A hospice nurse has raised awareness about Kennedy ulcers – a specific purple lesion that can appear without warning in the final days of life, suggesting the body's organs are shutting down. Julie McFadden, who runs the Hospice Nurse Julie YouTube channel, has highlighted what people should watch for.
Signs and symptoms
Julie explained: "Small, round or purple lesions. And they may be painful and they may bleed a bit. They don't have to bleed, but they can. They usually appear on the lower back of the sacrum area like right above the butt crack."
"And sometimes they are in the shape of a butterfly. They develop rapidly. That's the key note here. They develop rapidly unlike chronic ulcers. And they may be accompanied by other end-of-life things like unconsciousness, not eating and drinking, changes in breathing, cool extremities. So the person could also start looking like they're going to be actively dying soon."
She emphasised that the crucial distinction between Kennedy ulcers and other ulcers and wounds is that the latter form gradually over time, while the former materialise suddenly. She said: "The Kennedy ulcer is very specific because it's not there and then boom, it's there, and then boom, they die. That's how quick the Kennedy ulcer thing is. And the reason why it indicates it is the body is being like, I'm shutting down. I'm no longer perfusing the skin. The skin is shutting down."
Kennedy ulcers serve as a "final warning" and represent a terminal response where blood flow is redirected to vital organs, causing the skin to lose oxygen which results in rapid tissue breakdown.
Treatment
Julie explained they frequently appear in ICU or hospice patients, and regarding treatment, she said: "Pain management. If your loved one seems to be in pain, pain sitting on it, pain when turning, we need to help with pain management. Usually with low doses of morphine."
Secondly, she highlighted skin care, but cautioned: "We definitely want to be careful with their skin. The skin where the Kennedy ulcer is is usually very fryable, very easily torn. So usually not just that area, all the skin is pretty fryable we call it. So it's easy to tear, easy to fold, easy to break."
She explained the crucial thing was gently keeping it clean and dry, and despite common misunderstandings, she stressed that Kennedy ulcers were not a sign of neglect, but rather a consequence of the body shutting down.
Concluding thoughts
Julie emphasises the importance of understanding Kennedy ulcers, as it can prepare you for when a loved one is nearing the end of their life. She stated: "I don't want it to be an alarm bell and make everyone panic, but I also want people to know that this could indicate your loved one is getting close to the end of life."
"I also want people to understand that it doesn't necessarily mean that your loved one is being neglected or that you're neglecting or doing something wrong to your loved one. This is just the body's way of slowly shutting down in one of the ways we see it."
She recognised that witnessing such a condition can be distressing, but stressed the importance of ensuring your loved one's comfort, carefully cleaning the ulcer and considering pain management. Julie concluded: "Again, not every ulcer indicates that it's a Kennedy ulcer, but Kennedy ulcers do exist and they could mean that your loved one is getting closer to death than you think."
However, she described it as a "powerful sign" that the end-of-life stage is approaching, which can be crucial in helping you prepare. She added that it is often a natural part of dying, and does not imply that the person you care for cannot still have a peaceful death.
