Discussion About Death

Death is an inevitable and natural part of life. Yet, it is a topic that is often avoided and not openly discussed in society. Many people find it uncomfortable or even frightening to talk about death, but it is actually important to discuss this topic for several reasons. To create a good conversation about death, tact is required as well as finding natural ways to conduct the conversation.

Moving-In Conversation

The first conversation upon moving in is an excellent and important opportunity to lay the groundwork for the difficult conversations to come. Just the act of moving into a nursing home is a sign that the body's aging is beginning to intensify. For the individual and the relative, the move itself can be a dramatic change. It can be a starting point to begin the conversation about what is important for the individual and the relative. A way into this is the conversation about who should be contacted in case of deterioration. Here, the care also needs to know if it is okay to call during the night.

To be able to conduct difficult conversations in a good way, it is important to have a supportive relationship. In a nursing home, the doctor often has limited time to get to know all the residents. The nurse and other staff members therefore have a crucial role in contributing to a good conversational climate.

During the first conversation, relatives also have the opportunity to provide information about habits and needs, things that are valuable for the staff at the residence to know in order to provide continued good care and attention. Also, questions about when and how the relatives want to be contacted, for example during the night in case of deterioration, are important to bring up then.

Processing Our Fear of Death

Daring to talk about death can also help us process our fear of death. Many of us walk around with an underlying fear of the unknown and what happens after we leave this earthly life. Through conversation, we can alleviate fear and anxiety.

Conversations about death help us to prepare mentally and practically for death, our own or for someone we know. By having conversations about how we would like it when it comes to end-of-life care, funerals and what we want to happen with our property after our passing, we can ensure that our wishes are respected when the time comes.

Furthermore, it can help those who are left to mourn and cope with the loss of a loved one. By sharing memories of the deceased, we can help create a safe environment for mourners and give them the opportunity to process their grief together with others.

Appreciating the Remaining Life

Conversations about death also provide an opportunity to reflect on what is really important in life and what gives it meaning. It can be a reminder that our time on earth is limited and that we should focus on living fully and appreciating what really matters to us.

There may also be memories of events worth talking about to clarify questions, reconcile with the life that has been. Many have memories of events that are not so pleasant and that may be worth processing.

Finally, it is important to talk about death to promote a more conscious and prepared approach to life. By acknowledging and accepting that death is a natural part of the process, we can benefit from a deeper understanding of the course of life.

Breakpoint Conversations

Not daring to talk about an impending death can also mean that we deny the residents and their relatives the opportunity to make the most of the remaining time.

When a resident is in the final stage of life, they have the right to plan for the final time together with relatives and healthcare professionals – a so-called breakpoint conversation. But the formats and timing of such conversations often differ between different residences and hospitals. Then, the individual and relatives are given the opportunity to talk about and plan for the care during the last time. Good planning means that the dying person can die in peace with good symptom relief and without unnecessary hospital trips or other misguided medical interventions.

When relatives are not involved in the care, it is not certain that they have understood that the end of life is approaching. It is then easy for demands for life-prolonging measures to come, which are not really beneficial for the elderly. If there has been a dialogue in good time that swallowing difficulties are a common symptom for people who are at the end of a dementia course, it may be possible to avoid demands to insert a feeding tube to prolong life by a few weeks.

Conducting a Breakpoint Conversation

It is always difficult to predict how long someone has left to live. However, we know that many when they move into a nursing home have both great care needs and medical needs. Therefore, it is important to spend time on the first conversation.

Some tips for the conversation
- First of all, it is important to be prepared. Before you start the conversation, take time to reflect and prepare mentally. Think about what you want to say and what type of support can be most helpful for the person who is going to receive the information. Also be prepared to listen to the other person and be flexible in your communication.
- In order to facilitate the conversation, it is good to have more people in the room. Often it is the doctor who leads the conversation, but a nurse who knows the resident closer can help adapt the information to the resident and relative. A relative who can be there to support can be a great comfort. They can also help the resident ask questions, take notes and provide emotional support. Making relatives involved can also help facilitate care at the end of life.
- When the conversation itself begins, it is important to be clear and straightforward. Use simple and clear communication and avoid using medical jargon or other words that can be confusing. Make sure to be honest and open, but also be aware of the person's emotional state and adapt the information to that.
- Do not be afraid of silence. In these conversations, there may be moments of silence when words are not enough to express the feelings and thoughts that are present. It is important not to fill the silence with meaningless words or unwanted comments. Sometimes the best thing you can do is just hold each other and be there as a supportive presence.
- Give the person the opportunity to talk about their thoughts, feelings and fears. Try to be empathetic and really listen to what they have to say. You can also offer the opportunity to meet a psychologist or therapist who specializes in grief and loss, to get additional professional support.
- However, the communication should not stop at the first conversation. Continue to keep in touch and follow up regularly to see how the person is doing and how they are managing the situation. Offer your support and try to be present to the extent that the other person wishes and needs.

In conclusion, it is important to remember that conversations about an impending death are difficult and sensitive. Give yourself and the other person time and space to process and understand the situation. Be open to feelings and reactions, and be prepared that it can take time to accept and deal with everything that comes with it. With the right support and communication, these conversations can help create a sense of context and peace in the face of the impending death.

Time to Grieve

Many who live in nursing homes have lost their life partner and may have difficulty visiting the cemetery. Many nursing homes have a place where there is room for reflection and grief. Especially for those who may have difficulty visiting the cemetery.

Read more Dödsfall

Reflection questions - conversation about death
Care staff:
- What do you do to create a good relationship with the relatives?
- Is there a readiness for discussion about existential questions?
- Is there a place to reverently remember someone who has passed away?

Manager, Nurse, Occupational Therapist and Physiotherapist:
- Do you have good routines to talk about the end of life with the resident and their relatives?
- Is there a prepared care plan or can it occur that someone who is dying is sent to emergency care on dubious grounds?
- Do you have training for staff around "difficult conversations" and does the staff have access to supervision?
- Do you have a place at the residence that is suitable for reflection and grief?

Residents and Relatives
- Have staff at the nursing home talked about the end of life?
- Do you talk to each other about how you want things to be?

There is good material available to support breakpoint conversations in the palliative registry and there are good educational videos available online.

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day