There are typical visible/audible signs that a person may have less than two weeks to live. Sometimes, when we are so close to someone, we may miss the forest for the trees. Please allow me to go over some significant signs that a person with a terminal illness may have two weeks or less to live.
Sudden Onset of Symptoms
One of the most noticeable signs that a person may have less than two weeks to live is a sudden onset of symptoms within 24 hours. These symptoms may include (family members seeing these signs should reach out to their hospice provider's 24×7 number):
Generalized discomfort: The patient may feel pain or discomfort all over their body, even when not touched or moved. They may grimace, moan, or cry out in pain. They may need more pain medication or other comfort measures to ease their suffering.
Dysphagia: The patient may have trouble swallowing pills, food, or liquid. They may choke, cough, or gag when they try to eat or drink. They may lose their appetite or refuse to eat or drink anything. They may become dehydrated or malnourished as a result.
Lethargy: The patient may become very sleepy, drowsy, or unresponsive. They may not open their eyes, speak, or react to stimuli. They may drift in and out of consciousness or slip into a coma. They may not recognize their loved ones or their surroundings.
Spitting out food or having food appear to roll out of their mouth: The patient may lose their ability to control their mouth muscles. They may be unable to chew, swallow, or spit out food. They may drool or have food come out of their mouth. They may also have difficulty breathing or clearing their airway.
Restlessness and agitation: The patient may become restless, agitated, or confused. They may move around in bed, pull at their clothes or sheets, or try to get out of bed. They may yell “Help me, help me” or other words or phrases. They may have hallucinations, delusions, or paranoia. They may be experiencing anxiety, fear, or unresolved issues.
Skin mottling: The patient may have patches of purple, blue, or red skin on their hands, feet, arms, or legs. This is caused by poor blood circulation and low oxygen levels. The skin may also feel cold, clammy, or sweaty.
Dusky/ashen complexion: The patient may have a pale, gray, or bluish color on their face, lips, or nails. This is also caused by poor blood circulation and low oxygen levels. The patient may look like they are suffocating or dying.
Hyperventilation: The patient may breathe extremely fast, shallow, or irregularly, with more than 24 breaths per minute. They may have Cheyne-Stokes breathing, alternating rapidly and with no breathing periods. They may also have Kussmaul breathing, a pattern of deep, labored breathing. These breathing patterns indicate that the patient's body struggles to maintain normal functions.
Multiple falls within 72 hours: The patient may suddenly lose balance, coordination, or strength. They may fall or collapse when they try to stand up, walk, or move. They may injure themselves or become unconscious as a result. They may have a stroke, a seizure, or a brain hemorrhage.
These symptoms are typically tell-tale signs that, outside of an infection, the disease progression has taken a sudden turn, such that the patient may die at any moment and up to two weeks later. They indicate that the patient's vital organs, such as the heart, lungs, kidneys, liver, and brain, are shutting down and failing. They also indicate that the patient is experiencing a lot of physical and emotional distress and needs more care and support.
Frequency of Changes of Condition
Frequency of Change
Typically Means Death Within
One every 4 to 8 weeks
Less than 6 months
Every 3 to 4 weeks
Less than 3 months
Every 1 to 2 weeks
Less than 2 months
Once every week
Less than 1 month
Several times per week
Less than 2 Weeks
Every day
Less than 1 Week
Several times per day
Less than 72 hours
When a patient is closer to death, there is often a noticeable increase in the speed at which their condition changes.
Suppose the patient is determined to be at a point of dying anytime within two weeks or less. In that case, the hospice nursing frequency should be adjusted to optimally support the patient and family as the patient heads towards a good death.
Conclusion
Recognizing the signs that a terminally ill patient may be close to dying is crucial for providing optimal end-of-life care. The visible and audible signs such as generalized discomfort, dysphagia, lethargy, restlessness, skin mottling, dusky complexion, hyperventilation, and multiple falls within a short period can indicate that the patient may have two weeks or less to live. These signs, along with changes in appearance, sleep patterns, and vital signs, are important indicators of the patient's condition.
As a hospice registered nurse case manager, it's essential to be vigilant in assessing these signs and symptoms and to work closely with caregivers and the hospice team to provide the necessary support and care for the patient and their family. Understanding these signs can help adjust the nursing frequency to ensure the patient receives the best care as they approach the end of life.
By being aware of these significant signs and symptoms, caregivers, family members, and healthcare professionals can work together to ensure that the terminally ill patient's final days are as comfortable and peaceful as possible. This knowledge empowers everyone involved to provide compassionate, person-centered care, essential in the journey towards a good death.
Remember, each patient's experience is unique, and individual factors, such as their specific illness and treatments, can influence their signs and symptoms as they approach death. Therefore, it's important to approach each situation with empathy, understanding, and a commitment to providing the best possible care for the patient and their loved ones.
