Mouth care at end of life

When a person is dying, in their last hours or days of life, they are often require less food and fluids and people are often unconscious and mouth breathing. Less saliva is produced, and the mouth can become dry (xerostomia) and uncomfortable. Common medications such as opioids, diuretics, anticholinergics can increase dryness and other medications such as steroids and antibiotics increase the risk of oral thrush (candidiasis). 

Mouth care which cleans and cleanses the mouth is therefore a priority in end-of-life care, to help keep the mouth moist, hydrated and comfortable. This also supports the person to be able to eat, drink, swallow and communicate and to reduce mouth pain and soreness. The Mouth Care Matters in end-of-life care steering group, representing the four countries and from a range of professional backgrounds and clinical settings, created a downloadable clinical professional resource published by the RCN (2021). This includes information on the fundamental principles of mouth care, mouth care assessment, care planning, products, risks and alerts, see: Mouth Care Matters in End-of-Life Care.

Those people close to the dying person, their significant others, family and friends are often concerned with their loved one's mouths. Halitosis may not be distressing for the person but may cause embarrassment or concern and can be a barrier to being able to get close to their loved one. Regular effective mouth care can support this. 

Some family members may also want to be involved in providing personal care for their loved one and mouth care can be a part of this. There can be a reluctance to provide mouth care on another person, and this may be due to a fear of not knowing how to do mouth care, or a worry they do it wrong and cause pain or discomfort. They may also not know what tools to use or feel it is not a priority.

The Mouth Care Matters in end-of-life care steering group, created a freely available downloadable resource, published by the RCN (2023) for people at end of life, their families, relatives and those important to them. This helps them to understand why mouth care is important at end of life, products used to assist mouth care, how to prepare and provide mouth care and the importance of ‘taste for pleasure’. There is also a mouth care poster at the back of the publication which can be used as a guide by anyone, see: Mouth Care During End of Life Care.

Taste for Pleasure (2019) was created by Jules Lock, an end of life care lead volunteer with the Shrewsbury and Telford hospital NHS Trust. Jules sat with a patient for a week who was at the end of their life and from this experience the team worked to change the culture for people in the last hours or days of their life, being nil by mouth to introducing ‘taste for pleasure’. Those people receiving this end of life care could use their preferred tastes and flavours to provide mouth care or moisture into their mouth. Introducing ‘taste for pleasure’ opens up conversations with the person and their loved ones, about preferred drinks and tastes and can lead to other important conversations. It also helps to support personalised, individualised care.

Michelle Pearson, a dementia palliative care assistant, describes 'taste for pleasure':

“I supported a gentleman living with dementia who never tolerated mouth care. After a conversation about his life, I was told this gentleman loved Champagne. It was worth a try. it worked - he had the poshest mouth care in Derbyshire.”