3.2. Explain how an individual’s needs and priorities may change over time

This guide will help you answer 3.2. Explain how an individual’s needs and priorities may change over time.

End-of-life care focuses on meeting the physical, emotional, social, and spiritual needs of an individual as their condition progresses. Over time, as a person nears the end of their life, their needs and priorities can shift significantly. These changes could be gradual or sudden, and they can be influenced by various factors such as their medical condition, personal values, or family dynamics. Understanding these changes is essential to providing high-quality care that respects the individual’s dignity and choices.

Physical Needs

As the end of life approaches, physical needs often become more complex. These can include:

• Pain management: Controlling pain may become a priority if the individual develops conditions that cause chronic or severe pain. This could involve medication, physiotherapy, or alternative treatments like massage.
• Managing symptoms: Symptoms such as breathlessness, fatigue, appetite loss, nausea, and constipation may become more pronounced. Adjustments in care plans, medication, or diet might be required.
• Mobility support: Individuals may lose their ability to move around independently. They may need equipment like wheelchairs, hoists, or pressure-relieving mattresses.
• Personal care: Basic activities such as eating, bathing, and dressing may require assistance. Intimate care can also be distressing for some, so a respectful approach is important.
• Nutrition and hydration: Appetite might reduce significantly. Food and drink preferences or even methods of delivering nutrients, such as through a feeding tube, might have to be updated.

As a worker, being sensitive to these changes and discussing them openly with the individual and their family can create better outcomes for comfort and dignity.

Emotional Needs

Emotional needs can fluctuate greatly as someone nears the end of life. These shifts might reflect the person’s emotional wellbeing, coping mechanisms, or their understanding of the situation.

• Fear and anxiety: Worries about dying, the process of death, or leaving loved ones behind may intensify. These emotions might need counselling, reassurance, or even just a listening ear.
• Sadness or depression: People can feel a sense of loss for the life they are leaving behind. Depression may need specialist support, psychotherapy, or medication.
• Emotional resilience: In some cases, individuals may accept their situation and prioritise positive emotions. They may wish to reminisce or focus on meaningful activities.
• Privacy: Some people may prefer solitude as their condition progresses, while others might seek more companionship. Their need for privacy or connection can change over time.

It’s essential to approach emotional needs with empathy and encourage individuals to communicate what they want or how they feel.

Social Needs

Social needs usually centre around relationships and interactions with others. These priorities may evolve, especially as energy levels or the cognitive ability to engage decline.

• Family and friends: An individual’s priority may shift toward spending more time with their closest loved ones or reconciling unresolved relationships.
• Role in the community: Some may wish to remain active in their local groups, while others may withdraw as their health deteriorates.
• Decision-making: There might be a growing need to involve trusted people in making care or financial decisions on their behalf.
• Quality time: As physical abilities weaken, social engagement may take simpler forms, such as chatting, sitting together, or listening to music.

Respect the individual’s desires about whom they wish to see and support them in keeping meaningful connections.

Cultural and Spiritual Needs

Cultural beliefs and spiritual practices often become more significant closer to the end of life. These needs can change over time depending on a person’s outlook.

Examples of changes in these areas include:

• Spiritual comfort: People may wish to strengthen their connection to their beliefs, perhaps through prayer, blessings, or visits from religious leaders.
• Reflection: Individuals might spend more time thinking about their life, their legacy, or their belief about what happens after death.
• Rituals: Some may want specific cultural or religious rituals performed as they approach death or at the time they pass away.
• Environment: Preferences can emerge for the type of environment where they wish to spend their last days, such as a hospice, home, or hospital, depending on their sense of peace or familiarity.

Acknowledging and supporting these needs requires open communication and flexibility.

Cognitive Needs

An individual’s cognitive functionality may decline due to their illness or natural ageing, affecting their ability to communicate or make decisions.

• Advance planning: Early in their decline, individuals may focus on creating or updating legal documents, like wills or advance care plans (a document that outlines their preferences).
• Changes in understanding: As illnesses like dementia progress, cognitive impairments may affect memory, attention, or reasoning. They may need simpler explanations about their care or surroundings.
• Consistency: Familiarity and routines might become more important as cognitive ability reduces, as it can offer comfort and reduce confusion.

Paying attention to these cognitive changes helps maintain an individual’s dignity and autonomy where possible.

Practical Needs

Practical considerations often increase as someone’s condition changes. These needs may grow more immediate or urgent as the end of life nears.

Examples include:

• Legal matters: Handling documents like wills, powers of attorney (giving someone legal authority to make decisions on their behalf), or funeral arrangements may be a priority during earlier stages.
• Financial concerns: They may focus on ensuring loved ones are taken care of after their death. Budgeting for care needs, both medical and personal, should also be addressed.
• Personal arrangements: They might want to organise belongings, final messages, or gifts for family members.

These practical matters can bring a sense of relief and closure if handled in a timely manner.

Priorities Around Autonomy and Control

As the condition advances, people may have conflicting priorities around independence. Early on, they might try to maintain their independence for as long as possible. Later, they may accept more support but want full control of key decisions, such as when to stop certain treatments or where they want to pass away. These shifts need to be respected and incorporated into care planning.

Final Thoughts

Communication is essential to understanding how priorities change. Regular reviews of care plans and open discussions with the individual, family, and professional carers can help navigate these changes effectively. Tools like advance care planning documents can also guide choices when the person cannot communicate their wishes.

The evolving needs of someone nearing the end of life demand a holistic, person-centred approach. By observing, listening, and adapting care strategies as priorities shift, you can provide appropriate and compassionate support. Each change reflects the individual’s journey, and honouring these changes respects their dignity, values, and quality of life up to their final moments.