Nearing Life's End

This is a time to give acceptance, support and comfort.

It is important to be aware of the physical changes an individual will go through as his or her body “slows down” and prepares for the final stages of life. Each situation is different and not everyone will show the same signs and symptoms listed.

The following changes are presented in the order in which they usually appear but may occur for many days prior to death. Some practical advice and comfort measures are also included that may help the caregivers.

 

What You May Observe and What May Be Helpful:

When someone is dying they may...

Sleep longer and sometimes have difficulty waking.

This is due in part to changes in the metabolism of the body. S/he may also appear to be sleeping with open eyes.

  • Sit with and hold his/her hand; speak softly and naturally.
  • Plan conversation for times when s/he is more wakeful and alert.
  • Keep visiting times brief or encourage visitors to sit at bedside.
  • Speak directly and normally, even though there may be no response. Never assume that the person cannot hear; hearing is said to be the last of the senses to be lost.

Reduce what s/he eats and drinks.

The body will naturally begin to conserve energy which is expended in these tasks.

  • Offer small servings of light foods. Decrease portions as s/he is able to handle. Encourage but do not force fluids.
  • Be aware of the decrease in swallowing ability. Remind him or her to swallow.
  • Keep the person’s mouth moist and comfortable. Small chips of ice, frozen juices/popsicles may be refreshing.

Become confused and unable to recognize familiar people and surroundings.

  • Speak calmly, clearly, and naturally.
  • Remind him/her of time, place, and who is in the room.
  • If they are resisting something that will provide them comfort, communicate the reasons; for example, “It’s time to take your medication so you won’t begin to hurt.”

Experience, see or talk to deceased family members, or use symbolic language (e.g. talk about “going home”).

  • Allow the person to express his/her experience.
  • Be reassured that this behaviour is normal.

Become restless, pulling at bed linen and clothing.

  • Avoid physical restraint, if possible.
  • Calm and soothing music or gentle massage may ease a restless patient.
  • Call the family doctor if home safety becomes a concern.

Have irregular or shallow breathing.

It is quite common to have 10 to 30 second periods when breathing may stop. The person may also have periods of rapid, shallow panting type breathing. Sometimes there is a moaning-like sound on exhale. This is not distress, but the sound of air passing over relaxed vocal chords.

  • Elevating the head and/or turning the person onto one side may bring comfort.
  • Hold his/her hand; speak gently and reassuringly.
  • Be reassured that these patterns are very common and indicate a decreased circulation in the internal organs.

Develop “wet” breathing or congestion.

Saliva can collect at the back of the throat, which cannot be swallowed because of weak muscles, or there may be secretions in the lungs producing loud gurgling sounds from the chest.

  • Raise the head of the bed or raise the upper body with pillows so the secretions lay low and therefore don’t stimulate the gag reflex.
  • Turn the patient on his/her side.
  • Hold his/her hand; speak gently and reassuringly.

Have irregular pulse or heartbeat.

This is a normal pattern, and another sign of the “slowing down” process.

Lose control of bladder or bowels.

Your nurse can give advice on appropriate protective padding or recommend whether a catheter may be necessary.

Have changes in temperature or colour.

This is an indication that the circulation is conserving to support the most vital organs. Irregular temperatures can be a result of the brain sending unclear messages.

  • Keep the patient warm if he/she appears cold. If the person continually removes the covers, give him/her just a light sheet.

Need permission to go.

A dying person will often try to hold on, even though it brings prolonged discomfort, in order to be assured that those left behind will be all right.

  • A family’s ability to reassure and release the dying person from this concern is the greatest gift of love they can give at this time.

Saying Good-bye

When the person is ready to die, and the family is able to let go, this is the time to say good-bye in personal ways. This closure allows for the final release. It may be helpful to just lay in bed with the person, hold a hand, and/or say what you need to say. Tears are a natural part of making peace and saying good-bye.

At the Time of Death

  • There will be no response.
  • There will be no breathing.
  • There will be no pulse.
  • The eyes will be fixed in one direction; they may be open or closed.
  • The mouth may fall open as the jaw relaxes.
  • There may be loss of control of bladder or bowels.