Individuals in the process of dying undergo many changes physically, mentally and spiritually. Often they become drawn inward, sleeping more and showing disinterest in food, guests and other activities. The body weakens, and the mind may become agitated and confused. Fear and sadness may arise, as well as feelings of not wanting to be a burden. The patient may wish to talk about the past and review her/his life. Elizabeth KublerRoss, pioneer in the field of neardeath studies, identified five stages of grieving for the imminent loss of one’s life: denial, anger, bargaining, depression and acceptance,11 The process of death has been studied forthousands of years, and is described in ancient texts in similar terms as today:
In my experience, hospice is all about being present with what is. The practice of being unconditionally present and just listening, without having one’s own agenda, can be incredibly profound. Caring for the dying can be a deep spiritual calling where one is open to whatever comes up, and willing to give whatever is needed. In the words of spiritual teacher Ram Dass:
Hospice creates an attitude of service to the body, mind and spirit of the patient. Hospice has really made a difference in the lives and deaths of those it has touched, and by adding complementary Ayurvedic practices, opportunities are created to deepen compassion, mindfulness and integration.
1967: Saunders opens the first modern dedicated hospice facility in the UK.
- 11 Kubler-Ross, Elizabeth. On Death and Dying. Scribner: New York, 1969.
- 12 Caraka Samhita. Vol 2. Chapter 5. v. 90-91.
- 13 Dass, Ram. Still Here: Embracing Aging, Changing and Dying. Berkeley Publishing Group: New York, 2000. p. 178.
- 14 timeline information courtesy of National Hospice and Palliative Care Organization, Alexandria, VA.
1969: Elizabeth KublerRoss publishes On Death and Dying, a controversial book which sparks widespread public conversation on death and dying care in the US.
1974: Florence Wald of Yale University opens first hospice care facility in the US.
1982: Medicare begins to cover hospice benefits.
1984: Standardized hospice accreditation is initiated through the Joint Commission on Accreditation of Healthcare Organizations.
1986: Medicare hospice benefits are expanded and made permanent by US Congress.
2002: Department of Veterans Affairs launches program expanding hospice services to veterans and also providing continuing education in hospice and palliative care to clinicians.
2006: American Board of Medical Specialties recognizes hospice and palliative medicine as a medical specialty.
In recent years, research and policy work has been done in areas of hospice for HIV/AIDS patients in subSaharan Africa, pediatric hospice, expansion of hospice services for veterans and provision of hospice to individuals who are incarcerated.
Aromatherapy is the use of the sense of smell for healing. High quality essential oils distilled from plant sources can affect moods, balance the nervous system, and help calm and refresh the body and mind. Aromatherapy works powerfully on the mind, and helps create sattva, allowing for greater peace and serenity in the final stages of life.15 The sense of smell is perceived through the evolutionarily oldest part of the brain, the limbic system, which responds to stimuli instantly, without thought.16 Scents have the ability to penetrate deeply into the brain, and chemically alter the functioning of the nervous and endocrine systems. Studies have found that aromatherapy massage decreases anxiety, promotes relaxation, and stimulates autonomic nervous system function, especially in instances of palliative care.17
The application of aromatherapy in a hospice care setting can take many forms, all of which are userfriendly. Essential oils can be purchased in health food stores or online, and many of the oils suggested here are inexpensive. It is important that essential oils are pure and of good quality. “Fragrance oils” aren’t true essential oils be aware of synthetic and adulterated oils used in the cosmetic and food industry. They do not have the therapeutic value of natural oils.18 Essential oils can be added to a tub of warm water for a foot or hand soak, added to a massage oil, or dripped into a spray bottle full of water. Bear in mind that essential oils should generally not be placed directly on the skin. One drop of an oil can be placed on a cotton ball to scent a room. A spray bottle of rose water hydrosol can be used instead of rose essential oil, which is more cost effective.19
- 15 Sushruta Samhita. Section 8, verse 10.
- 16 Wall, Carly. Setting the Mood With: Aromatherapy. Sterling Publishing Company: New York, 1998. p. 12.
- 17 American Journal of Hospice and Palliative Care. “The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours.” Downey et al. Aug/Sep 2009.
Excellent oils for reducing anxiety, stress and worry are lavender, chamomile, clary sage, lemon balm, rose geranium, rosemary and sandalwood. Lavender creates a calm and positive attitude and stimulates brain secretions of serotonin, as well as calming and soothing the nervous system.20 21 Lemon balm, also known as melissa, is an excellent restorative of the nervous system.22 Rosemary is known to ease emotional tension.23 Sandalwood is known to relieve irritability that stems from anxiety.24 Chamomile is a nervine sedative specific to anxiety and stress.25 Clary sage is useful in cases of despair stemming from anxiety and stress.26 Feel free to make your own oil blends and remember that one drop goes a long way; only a few drops are needed in a foot bath or 4 oz spray bottle.
Many oils are helpful in aiding relaxation and supporting restful sleep. This allows patients to respond to the stresses of living and dying from a more peaceful place. Oils specific to this purpose are lavender, chamomile, frankincense, jatamamsi, lily, nutmeg, rose and sandalwood. Lily soothes the nerves and relieves irritability.27 Many of the oils listed in for anxiety, stress and worry are also helpful with stress relief and relaxation.
Anger and resentment can arise at different stages of the dying process, especially in patients with high pitta. Resistance to the dying process, asking “why me?”, loss of control over the body and one’s life, and family related dramas that come up during difficult times can all cause pitta to rise. Spearmint, lemongrass, fir and cedar can all rebalance the body and cool hot feelings.28 Lavender, rose and sandalwood are excellent oils for relaxing and purifying a heated pitta mind. Rose increases love and compassion.29 Sandalwood deeply nourishes the heart.30 Jasmine is great for releasing anger, and purifying the mind and emotions.31 32 Lily calms the heart and soothes the nerves, reducing irritability and increasing faith and devotion.33
- 18 Wall, Carly. p. 16.
- 19 Edgar Cayce Rosewater is highly recommended and inexpensive. Reputable brands of essential are Floracopeia, Simplers, Mountain Rose, Young Living and Doterra.
- 20 Wall, Carly. Setting the Mood With: Aromatherapy.
- 21 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
- 22 Wall, Carly. Setting the Mood With: Aromatherapy.
- 23 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
- 24 Ibid.
- 25 Page, Linda. Healthy Healing. Quality Books Inc: 1985.
- 26 Young, Gary. Aromatherapy: The Essential Beginnings. Essential Press Publishing, Salt Lake City,1996.
- 27 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
- 28 Wall, Carly. Setting the Mood With: Aromatherapy.
- 29 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
- 30 Ibid.
Loss, sadness, depression and grief are often present in the dying process. Patients may have regrets from the past, sadness at not being able to accomplish things they want to, and grief at saying goodbye to loved ones. Gently uplifting oils can be beneficial in shifting the mind and increasing movement towards acceptance. Coriander, pine and helichrysum are great for softening the grief process.34 Rose is a wonderful soothing oil for the mind and an antidepressant, allowing for greater experience of love and increased self esteem.35 Rosemary, tulsi (holy basil), patchouli, cardamom and wintergreen also help alleviate depression.36 37 Citrus oils such as bergamot, lemon and orange are very uplifting.38 break through despondency.39 Cypress and eucalyptus can help break through despondency.39
Aromatherapy can bring about a sattvic state of consciousness, spiritualizing the death process and awakening higher awareness. Scent has the power to bring us back into alignment with our authentic self. Oils that have this property have been used in many of the world’s spiritual traditions. Frankincense creates a space of purity in which higher virtues can come forth.40 Sandalwood and rose are other herbs that possess this sacred quality. Essential oils can be selected for their therapeutic purposes and used not only in aromatherapy, but also in touch therapy or massage.
Massage and Gentle Touch
Massage has a long history as an integrative part of many healing traditions, including Ayurveda. Ayurvedic massage can feed the senses and nourish the body and mind through the application of therapeutic touch. It supports restful sleep and a calm, happy mind.41 A recent study of complementary practices in a hospice setting found that massage was not only beneficial to patient care, but reported by patients themselves as the most beneficial treatment they received. 42 Sharing massage with a patient or loved one can be a deep expression of love, care and compassion. Especially while caring for those in hospice, it is important to maintain a sattvic touch, which is light, mild, gentle, balancing, harmonizing, warm, pleasant, sweet and nourishing.43 When massage is done with love, care, gentleness and sensitivity, it will increase sattva in the patient. The massager must also have a sattvic quality in their attitude and manner of application.44 Healing benefits of massage and application of oils build up over time, and are also immediately beneficial to skin, muscles and the nervous system.45
- 31 Halpern, Dr. Marc. p. 324.
- 32 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
- 33 Ibid.
- 34 Worwood, Valerie Ann. The Complete Book of Essential Oils and Aromatherapy. New World Library: San Rafael, CA, 1991.
- 35 Wall, Carly. Setting the Mood With: Aromatherapy.
- 36 Halpern, Dr. Marc.. p. 324.
- 37 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
- 38 Page, Linda. Healthy Healing. Quality Books Inc: 1985.
- 39 Young, Gary. Aromatherapy: The Essential Beginnings.
- 40 Frawley, David. Ayurvedic Healing for Healthcare Professionals.
- 41 Lad, Vasant. Complete Book of Ayurvedic Home Remedies. Three Rivers Press: New York, 1998. p. 60.
- 42 American Journal of Hospice and Palliative Care. “Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.” Downey, et al. Aug 2009.
Massage is recommended for patients with high vata, pain and hypersensitivity, as well as any disturbance of the mind, emotions and nerves.46 Sesame oil and almond oil are recommended as they are softening to the tissues of the body. Mild and sweet essential oils such as sandalwood, rose and lavender can be added.47 Incorporating aromatherapy into massage helps the mind and body prepare for a deeper opening. Gentle massage of patients is recommended three times a week, or even daily. Frequency of this practice allows oils and herbs to penetrate deep into the skin, creating permanent changes.48
Techniques and supplies for this practice are very simple. Purchase cold pressed, organic sesame or almond oil at a health food store. Pour some oil into a bottle and store the rest in a cool, dark place. Add essential oils according to patient needs. Warm oil prior to application in a hot water bath in a sink or a pan. Test temperature on wrist before use. Pour oil in hand liberally, and use both hands to spread oil along body part. Use long strokes for long parts, such as arms, legs, and torso, and use circular strokes around joints. Rub the oil in and allow the body to soak it up. Maximum absorption is important and may take 20 minutes or more. Stress reducing or mindfulness practices such as meditation may be done while the oil is absorbing. After absorption, pat off excess with a cloth, and if necessary, some warm water. Removing oil with soap is not recommended.49
If massaging the whole body is not available, a simple foot and scalp massage will have many of the same therapeutic benefits, and will assist in relieving sleeplessness and fatigue.50 Head massage can relax the entire body by relaxing the nervous system and relieving mental strain and stress.51 and scalp.52 Brahmi oil, available online, is especially recommended for the soles of the feet and scalp. 52
Altars and Color Therapy
- 43 Frawley, David. p. 502.
- 44 Ibid.
- 45 Halpern, Dr. Marc. Principles of Ayurvedic Medicine. p. 167.
- 46 Sushruta Samhita. Section 5, verses 90-91
- 47 Frawley, David. p. 506
- 48 Ibid.
- 49 massage technique from Halpern, Dr. Marc. Principles of Ayurvedic Medicine. p. 168.
- 50 Johari, Harish. Ayurvedic Massage: Traditional Indian Techniques for Balancing Body and Mind. Healing Arts Press: Vermont, 1996. p. 4-5.
- 51 Charaka Samhita.Vol 1. Section 5, verse 81-83.
- 52 Lad, Vasant.p. 260.
The visual images that we take in through our sense of sight can bring pleasure or pain. The sense of sight can trigger memories, feelings and thoughts that are sattvic, rajasic or tamasic. The skillful use of color can add psychological harmony and peace of mind, and contribute positively to a patient’s emotional wellbeing during the dying process.53 This happens on a very subtle level and the psychological effects of color are not always consciously apparent to the viewer. Color is vibrational energy that enters the eye and goes directly to the brain and mind.54
Color therapy can be applied in many ways. Various methods include surrounding ourselves in therapeutic color choices through clothing, linens, window coverings, paint choices, colored light bulbs, flowers, candles, artwork and nature imagery. Soft lights can be used instead of fluorescent or neon, and full spectrum light bulbs can be used in winter.55 Choosing decor with awareness of the specific effects of different colors can calm the mind and increase sattva.
The color gold is especially powerful in harmonizing the mind, strengthening the heart, and supporting ojas and immune and endocrine system health.56 Gold also provides stability, relieves anxiety, uplifts the spirit, and supports greater awareness and transformation of consciousness.57 For these reasons, gold is highly beneficial in hospice care settings.
The colors white and blue can also be used therapeutically. White invokes purity, virtue and spirituality, and calms the heart, mind, nerves and emotions.58 It promotes meditation and spiritual awareness, and supports a state of mind that is expansive, flowing, clear and effortless. 59 Although these aspects are beneficial, white can increase vata and is not recommended in
excess. Blue spiritualizes anger, antidotes the critical mind and reduces attachment and pitta, however, blue is very cold, light and dry and in excess, can increase vata.60
Another way to experience color is through creating an altar. An altar creates a physical and tangible sacred space to facilitate mental and spiritual peace.61 Cocreating an altar with a patient allows for intimacy, connection, grounding and creativity. Any objects can be used that have meaning and provide inspiration.
Mantras, Music and Affirmations
- 53 Tirtha, Swami Sadashiva. Ayurvedic Encyclopedia: Natural Secrets to Healing, Prevention and Longevity. Ayurveda Holistic Center Press: New York, 1998. p. 319.
- 54 Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. Lotus Press: Wisconsin, 2011. p. 126.
- 55 Tirtha, Swami Sadashiva. p. 319.
- 56 Ibid. p. 320.
- 57 Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. p. 126.
- 58 Tirtha, Swami Sadashiva. p. 321.
- 59 Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. p. 126.
- 60 Ibid.
- 61 Simpson, Liz. The Book of Chakra Healing. Sterling Publishing Co: New York, 1999. p. 24.
The sense of hearing, like the sense of sight, can be used in ways that create harmony and peace, or in ways that agitate and disrupt the mind and body. Hearing is the first sense that develops in utero. The fetus reacts to its mother’s voice and external sounds as early as 4 ½ months.62 Hearing is the last sense to go as people transition into death. Even unresponsive patients can often hear what is said to them. Relaxing music, uplifting mantras such as ‘om,’ and affirmations are all sattvic tools that can be incorporated into patient care.
An affirmation is a positive, personally inspiring phrase that is a powerful tool to focus positive intention and counteract previous negative conditioning.63 Affirmations can be used to shift awareness and belief. They can be played in the background, repeated aloud by patient or caregiver, written and placed around the space, or repeatedly mentally. Patients and caregivers can develop their own affirmations, or use existing ones such as: May I be free from suffering, May I be at peace, May my heart flower.64 Other helpful affirmations are: I am at peace in this moment. I release control; I embrace the unknown.65 Repeating affirmations creates the openness in mind and heart to receive what is longed for. If possible, repeat affirmations, or have them playing in the background, throughout the day.
Mantras are sound forms that create a shift in consciousness. Like affirmations, they can be chanted aloud or internally, or listened to in music. To pacify vata, and create sattva, mantras need to be soft, warm, soothing, and calming.66 Patients should only chant out loud briefly, if at all, as this can deplete energy. The mantra ‘om’ (rhymes with ‘home’) balances mind, body and spirit, promotes awareness, harmonizes the nervous system and clears the energy.67 The mantra ‘lum’ (rhymes with ‘chewing gum’) can be used to stabilize, ground, calm, and bring joy, happiness and contentment, and is especially useful when vata is high.68 Mantras resonate with the chakras and help to spiritualize the awareness on a subtle level.
Music can support the dying process in ways ranging from stress relief, to bedside support, to grief recovery. Because music reaches a deep, nonrational part of the mind, it is ideally suited to shift feelings such as grief, fear, anxiety, sadness and anger that create rajas in the mind. Music can release blocked or painful feelings and can stimulate positive ones such as hope, love and gratitude. Sharing music together can lead to sharing of the emotions that the music brings up.69 70
- 62 Gass, Robert. Chanting: Discovering Spirit and Sound. Broadway Books: New York, 1999. p. 23
- 63 Simpson, Liz. p. 138.
- 64 Levine, Stephan. Healing Into Life and Death. Doubleday: New York, 1987. p. 23-24.
- 65 Ibid. p. 27.
- 66 Tirtha, Swami Sadashiva. p. 314.
- 67 Ibid. p. 312.
- 68 Ibid. p. 313.
- 69 Levine, Stephan.. p. 25.
- 70 http://www.growthhouse.org/music.html This website streams music that is intended to support the death process and patients in hospice and palliative care settings.
Sound is a nutrient for the spirit as well as for the body.71 When the moment of transition into death arises, chants can be used to say goodbye. Stephan Levine suggests: Go in beauty. Peace be with you. Til we meet again in the light.72 Another chant, made famous in Kundalini Yoga circles, that can be used comes from a popular song from the 1960s:
May the longtime sun shine upon you, May all love surround you,
And the pure light within you guide your way home.73
Meditation Practices for Hospice and Palliative Care
Meditation is a journey to the center of our own being.74 Meditation can be done anywhere, at any time, sitting, lying down, or walking.75 One can meditate with a mantra, a thought or feeling, by looking at nature, thinking about God, feeling pure love, or with any technique that doesn’t cause strain, anger or worry that one is not doing it properly.76 There are countless techniques for meditation, and they are all valid. The technique introduced here is simple to learn and to practice. Any other techniques can also be used. The most important aspects to practice are devotion and sincerity.77
Meditation is an art of bringing harmony to body, mind and consciousness.78 It has been shown to be clinically beneficial in healing body and mind.79 It gives us a respite from the pressures of life. As we relax, the heart beats more slowly and the blood pressure lowers. Meditation helps retrain response mechanisms so we don’t react as strongly or as negatively to adverse situations. It gives us the ability to be more centered, and more in control of our reactions.80 Meditation allows the mind to be healthy and sattvic, alert, positive and calm.81 When we meditate, we release rajasic mental states such as fear, worry and anger and replace them with positive attitudes.82 By practicing meditation as regularly as possible, we gradually gain control over the flow of our emotions and movement of our minds. This allows us to turn awareness inward.83
- 71 Levine, Stephan.. p. 25.
- 72 Ibid. p. 27.
- 73 lyrics written by Incredible String Band.
- 74 Novak, John. Ananda Course in Self-Realization: Part 1: Lessons in Meditation. Ananda Church: USA, 1997. p. 13.
- 75 Tirtha, Swami Sadashiva.. p. 595.
- 76 Ibid.
- 77 Ibid.
- 78 Lad, Vasant..p. 76.
- 79 International Journal of Palliative Nursing. “Mindfulness Based Cognitive Therapy.” Kabat-Zinn, Dr. Jon. June 2001.
- 80 Novak, John. p. 15.
- 81 Ibid.
- 82 Ibid. p. 16.
- 83 Ibid.
One advantage of the form of meditation outlined below as a treatment method is that it is very safe, has no side effects, and is easy to teach and share.84 This form of practice creates the ability to look within and contact the deeper aspects of consciousness. In So Hum meditation we sit quietly and watch our breath.85 Patients can be in supine position or seated. Keeping the spine straight is helpful. Patients can be supported with pillows to suit their comfort. Begin by allowing the mind to be present. Let go of stories in the mind and thoughts about what’s going on elsewhere. Relax and be comfortable. Take a few deep breaths in, if possible. Inhale and
exhale through the nose, if possible. As you inhale, mentally think ‘so’ (rhymes with ‘no’). As you exhale, mentally think ‘hum’ (rhymes with ‘chewing gum’). Continue this pattern of repeating ‘sohum’ with the breath. The syllable ‘so’ represents the life force entering the body through inhalation, and the syllable ‘hum’ represents the release of limitations through the exhalation.86 If the mind starts to wander, just bring it back to focus on the mantra and the breath.87 Breathe through whatever comes up. In this practice, for most people, the breath naturally deepens. You will very likely become distracted, just bring the mind back to focus on the breath and mantra, be gentle with yourself, and keep going. When beginning this practice, 23 minutes of practice is suggested. Practicing consistently brings benefit. After the practice is finished, allow a few moments to bring the mind back to normal awareness.88
Another practice that supports deep relaxation and spiritualizing one’s awareness is yoga nidra. Yoga nidra begins with the patient in a supine position, supported with pillows for comfort. This practice is guided by a soothing voice, and many good recordings are available.89 Yoga nidra takes the body through a total relaxation process, calms the mind and releases tension and stress. Yoga nidra brings the mind to focus on different parts of the body, feeling them distinctly, and then fully relaxing. It brings the mind to focus and creates intention. Although it is not intended to cause one to fall asleep, one will receive benefit even if one is asleep. If possible, keep the mind alert and focused. When practiced effectively, this technique is as restorative as sleep.90
Breathing Practices for Hospice and Palliative Care
The breath is the primordial life force governing mental and physical function. One’s breath is the essence of one’s life. The first breath is taken shortly after arriving in the world, even before the umbilical cord is cut. The breath continues, unbroken, until death. Breathing does not require conscious attention, but by choosing to bring awareness to the breath, one can influence the body and mind. Mindful breathing clears the mind, brings calm and allows individuals to connect their personal energy with the universal energy.91
- 84 Frawley, David. p. 517.
- 85 Lad, Vasant..p. 79.
- 86 Ibid.
- 87 Chopra, Deepak and David Simon. The Seven Spiritual Laws of Yoga: A Practical Guide to Healing Body, Mind, and Spirit. John Wiley & Sons, Inc: New Jersey, 2004. p. 90-91.
- 88 For different meditation techniques, consult the many books of Pema Chodron, as well as titles by Stephan Levine Who Dies? and Healing into Life and Death.
- 89 Yoga nidra recordings are widely available on CD, iTunes and YouTube. The recording of Dr. Marc Halpern guiding Yoga nidra is recommended.
- 90 Feuerstein, Georg and Larry Payne. Yoga for Dummies. IDG Books Worldwide, Inc: California, 1999. p. 61.
To practice mindful breathing, sit or lie in a comfortable position. Relax the shoulders. Breathe deeply and slowly, allowing the breath to come from the abdomen. Imagine that the belly is breathing, rather than the chest. If possible, have the entire breathing movement come from the diaphragm. After a few minutes, observe the effects of this practice on the body and mind.
Support for Caregivers
Caregivers for the dying often become distressed, depressed and drained of energy. They often become the second patient.93 In times of stress it is easy to focus one’s attention outward, and forget one’s own needs. There may seem to be no time for caregivers to focus on their own needs such as nourishing and healthy food, sleep, quiet time or meditation and time to unwind in nature or with loved ones. For those who devote their time to caring for the ill and dying, it is especially important to prioritize selfcare, ask for help and delegate responsibility to others.
Studies have shown that caregivers experience a rise in anxiety, depression and salivary cortisol, and that regular practice of yoga and meditation reduces all three of these symptoms.94 Caregivers can use all five of their senses to create harmony, peace and balance.95 The recommendations outlined in this paper can also apply to caregivers. Massage nourishes the sense of touch, aromatherapy can influence the mind through the sense of smell, relaxing music and healing mantras can serve as sound therapy and color therapy can be applied through flowers and pleasant visual impressions. Caregivers need to bring their attention to keeping ojas high, therefore, ojas building foods are recommended, such as nourishing soups, dates, almonds, and hearty grains such as basmati rice, quinoa and oatmeal with warming spices.
Helping others have a peaceful and dignified death, either as a professional or familial caregiver, is heartcentered work. Caregivers in hospice situations extend themselves above and beyond usual boundaries. Having a “good death” is important to people, and contributing to that end is a deep calling and not something that everyone is called to do.96 In order to be able to continue to give, one must avoid draining one’s self. Ayurveda has profound wisdom to offer in this capacity.
- 91 Chopra, Deepak and David Simon. p. 99-104
- 92 Ibid.
- 93 Berman, Claire. Caring for Yourself While Caring for Your Aging Parent: How to Help, How to Survive. Henry Holt: New York, 1996. p. 34.
- 94 Evidence Based Complementary and Alternative Medicine. “A yoga and compassion meditation program reduces stress in familial caregivers of Alzheimer's disease patients.” Danucalov et al. April 2013.
- 95 Sushruta Samhita. Section 8, verse 10.
- 96 Sneesby and Mater. “Home is Where I Want to Die: Kelly’s Journey.” Contemporary Nurse. Aug 2013.
Ayurveda is an ancient system that can be used to offer ease and comfort to patients in hospice care settings, as well as their family and caregivers. Techniques explored in this paper help support relaxation, manage stress and anxiety, and create feelings of peacefulness and upliftment. These practices assist all who are involved in experiencing and being present to the sacredness of dying. Through Ayurveda, we can explore the dimension of spirituality within us, unlocking greater capacity to love, care and be compassionate.
Berman, Claire. Caring for Yourself While Caring for Your Aging Parent: How to Help, How to Survive. Henry Holt: New York, 1996.
Chopra, Deepak and David Simon. The Seven Spiritual Laws of Yoga: A Practical Guide to Healing Body, Mind, and Spirit. John Wiley & Sons, Inc: New Jersey, 2004.
Danucalov et al. “A yoga and compassion meditation program reduces stress in familial caregivers of Alzheimer's disease patients.” Evidence Based Complementary and Alternative Medicine. April 2013.
Dass, Ram. Still Here: Embracing Aging, Changing and Dying. Berkeley Publishing Group: New York, 2000. Downey, et al.“Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.” American Journal of Hospice and Palliative Care. Aug 2009.
Feuerstein, Georg and Larry Payne. Yoga for Dummies. IDG Books Worldwide, Inc: California, 1999.
Frawley, David. Ayurvedic Healing for Healthcare Professionals. California College of Ayurveda: Nevada City, CA, 1988.
Gass, Robert. Chanting: Discovering Spirit and Sound. Broadway Books: New York, 1999.
Halpern, Dr. Marc. Healing Your Life: Lessons on the Path of Ayurveda. Lotus Press: Wisconsin, 2011. Halpern, Dr. Marc. Principles of Ayurvedic Medicine. California College of Ayurveda: California, 1995. Heyn, Birgit. Ayurvedic Medicine: The Gentle Strength of Indian Healing. Thorsons Publishing Group: Vermont, 1987.
Johari, Harish. Ayurvedic Massage: Traditional Indian Techniques for Balancing Body and Mind. Healing Arts Press: Vermont, 1996.
Kabat Zinn. “Mindfulness Based Cognitive Therapy.” International Journal of Palliative Nursing. June 2001.
KublerRoss, Elizabeth. On Death and Dying. Scribner: New York, 1969.
Lad, Vasant. Complete Book of Ayurvedic Home Remedies. Three Rivers Press: New York, 1998.
Novak, John. Ananda Course in SelfRealization: Part 1: Lessons in Meditation. Ananda Church: USA, 1997 Page, Linda. Healthy Healing. Quality Books Inc: 1985.
Shanbhag, Vivek. A Beginner’s Introduction to Ayurvedic Medicine: The Science of Natural Healing and Prevention Through Individualized Therapies. Keats Publishing, Inc: CN, 1994.
Simpson, Liz. The Book of Chakra Healing. Sterling Publishing Co: New York, 1999.
Sneesby and Mater. “Home is Where I Want to Die: Kelly’s Journey.” Contemporary Nurse. Aug 2013. Sushruta Samhita.
Tirtha, Swami Sadashiva. Ayurvedic Encyclopedia: Natural Secrets to Healing, Prevention and Longevity. Ayurveda Holistic Center Press: New York, 1998.
Wall, Carly. Setting the Mood With: Aromatherapy. Sterling Publishing Company: New York, 1998.
What Hospice Is, What Hospice is Not. Patient education pamphlet distributed by Vitas Innovative Hospice Care.
Worwood, Valerie Ann. The Complete Book of Essential Oils and Aromatherapy. New World Library: San Rafael, CA, 1991.
Young, Gary. Aromatherapy: The Essential Beginnings. Essential Press Publishing, Salt Lake City,1996.
from Contemp Nurse. 2013 Aug 4.
Home is where I want to die: Kelly's Journey.
Sneesby L, Mater C.
The definition of a "good death" is centred on being peaceful, dignified and pain free. The preferred place of death has also been highlighted as an important concept in defining a good death (Cox, Almack, Pollack & Seymour, 2011) 70% of Australians express the desire to spend their last days at home. In reality only 16 % of people die at home (Preferred place of death, 2008). With 10% of Australians dying in residential aged care facilities and approximately 20% in hospices, the rest die in hospitals (Parish et al., 2006). Family support and the family's care giving ability play a major role in determining whether a person is able to die at home. Other factors include the availability of medical and nursing care.
fromEvid Based Complement Alternat Med. 2013 Apr 18.
A yoga and compassion meditation program reduces stress in familial caregivers of Alzheimer's disease patients.
Danucalov MA, Kozasa EH, Ribas KT, Galduróz JC, Garcia MC, Verreschi IT, Oliveira KC, Romani de Oliveira L, Leite JR.
Familial caregivers of patients with Alzheimer's disease exhibit reduced quality of life and increased stress levels. The aim of this study was to investigate the effects of an 8week yoga and compassion meditation program on the perceived stress, anxiety, depression, and salivary cortisol levels in familial caregivers. A total of 46 volunteers were randomly assigned to participate in a stressreduction program for a 2month period (yoga and compassion meditation programYCMP group) (n = 25) or an untreated group for the same period of time (control group) (n = 21). The levels of stress, anxiety, depression, and morning salivary cortisol of the participants were measured before and after intervention. The groups were initially homogeneous; however, after intervention, the groups diverged significantly. The YCMP group exhibited a reduction of the stress (P < 0.05), anxiety (P < 0.000001), and depression (P < 0.00001) levels, as well as a reduction in the concentration of salivary cortisol (P < 0.05). Our study suggests that an 8week yoga and compassion meditation program may offer an effective intervention for reducing perceived stress, anxiety, depression, and salivary cortisol in familial caregivers.
from Am J Hosp Palliat Care. 2009 AugSep
Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.
Downey L, Engelberg RA, Standish LJ, Kozak L, Lafferty WE.
Improving endoflife care is a priority in the United States, but assigning priorities for standard care services requires evaluations using appropriate study design and appropriate outcome indicators. A recent randomized controlled trial with terminally ill patients produced no evidence of benefit from massage or guided meditation, when evaluated with measures of global quality of life or pain distress over the course of patient participation. However, reanalysis using a more targeted outcome, surrogates' assessment of patients' benefit from the study intervention, suggested significant gains from massagethe treatment patients gave their highest preassignment preference ratings. The authors conclude that adding a menu of complementary therapies as part of standard endoflife care may yield significant benefit, that patient preference is an important predictor of outcome, and that modifications in trial design may be appropriate for endoflife studies.
from Am J Hosp Palliat Care. 2009 AugSep
Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.
Downey L, Engelberg RA, Standish LJ, Kozak L, Lafferty WE.
Research suggests that aromatherapy massage (AM) is increasingly being used by cancer patients, especially in the palliative care setting, although few studies have assessed its effectiveness. I wanted to find out whether AM reduces anxiety in patients with a primary malignant brain tumour attending their first followup appointment after radiotherapy. Eight patients were recruited to the study, which comprised three methods of data collection: the measurement of physical parameters; the completion of Hospital Anxiety and Depression Scales (HADS); and semistructured interviews. The results from HADS did not show any psychological benefit from AM. However, there was a statistically significant reduction in all four physical parameters, which suggests that AM affects the autonomic nervous system, inducing relaxation. This finding was supported by the patients themselves, all of whom stated during interview that they felt 'relaxed' after AM. Since these patients are faced with limited treatment options and a poor prognosis, this intervention appears to be a good way of offering support and improving quality of life.
from Int J Palliat Nurs. 2001 Jun;
The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours.
Mindfulness is a lifetime engagementnot to get somewhere else, but to be where and as we actually are in this very moment, whether the experience is pleasant, unpleasant, or neutral.Mindfulness is a lifetime engagementnot to get somewhere else, but to be where and as we actually are in this very moment, whether the experience is pleasant, unpleasant, or neutral.