Hospice Care was intended to be and should be a holistic approach to the care of the dying patient. The program was intended to approach all facets of the individual, mind, body, and soul. A good hospice team takes the time to learn and identify problems with the idea that a single problem can affect the outcome that the end-of-life patient experiences. Recently, during a caregiver support group, we discussed triggers. How a smell, noise, or song can trigger a good emotion, and in the same respect, they can also trigger a bad emotion. When we evoke a bad memory, it can cause us to look back on the memory and sometimes relive the scenario. This got me thinking about our patients and if we are evoking comforting, sweet memories that help the patient relax or are we inadvertently causing a discomfort by triggering a bad memory.
Some people may view the bad triggers as a form of post-traumatic stress disorder and it certainly can, but everyone has triggers that take them back. Identifying what makes the patient feel good and provides a pathway to that memory, can often help in a way that narcotics and anti-anxiety medications cannot. There is a video of prima-ballerina Marta Gonzalez, who was suffering from Alzheimer’s and when listening to Swan Lake, she began to relive the dance, her arms and upper body flowing as it had once done on stage. It’s a beautiful reminder of what the mind can remember with just sound.
Think about your own triggers. My maiden name is Beegle, pronounced like the dog. As a child, bullies would whistle at my sister and me, or we were referred to as “the Beegle pups.” To this day, I cringe when someone whistles at me. This was a source of contention for me and my husband as he was raised with his mother whistling for the kids when it was time to come in from play. You see, good triggers for one person may be a bad trigger for someone else. Therefore, it is so important to know what the patient’s triggers are, both good and bad. We can then find conscientious ways to evoke the good memories for a patient and be vigilant to the bad. In doing so, we are creating an environment where the patient is given a focus of comfort that is designed specifically for them.
How do we learn what our loved one’s triggers are?
With new dementia patients, the Alzheimer’s Association recommends building a memory book. I recommend doing this for all patients in end-of-life. It is a wonderful thing to look back on, and it helps to draw out questions that help in reminiscing. See attached link https://montessoridementia.org/file/memory-book-template
I also like ask “What is your favorite smell? Why?” and then try to create that. I had a patient that loved the smell of cooking in her home. She really didn’t care what it was but loved to know that something was going on in the kitchen. Her daughters didn’t worry about the food waste (they froze a lot) but instead kept the crockpot full of their mom’s favorites. She truly enjoyed this.
Another patient loved Elvis. All Elvis, all the time. Her children placed an “Alexa” home streaming device in her living room. She would state, “Alexa, play Elvis.” And her home would fill with the sounds of Elvis Presley. Often, even during the most painful of things, she and I would sing along. That is comfort.
In the hospice world, we focus a lot on medications, and that is okay. But if we can create an environment that is literally built for the comfort of the patient, we improve the day and set it up for success. At Generations Hospice Care we have initiated a “dessert first” form in our admission pack. We ask about favorites such as favorite foods and things to do, and we try to communicate that to our team.
I hope this helps those who struggle to find a way to promote comfort in their lives and those they love. It does not have to be a situation of end-of-life. There are only benefits by knowing what triggers emotion in our lives.
If you or anyone you love has questions about end-of-life care or just needs resources, please feel free to reach out to us at Generations Hospice Care.