, also known as , are skin sores that can develop in individuals during their final hours or days of life. These ulcers can be distressing for both patients and their caregivers, but understanding what they are and how to provide proper care is crucial for ensuring the comfort and dignity of the patient. In this , we'll explore , including what they look like, how to identify them, their proper care and treatment, and what they mean in terms of proximity to the end of life.

Kennedy Ulcers: What Are They?

Kennedy ulcers are skin sores that appear as part of the dying process. These sores are unique and typically develop in individuals in the final stages of life. Recognizing them as a natural part of the end-of-life journey rather than a complication is essential. Here's what you need to know:

Appearance: Kennedy ulcers often present as irregularly shaped, maroon, or purple skin lesions. Some look like bruises or open sores, and some look like butterflies. Kennedy ulcers usually appear on the lower back, near the tailbone, but can also appear on other body parts, such as the heels, arms, or elbows. They can grow very quickly, sometimes within hours.

Causes: These ulcers are believed to result from changes in blood flow and tissue breakdown, often related to the body's natural shutting down processes. When the body is nearing the end of life, it may not be able to pump enough blood to the skin, especially in areas with pressure from the bones. This can cause the skin to become damaged and form ulcers. Some illnesses affecting the whole body, such as organ failure or progressive diseases, may also increase the risk of Kennedy ulcers.

: In most cases, a doctor or a provider can recognize Kennedy ulcers by their appearance and location. However, sometimes, a caregiver or a loved one may be the first to notice the ulcer. If you think you or a loved one might have a Kennedy ulcer, tell a doctor as soon as possible.

Treatment: Kennedy ulcers are considered unavoidable, meaning they cannot be prevented or cured. However, there are some ways to provide comfort and care for the person who has them. These include:

  • Keeping the skin clean and dry
  • Applying gentle dressings or creams to protect the skin and prevent infection
  • Changing the position of the person frequently to relieve pressure and pain
  • Using pillows or cushions to support the body and reduce friction
  • Giving pain medication as prescribed by the doctor
  • Providing emotional support and reassurance to the person and their family

Coping: Kennedy ulcers can be distressing and upsetting for the person who has them and their loved ones. They signify that the person is in the final stages of life and may not have much time left. Feeling sad, angry, scared, or guilty about this situation is normal. However, it is important to remember that Kennedy's ulcers are not a fault or a failure of anyone. They are a natural part of the dying process and do not affect the person's dignity or value. You can cope with Kennedy ulcers by:

  • Seeking information and guidance from the doctor or the team
  • Talking to a counselor, a therapist, a , or a support group
  • Expressing your feelings and concerns to someone you trust
  • Spending quality time with the person and cherishing the moments you have together
  • Saying goodbye and letting the person know how much you love and appreciate them

Identifying Kennedy Ulcers

Kennedy ulcers are a sign that the person you love is nearing the end of their life. It can be hard to see them develop these sores, but knowing how to identify them and what they mean is essential. Here are some things to look for:

Location: These ulcers are commonly found on the sacrum, the bone at the base of the spine. This is because the sacrum is often under pressure from lying down or sitting for a long time. The ulcers can sometimes appear on other body parts with less blood flow, such as the heels, elbows, or arms.

Appearance: Kennedy ulcers appear maroon or purple, distinguishing them from other sores. They may look like bruises or open wounds, and some look like butterflies. They are usually irregular in shape and size and may have black or yellow edges. They can change quickly, sometimes within hours.

Acceleration: Most Kennedy ulcers have a fast onset and progress quickly. They can appear suddenly without any warning signs. They can also grow larger and deeper in a short time. They may not heal or improve, even with treatment.

Patient's Condition: These ulcers often develop in individuals' last days or hours of life. They are a sign that the body is shutting down and preparing for death. They may occur along with other symptoms, such as breathing, pulse, temperature, or consciousness changes. They may also indicate that the person is feeling less pain or .

If you notice these signs, you should immediately contact the doctor or hospice care team. They can help you confirm the and provide the best care for the person and their family.

Proper Care and Treatment

When someone has Kennedy ulcers, they are very close to the end of their life. They may not be able to talk or move much, but they can still feel pain and . That is why taking good care of them and their skin is important. Here are some things you can do to help them:

Pain Relief:  is a top priority. You want to make sure the person is as comfortable as possible. Consult a healthcare professional to determine the most suitable pain relief methods. They may prescribe some medication or suggest some natural remedies. You should follow their instructions carefully and give the person the right dose at the right time. It would be best to watch for any signs of pain, such as grimacing, moaning, or tensing up. You should report any changes to the healthcare professional.

Prevention of Complications: Regular repositioning to relieve pressure on the sacrum is crucial. The sacrum is the bone at the base of the spine, where the ulcers usually appear. If the person stays in one position for too long, the ulcers can worsen and cause more pain. It would be best to try changing the person's position every two hours or as often as needed. You can use appropriate cushions and support surfaces to prevent pressure sores. These special pillows or mattresses reduce the friction and pressure on the skin. You should also check the skin for signs of infection, such as redness, swelling, or pus. You should report any signs of infection to the healthcare professional.

Hygiene: Keep the area clean and dry to prevent infection. You should gently wash the skin with mild soap and water daily or as often as needed. You should pat the skin dry with a soft towel and avoid rubbing or scratching. You should apply gentle dressings or creams to protect the skin and prevent infection. You should follow the healthcare professional's advice on how to care for the wound. Changing the dressings or creams as often as instructed would be best. It would help to keep the person's clothes and bedding clean and dry.

By following these steps, you can provide proper care and treatment for the person with Kennedy ulcers and show them that you love and respect them. Remember, you are not alone in this journey. You can always ask for help and support from the healthcare professional or the hospice care team. They are there to help you and the person you love.

What Kennedy Ulcers Mean

When someone you love has Kennedy ulcers, it means they are very close to dying. This can be very hard to accept, but it can also help you prepare for what will happen. You can use this time to say goodbye and make peace with the person and yourself. You can also make sure they are comfortable and surrounded by love. These ulcers are not your fault or their fault. They are not a sign that you did something wrong or that they suffered too much. They are a sign that their body is shutting down and letting go of life. This is a natural part of the dying process and nothing to be ashamed of. You can honor the person and their life by respecting their wishes and remembering the good times you shared. 

Conclusion

Kennedy ulcers are skin sores that appear when someone is very close to dying. They are not a sign of bad care or suffering but a part of the natural dying process. You can help the person who has them by giving them pain relief, keeping their skin clean and dry, and changing their position often. You can also show them love and respect by saying goodbye and honoring their wishes. You may feel sad, angry, or scared when you see these ulcers, but you are not alone. You can get help and support from the doctor, the hospice care team, or others who understand your situation.

Resources

A Butterfly That May Herald End of Life

Kennedy Terminal Ulcer: The “Ah-Ha!” Moment and Diagnosis

Reexamining the Literature on Terminal Ulcers, SCALE, Skin Failure, and Unavoidable Pressure Injuries (PDF)

Clinical Advisor: A Kennedy Terminal Ulcer in a geriatric patient

National Library of Medicine: The Death of the Kennedy Terminal Ulcer

Palliative Care Network Of Wisconson: Kennedy Terminal Ulcer

Nursing Home Law Center: What Is a Kennedy Ulcer?

The Importance of Caregiver Journaling

Reporting Changes in Condition to Hospice

Eldercare Locator: a nationwide service that connects older Americans and their caregivers with trustworthy local support resources

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My Aging Parent Needs Help!: 7-Step Guide to Caregiving with No Regrets, More Compassion, and Going from Overwhelmed to Organized [Includes Tips for Caregiver Burnout]

Take Back Your Life: A Caregiver's Guide to Finding Freedom in the Midst of Overwhelm

The Conscious Caregiver: A Mindful Approach to Caring for Your Loved One Without Losing Yourself

Dear Caregiver, It's Your Life Too: 71 Self-Care Tips To Manage Stress, Avoid Burnout, And Find Joy Again While Caring For A Loved One

Everything Happens for a Reason: And Other Lies I've Loved

The Art of Dying

Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death.”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

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Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side, A Guide for Caring for the Dying at Home

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