When a loved one is near the end of their life, it can be difficult to know what to do or expect. As a hospice worker or family member of a terminally ill patient, it is important to be aware of the signs that death is approaching. By being attuned to these signs, you can make the final days and hours as comfortable as possible for your loved one.
Desire for Food and Drink Ends
As death approaches, the terminally ill stops feeling hungry or thirsty. This happens because the body’s metabolism begins to slow down and less energy is needed. As a result, the person will lose interest in food and drink and may even stop eating and drinking altogether.
In addition, the person’s gastro-intestinal system will begin to shut down. This will make eating or drinking uncomfortable which is especially why you should not force food or water into a dying person. At this point, even administering sips of water will eventually be too much for the person and could cause them to choke. Medication such as tablets will likely just cause them discomfort or even pain if swallowed.
Activity Level Declines
A terminally ill person will naturally become more and more lethargic as death nears. This is due to the body’s decreasing energy levels. The person may spend more time in bed and have less interest in moving around or engaging in activities.
As the person’s activity level declines, they will also sleep more. This increased need for sleep is normal and should not be confused with unconsciousness. In the final stages of life, a person may sleep for long periods and be awake only for very short periods of time.
Turning them or moving them too much will also become increasingly difficult and cause them visible discomfort. Rather, let them position themselves in whatever way is most comfortable for them.
Withdrawal Sets in
As a person approaches death, they will increasingly withdraw from people and social activities. This is due to the fact that they are withdrawing from life itself. The terminally ill person may become uninterested in conversation or communication and prefer to be left alone. This withdrawal is part of their detachment from the world as they prepare for what they know is to come.
Do not take this withdrawal personally. It is not a reflection of how the person feels about you but rather a sign that they are preparing for death. They are fully aware of what is happening and are not necessarily in any pain, they are just tired and ready to let go.
If you are able to, spend time with the person and talk to them about their life. Share any memories you have or just play their favorite music. This will provide them with comfort in their final days. Hearing is one of the last senses to go so they will still be able to appreciate your presence even if they are not able to respond.
Body Temperature Drops
As death approaches, the body’s temperature will start to drop. This happens because the body is shutting down and no longer needs to maintain a constant temperature. The person may feel cold to the touch especially in their extremities such as their hands and feet as circulation starts to fail.
To make them more comfortable, cover them with a blanket or lightly massage their hands and feet to help improve circulation. Do not try to increase their body temperature by using heating pads or hot water bottles as their fragile skin risks being burned.
Bowel and Bladder Gets Disrupted
In the final days, a person’s bowel and bladder functions will start to fail. They may no longer be able to control their bodily functions and may start to urinate or defecate involuntarily. While this may be upsetting, it is a natural part of the dying process and nothing to be embarrassed about. To make them more comfortable, keep them clean and dry. Use adult diapers if necessary to prevent soiling their clothes or bedding.
If the bladder is withholding urine, a foley catheter may be necessary to help relieve the pressure. This will provide relief and make them more comfortable without causing them further pain.
Confusion and Disorientation Kicks in
As death approaches, it’s not uncommon for patients to become confused or disoriented. They may forget familiar people or places and have trouble communicating their needs. This is caused by changes in brain function as the body starts shutting down. They may begin to see illusions or hallucinations as well. They may also become delusional and believe people are trying to hurt them.
Do your best to reassure them and make them feel safe. Speak to them in a calm and comforting voice. Let them know that you are there for them and that you will not leave them.
If they become agitated or violent, do not try to restrain them as this will cause them further distress. Instead, try to distract them with music or conversation. If necessary, consult their doctor for additional help.
Skin Rapidly Changes
As death nears, circulation decreases which can cause skin changes such as discoloration and skin mottling (a marbled appearance). The skin may also appear thin and papery as fluid is lost from tissues. If you notice any of these changes, death is likely to occur within days or hours. There is nothing that can be done to reverse the process so focus on making the person comfortable.
If the patient has been bedridden for a while, their muscle mass and general weight will be diminished, making them more susceptible to developing pressure wounds. Pressure wounds (bed sores) may form if the person is not moved often enough. The skin is an organ and as it starts to fail, it will become increasingly obvious that time is running out.
Breathing Pattern Changes
As death nears, a person’s breathing pattern will change drastically. Their breathing may become shallow and irregular or they may have long periods of apnea (no breathing). The period of apnea will become longer as time goes on and eventually they will take their final breath. This is known as Cheyne-Stokes breathing, named after the person who identified it. By this time, death is very close and will occur within minutes or hours.
Breathing Gets Noisy
In addition to pattern changes, the person’s breathing will become noisy as they struggle to get enough air. This is caused by fluid buildup in the lungs and is a sign that their body is shutting down. You might hear a rattling sound when breathing known as death rattle, patients may make other noises due to mucus buildup in their throat. This could sound like gurgling, moaning, or snoring. Don’t be alarmed, this is a normal part of the dying process and is not painful for the patient.
By now, they may have already been intubated (a breathing tube inserted through the nose or mouth into the lungs) to help them breathe. They may also already be in a coma-like state and may not be aware of their surroundings.
Consciousness Fades
As death nears, the person will eventually fade into a very deep state of unconsciousness and will no longer be aware of their surroundings. This could happen over the course of hours or days. You may notice their eyes become fixed and dilated as consciousness is lost. This is usually a sign that death will occur soon.
They may not be fully aware of their surroundings but may still be able to hear you and perceive pain even though they cannot respond. It is important to talk to them and let them know you are there with them in these last moments.
These signs are general and may not all be present in every case. If you notice any of these signs, it is important to contact the person’s doctor or hospice nurse for guidance as death is likely to occur soon. They will be able to provide you with more specific instructions on how to care for the person and what to expect in the coming hours or days.
End of Life Timeline
The end of life transition process usually occurs over the course of days or weeks, however, it can sometimes happen very quickly. Here is a general timeline of what to expect:
Weeks before death:
- The person may become increasingly tired and withdrawn.
- They may have difficulty eating and drinking and may lose interest in food altogether.
- Their mental state may change and they may become confused or disoriented.
Days before death:
- The person’s breathing pattern will change and they may have periods of apnea.
- Their skin will become thin and papery as fluid is lost from tissues.
- They may develop pressure wounds (bed sores).
One day before death:
- The person will become unconscious and will not respond to stimuli.
- Their breathing will become noisy as fluid builds up in the lungs.
Hours before of death:
The person’s heart rate will drop and they may have periods of bradycardia (slow heart rate).
Their blood pressure will drop and they may develop hypotension (low blood pressure).
Their skin will become cool and mottled as circulation decreases.
Minutes before death:
- The person’s breath may be deep and long or shallow and irregular.
- Their body will relax and their muscles will loosen.
- Their eyes will become fixed and dilated as they lose consciousness.
How to Know your Loved one has Died
At the time of death, there are a few physical signs that will occur. Family may not see all of these signs as they happen due to high emotions or denial, but the hospice nurse or doctor will be able to confirm that death has occurred.
- The person’s heart rate and blood pressure will drop to zero.
- Their breathing will stop and they will not take any more breaths.
- Their pupils will dilate and their eyes will become fixed.
- Their skin will become pale and mottled as circulation ceases.
- Their body will become stiff.
- They will not wake up.
Death is usually diagnosed when the person’s heart stops beating and they are no longer breathing. A medical professional will check for signs of life and pronounce death when these signs are absent.
In the absence of a medical professional, you can check for signs of life by checking for breath and pulse. To check for breath, place your ear near the person’s mouth and nose and look for any rise and fall of their chest. To check for pulse, place your fingers on the inside of their wrist, on the side of their neck, or behind their knee. You should feel a pulse if they are still alive.
If you are unsure if the person has passed away, it is always best to have them checked by medical professionals.
What Next?
Once death has occurred, it is important to contact the person’s doctor or hospice nurse. They will be able to provide you with instructions on how to care for the body and what paperwork needs to be completed.
If the death was expected, arrangements may likely have already been made in advance ensuring the funeral can take place not long after death. If the death was sudden or unexpected, you will now need to start making these arrangements.
It is also important to notify the person’s friends and family members of their death. This can be a difficult task, but there are resources available to help you through this process.