Death Rattle Distress, Drug Treatment (Research, Video .43)

The gurgling death rattle sounds of dying patients attracts a lot of attention. Onlookers who witness it often agonize over the noisy breathing of loved ones during their final phase of life. Many have expressed an interest in the death rattle to me. This is how Wikipedia defines it:

“A death rattle is the sound produced by someone who is near death when saliva accumulates in the throat. Those who are dying may lose their ability to swallow, resulting in such an accumulation. Usually, two or three days earlier the symptoms of death can be observed as saliva accumulates in the throat, making it very difficult to take even a spoonful of water. Related symptoms can include shortness of breath and rapid chest movement.”

By the time dying people begin the death rattle experience, their consciousness is low. Although it may appear that they are actively choking, there seems to be a general assumption that these patients are not in any pain.

Drug Treatment Research Concerns:

Patients experiencing the death rattle are often treated with drugs. Some say the drugs are given to the patients more to relieve loved ones witnessing the experience which they may perceive as very distressful for themselves and patients. Unfortunately, some of the drugs involved have negative side effects. Lately, research questions the purpose of using drugs at all for death rattles and encourages more reassuring education for loved ones about the experience so they won’t be so worried.

This video features death rattle sounds from the mouth of a dying patient.

Visit here to read 2015 research on the death rattle.

Visit here to read over 40 comments from readers about the death rattle.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Hospice and Nursing Homes Blog

End-of-Life Racial Disparities in Nursing Homes: Hospice, Hospitalization, Advance Directives (Research, Video 3:00)

Healthcare disparities refer to inequalities that exist in the quality of healthcare among groups such as racial and ethnic populations. Causes for the inequalities may be access to good health care, community obstacles, and personal behaviors.  In America, racial-ethnic disparities have continued to persist, even when income, health insurance, and access to care are the same among various racial-ethnic groups. This post focuses on research on end-of-life racial disparities in nursing home residents who are deceased.

Nursing homes certified for Medicare or Medicaid reimbursement were included in this study. Assessed were advance directive measures, hospice use, and hospitalization with these results:

1)   Across different types of advance directives, black, Hispanic, and Asian nursing home residents were significantly less likely to have these documented in their files.

2)   Compared with white residents, Asian residents were also significantly less likely to receive hospice services during their last year of life, whereas Hispanic residents were more likely to receive services.

3)   Finally, all racial-ethnic groups were more likely to experience hospitalization within 90 days before death, regardless of whether they had documentation of a do-not-hospitalize order.

These results indicate a great need for more education of healthcare workers and community members as well as more monitoring and accountability to eliminate disparities.

You can read more about cradle-to-grave African American healthcare disparities here: https://www.linkedin.com/pulse/african-american-pain-treatment-disparities-emergency-parker?trk=mp-author-card

An explanation of racial inequalities in healthcare is featured in this video:

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at booksellers such as Amazon and Barnes and Noble.

Hospice and Nursing Homes Blog

Prison Inmate Hospice Volunteers: Can They Change? (Video 2:55)

Thousands in need of end-of-life caregiving die in prison every year. Some people ask, “So what? Did these prisoners treat their victims with dignity? Why be concerned about their death journeys?” One response is that society should be held to a higher standard of treating prisoners better than they treated victims. At several prisons, inmate hospice volunteers serve as caregivers for terminally ill inmates. There are those who say this is the ultimate test for inmates to prove whether they have changed or not.

Serving Life, a film that premiered on the Oprah Winfrey Network (OWN), documents a hospice program inside the Louisiana State Penitentiary, a maximum-security prison at Angola. Award-winning actor Forest Whitaker narrates and produces this film. Hospice volunteer inmates viewed as hardened criminals care for dying fellow inmates at this prison where inmates have average sentences of more than 90 years. Can these inmates find redemption through caregiving involvement with hospice care?

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at booksellers such as Amazon and Barnes and Noble .

Hospice and Nursing Homes Blog

More Healthcare Humor Needed (Nurse-Patient Research)

This cartoon is an example of a humorous exchange between a patient and a healthcare worker. Whether the patient was pretending to be serious or really was serious, the idea of breakfast with a cocktail and dessert is just funny for many people. While funny stories are not uncommon in the healthcare field, healthcare workers would probably have many more humorous stories to tell if they initiated more humor themselves. 

Research on healthcare humor reports that humorous exchanges with patients are important and should be encouraged. With four patient focus groups participating in interviews, Lancaster University UK researchers explored patients’ perspectives on humor. Conclusions indicated that there is a gap between what patients want in healthcare humor and what they receive. Why is this? Initiating humor involves a risk factor that many healthcare workers may be reluctant to take.

Here are three healthcare jokes for starters:

Patient: "Nurse, I just swallowed my pillow!" 


Nurse: "How do you feel?" 


Patient: "A little down in the mouth"


Nurse in Kentucky to Patient: “How did you like your breakfast this morning?’

Patient: “I really enjoyed it, except for the Kentucky jelly. I‘m not used to the taste.”

Nurse: That’s interesting. Let me see it.

Patient: The man showed her a foil packet labeled “KY Jelly.”

A man walks into a doctor's office. He has a cucumber up his nose, a carrot in his left ear, and a banana in his right ear.
"What's the matter with me?" he asks the doctor. The doctor replies, "You're not eating properly."

Do you know any jokes or stories about healthcare workers and patients that you can share? (Surely, you can do better! lol)

You can read funny hospice caregiving stories here.      

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at booksellers such as Amazon and Barnes and Noble .

Hospice and Nursing Homes Blog

Older Adult Obesity: Marriage, Gender, Diabetes (Research, Video 2:28)

Question: If marriage promotes health and increases longevity, are fewer married older adults obese?

Not according to this research on older adult marriage, gender, and obesity. Using the Health and Retirement Study (HRS) including men and women aged 51-70, marriage is associated with weight gain. Leaving a marriage is associated with weight loss.

What other theories about older adult obesity should be considered?

1)    Shared risk factors, such as social obligations regarding meals, increases weight for married couples, but does not last for marriage duration.

2)    Marital transitions, not marital status, determine differences in body fat. Short-term effects are seen for divorce, but not for the persistent weight gains associated with marriage or the persistent weight loss following widowhood.

Question: Based on marriage and gender, who are the heaviest older adults?

3)    Prominent gender differences in late middle age reveal the heaviest group is unmarried women and the lightest is unmarried men.

4)    Pressures of the marriage market in combination with gendered preferences regarding partner body fat may account for differences found in this data.

Obesity is related to many health problems that reduce the quality of life for older adults. Type 2 diabetes, the most common form, is more prevalent as people grow older and gain more weight.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Hospice and Nursing Homes Blog