from the patient and his / her consent.

In some cases, however, food can no longer be adequately absorbed through the intestines. Parenteral nutrition is then possible.

The fluid intake or administration is individually adapted. A lack of fluids can lead to stressful conditions (for example delirium), which can be improved by hydration.

Especially in the dying phase, the administration of food or fluids should not be imposed and parenteral nutrition should be stopped. It is usually rather stressful for the dying person. There is usually no unpleasant feeling of hunger. If there is a feeling of thirst, regular oral hygiene can often be better relieved in the dying phase than through hydration.

How nutrition should be designed in the last phase of life, when it is no longer possible to eat independently, should best be decided by the patient himself / herself. Requests in this regard can be communicated to medical staff by means of a living will if the patient is no longer able to communicate adequately. If no living will has been drawn up, a person with a power of attorney or an adult representative decides after medical advice.

How can nausea and vomiting be treated?

Nausea and vomiting are common and very stressful symptoms in terminally ill people. They can have a variety of causes, such as:

• Reluctance to eat certain foods or smells,
• Diseases of the gastrointestinal tract,
• increased intracranial pressure,
• Radiotherapy,
• Medicines - for example chemotherapy drugs or opiates (opioids) or
• Fear.

Therefore, depending on the cause, they are treated in different ways (medicinal, surgical or complementary medicine).

How can constipation and diarrhea be treated?

Defecation problems are also common. The causes for this are manifold. You can prevent these complaints by adjusting your food and fluid intake and - if possible - through exercise. Abdominal massages can also help with constipation. In addition to the causal treatment, drugs that regulate bowel movements are available for therapy.

Note Opiates (opioids) very often lead to constipation. Medicines against constipation are therefore used as a precaution in therapies with these drugs.

How can breathlessness be treated?

There are many causes of shortness of breath - e.g. lack of oxygen, anxiety or pulmonary edema, which are treated very differently. Oxygen should only be administered if there is evidence of a lack of oxygen, as oxygen therapy leads to the dehydration of the oral mucosa.

Opiates (e.g. morphine) counteract shortness of breath and do not have a negative effect on breathing when dosed correctly.

Shortness of breath is a very distressing symptom and causes anxiety. Fear, in turn, leads to a feeling of shortness of breath. An anxiety-relieving drug (benzodiazepine) can be administered to break the cycle between anxiety and shortness of breath. In clinical practice, these drugs are considered to be very effective and are often given in the event of shortness of breath. Large comparative studies compared the effects of benzodiazepines and placebos (dummy drugs) against dyspnoea. Thereby no superior effect of benzodiazepines could be proven.

Fresh air by opening the windows and hand fans are simple practical aids in case of shortness of breath.

Breathing training and calming techniques can prevent or alleviate shortness of breath. In addition, using a rollator when walking can often reduce shortness of breath. The presence of familiar people and physical proximity (e.g., caressing) can also alleviate the symptoms of shortness of breath.

Rattle breathing: what is it?

In the process of dying, the muscles of the throat loosen up. The ability to cough and swallow decreases. As a result, saliva can no longer be coughed up or swallowed and remains in the airways. As a result, there may be a rattling noise. Most patients are unconscious during this period.

Note As a rule, rattle breathing is not considered to be stressful for the person affected. However, it often triggers fear and discomfort in loved ones.

Rattle breathing can be reduced by administering little or no fluid in this phase. In addition, rattle breathing is often treated by changing position and using medication to inhibit saliva formation (anticholinergics). The positive effects of anticholinergics on rattle breathing have been reported in practice, but they have not been proven in studies. Sucking off fluids through the mouth is more likely to be avoided in the dying. This measure puts an enormous strain on the patient, usually only reduces the rattle for a few minutes and increases the production of fluid in the mucous membrane of the mouth and throat.

Whom can I ask?

Doctors with a diploma in palliative medicine or a master of palliative care are specially trained to treat people with serious, incurable diseases. Other treating physicians (e.g. family doctor, specialists from all specialties) may also be able to provide information on palliative treatment options or initiate palliative treatment.

Further information is available, for example, on the websites of the Austrian Palliative Society (OPG), the Austrian Cancer Aid or the umbrella organization Hospiz Österreich (DVHÖ).

How are the costs going to be covered?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. Your doctor will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution) (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see Costs and Deductibles.

For certain examinations, approval from the health insurance provider responsible (medical service - "chief physician") may be required, as well as for certain medicinal or non-medicinal treatments (e.g. physical therapy). For certain services (e.g. stay in a palliative care unit, aids and medical aids) - depending on the health insurance provider - patient co-payments are provided.

Most health insurance providers provide for a permit, sometimes depending on the type of medical aid. The prescription fee has to be paid for medication on a “prescription”.

For information on the respective provisions, please contact your health insurance provider, which you can find on the website of your social insurance company, for example.