The last hours/days of life can be a very difficult time.
However, knowing what might happen can help make this time be less stressful.
Each person is unique but, there are common signs that indicate a person may be dying.
Death usually comes gradually and peacefully. The signs of nearing death may happen, but not necessarily in any particular order.
Most changes that occur at this time are normal and don’t need any special treatment.
You can provide comfort and reassurance for the dying person by simply being present, sitting quietly, talking to them or holding their hand. You may/or may not like to help with their physical care.
This is the time to consider if the person has an Advanced Care Plan, or any specific wishes for this period of time. This may include any cultural, religious, spiritual beliefs or wish for Organ/tissue donation. Let the Care Team know.
If you are concerned or unsure about anything, please let the Care Team supporting you.
Here are some of the changes that may occur:
Change in awareness
As weakness increases, the person may spend more time in bed and have less interest in their surroundings. From a very sleepy state, they may lapse into unconsciousness. This could last for a very short time, or for several days. The person may still be aware of their surroundings and hear you talking to them.
Not eating and drinking
When a person starts to die and the body begins to slow down, the person often loses their appetite and neither wants or needs food and fluid and may result in less urine output. Frequently they may not be able to swallow safely.
Caring may be continued in other ways including moistening their mouth with a damp, cool swab, using the person’s preferred fluid such as iced tea etc. and applying lip balm.
Increased confusion and restlessness
You may notice increased restlessness, calling out, pulling at bedclothes, or muddled thinking and conversations. Reassure the person by talking calmly, saying who you are, and holding their hand (if appropriate). You might want to play familiar music, or have some of their own items such as a special blanket or bed socks.
Trying to get out of bed when they are too weak to stand, and safely do so, may indicate the need to go to the toilet. Comfort and dignity can be maintained by the use of pads or sometimes considering a urinary catheter.
Occasionally, a dying person may see or hear people from their past (that are not visible to you). This is often reassuring to them.
If the restlessness continues or is distressing, contact your Care Team. Sometimes medication may be needed to calm and sooth their restlessness.
Changes in breathing
It is normal for breathing patterns to change. The rate, rhythm and noise of breathing may all alter. There may be shallow gentle breaths or louder breaths, like snoring. Frequently gaps or pauses in the rate of breathing occur. It is common for the person to breathe through the mouth and the mouth to stay open. Continue with caring by keeping mouth clean and moist and applying lip balm.
Noisy, rattly, gurgling breathing
Occasionally there can be a noisy rattle to the breathing due to a small amount of saliva near the air passages. This is not usually distressing for the person, but it might be for you. A change of position and/or medication may help.
Changing colour / temperature
You may notice that the person’s arms, hands, legs, feet, nose and ears feel cool and possibly look patchy or dark in colour Also, body temperature may fluctuate and the person may feel hotter or cooler. These are both a normal part of the dying process and comfort can be managed by providing or removing blankets as required.
If you are concerned or unsure about anything, please discuss this with the Care Team supporting you.