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Dying back phenomenon — Clinical Guidelines

Overview

The dying back phenomenon refers to the progressive decline in physiological functions and increasing prevalence of distressing symptoms as patients approach death, particularly notable in oral symptoms such as xerostomia, dysphagia, and mastication problems in palliative care settings 1.

Diagnosis

Prevalence of Oral Symptoms: Increased frequency of oral symptoms, especially xerostomia, dysphagia, and mastication problems, observed as patients near death 1.

Assessment Tools: Use of RAI-NH and RAI-PC for evaluating mouth care, nutrition, and bedsores; MOBID-2 for pain intensity assessment 1.

Management

Oral Care: Frequent mouth care recommended, though adherence is often low (only 16% received care every hour) 1.

Pain Management: Address pain during mouth care procedures, noting that only 12% experienced pain during these interventions 1.

Supportive Care: Focus on holistic support, including psychological and spiritual care, though specific interventions are not detailed in the abstracts 2 4.

Special Populations

Elderly: Significant focus on elderly patients in nursing homes, highlighting the need for specialized palliative care approaches 1.

Cultural Sensitivity: Consider cultural scripts and beliefs influencing perceptions of death and dying, particularly relevant in diverse patient populations 5 8.

Key Recommendations

Regular Oral Assessment and Care: Implement frequent oral assessments and care to manage symptoms like xerostomia and dysphagia as patients approach death (Evidence: Moderate 1).

Pain Management During Procedures: Ensure pain management strategies are in place, especially during distressing procedures like mouth care (Evidence: Moderate 1).

Cultural Competency Training: Provide cultural competency training for healthcare providers to better understand and address diverse cultural perspectives on death and dying (Evidence: Expert opinion 5 8).

References

1 Sandvik RKNM, Husebo BS, Selbaek G, Strand G, Patrascu M, Mustafa M et al.. Oral symptoms in dying nursing home patients. Results from the prospective REDIC study. BMC oral health 2024. link 2 Nagdee N, Manuel de Andrade V. 'I don't really know where I stand because I don't know if I took something away from her': Moral injury in South African speech-language therapists and audiologists due to patient death and dying. International journal of language & communication disorders 2023. link 3 Bolkan C, Srinivasan E, Dewar AR, Schubel S. Learning through loss: implementing lossography narratives in death education. Gerontology & geriatrics education 2015. link 4 Schou K, Alvsvåg H, Blåka G, Gjengedal E. The (dis)appearance of the dying patient in generalist hospital and care home nurses' talk about the patient. Nursing philosophy : an international journal for healthcare professionals 2008. link 5 Long SO. Cultural scripts for a good death in Japan and the United States: similarities and differences. Social science & medicine (1982) 2004. link 6 Spall B, Read S, Chantry D. Metaphor: exploring its origins and therapeutic use in death, dying and bereavement. International journal of palliative nursing 2001. link 7 Newsome BR, Dickinson GE. Death experiences and hospice: perceptions of college students. Death studies 2000. link 8 Hallenbeck J, Goldstein MK, Mebane EW. Cultural considerations of death and dying in the United States. Clinics in geriatric medicine 1996. link

Dying back phenomenon