When someone you love has a terminal illness, you may wonder how much time they have left. You may also want to know what to expect and how to prepare for their final days. This is called prognostication, which means predicting the future. Prognostication is vital in hospice care because it can help you and the hospice team make the best decisions for your loved one’s comfort and dignity. It can also help you cope with your emotions and plan for your well-being.
One of the ways to estimate how close someone is to dying is by looking at their sleep patterns. Sleep is a natural part of life but can also signify approaching death. When someone is very sick, their body and brain need more rest to cope. They may sleep increasingly more and more and be awake less and less. They may also have changes in their breathing, heart rate, and body temperature while they sleep. These changes can indicate how the body is shutting down and preparing for the end of life.
In this article, we will explain how you can use sleep as a prognostication tool for a terminally ill patient in hospice. We will also share some tips and advice on caring for your loved one and yourself during this difficult time. Our main goal is to help you understand what is happening and what you can do to make the most of the time you have left with your loved one.
Functional Decline
When someone has a terminal illness, their body and mind gradually lose their ability to function normally. They may have difficulty doing things they used to do easily, such as walking, eating, talking, or thinking. This process is called functional decline, a natural part of the dying process. Functional decline can help us estimate how close someone is to dying and how to care for them.
Functional decline has various stages, depending on how much the person can do by themselves or with assistance. These stages are:
Independent: The person can do most things themselves, such as bathing, dressing, or feeding. They may need help with chores or errands but can still make decisions and express their wishes.
Assisted: The person needs help with daily activities, such as getting in and out of bed, using the toilet, or taking medications. They may also need guidance or reminders with tasks or choices, but they can still communicate and interact with others.
Dependent: The person needs a lot of help with everything, such as moving, eating, or breathing. They may also have trouble understanding or speaking or be confused or forgetful. They may not recognize their loved ones or their surroundings, or they may withdraw from others.
Unresponsive: The person cannot do anything alone and is unaware of what is happening. They may not open their eyes, respond to touch or sound, or make only some noises or movements. They may also be entirely still.
These stages can help us estimate a hospice patient’s prognosis, which is how long they have left. Usually, the more the person declines, the closer they are to dying, especially when the declines happen quickly in a short period. For example, an independent person may have months or years left, while an unresponsive person may have days or hours left. However, this is not always accurate because every person is different, and some illnesses can cause sudden changes or complications.
Therefore, it is essential to assess and manage the functional decline of a hospice patient, which means to check and support their abilities. We can do this by:
Observing the person’s behavior and condition and noticing any changes or signs of decline
Asking the person or their caregiver how they are feeling and coping and what they need or want
Measuring the person’s vital signs, such as blood pressure, pulse, or temperature, and checking for any problems or infections
Adjusting the person’s care plan, such as changing their medication, equipment, or services, to match their needs and preferences
Helping the person with their daily activities, such as bathing, dressing, or feeding, and making them comfortable and safe
Respecting the person’s dignity, autonomy, and wishes and letting them do as much as they can or want
Communicating with the person and their family and providing information, education, and guidance
Supporting the person and their family emotionally, spiritually, and practically, and offering comfort, compassion, and empathy
By doing these things, we can help the loved one have a better quality of life and prepare ourselves for their final days.
Velocity of Changes
When someone is dying, their condition can change very quickly or very slowly. This is called the velocity of change, an indicator of approaching death. Velocity of changes can help us predict when someone will die and how to prepare for it.
Velocity of changes has two types, depending on how fast or slow the changes are. These types are:
Fast velocity: The person’s condition changes rapidly, within hours or days. They may have sudden or severe symptoms, such as pain, bleeding, infection, or organ failure. They may also have sudden or profound changes in their consciousness, such as confusion, delirium, or coma.
Slow velocity: The person’s condition changes gradually over weeks or months. They may have mild or stable symptoms like fatigue, weakness, or appetite loss. They may also have mild or stable changes in their vital signs, such as blood pressure, pulse, or temperature. They may also have mild or stable changes in their consciousness, such as sleepiness, withdrawal, or peacefulness.
These types can help us predict the timing of death of a hospice patient, which means when they will die. Usually, the faster the velocity, the sooner the death. For example, a person who has fast velocity may die within hours or days, while a person who has slow velocity may die within weeks or months. However, this is not always accurate because every person is different, and some people can have fast and slow velocities at various times.
Therefore, it is crucial to monitor and cope with the velocity of changes of a hospice patient, which means to watch and deal with their changes. We can do this by:
Observing the person’s behavior and condition and noticing any changes or signs of velocity
Asking the person or their caregiver how they are feeling and coping and what they need or want
Measuring the person’s vital signs, such as blood pressure, pulse, or temperature, and checking for any problems or complications
Adjusting the person’s care plan, such as changing their medication, equipment, or services, to match their velocity and needs
Helping the person with their symptoms, such as pain, bleeding, infection, or organ failure, and making them comfortable and safe
Respecting the person’s dignity, autonomy, and wishes and letting them do as much as they can or want
Communicating with the person and their family and providing information, education, and guidance
Supporting the person and their family emotionally, spiritually, and practically, and offering comfort, compassion, and empathy
By doing these things, we can help the person have a peaceful and dignified death, and we can prepare ourselves for their final moments.
Significant Signs
When someone is very close to dying, they may have some changes or signs that show that their body and mind are shutting down. These are called significant signs, the last indicators of the end of life. Significant signs can help us recognize when someone is about to die and how to be with them.
Significant signs have different categories, depending on what part of the person is affected. These categories are:
Physical signs: The person’s body functions slow down or stop working. They may have changes in their breathing, heart rate, blood pressure, or temperature. They may also change their skin color, moisture, or temperature. They may also have changes in their eyes, mouth, or muscles. They may also have changes in their urine, stool, or sweat.
Mental signs: The person’s brain activity decreases or stops working. They may have changes in awareness, alertness, or responsiveness. They may also have changes in memory, thinking, or speech. They may also have changes in mood, emotions, or personality. They may also have changes in their dreams, visions, or hallucinations.
Spiritual signs: The person’s soul or spirit prepares to leave their body. They may have changes in their beliefs, values, or faith. They may also have changes in their relationships, connections, or attachments. They may also have changes in their meaning, purpose, or legacy. They may also have changes in their peace, acceptance, or readiness.
These categories can help us recognize the imminent death of hospice patients, which means that they will die very soon. Usually, the more signs the person has, the closer they are to dying. For example, a person who has many physical, mental, and spiritual signs may die within minutes or hours, while a person who has few or no signs may die within days or weeks. However, this is not always accurate because every person is different, and some signs can come and go or vary in intensity.
Therefore, responding to and supporting the significant signs of a hospice patient is essential, which means acting and helping with their signs. We can do this by:
Observing the person’s behavior and condition and noticing any changes or signs of death
Asking the person or their caregiver how they are feeling and coping and what they need or want
Measuring the person’s vital signs, such as blood pressure, pulse, or temperature, and checking for any problems or complications
Adjusting the person’s care plan, such as changing their medication, equipment, or services, to match their needs and preferences
Helping the person with their symptoms, such as pain, dryness, or restlessness, and making them comfortable and safe
Respecting the person’s dignity, autonomy, and wishes and letting them do as much as they can or want
Communicating with the person and their family and providing information, education, and guidance
Supporting the person and their family emotionally, spiritually, and practically, and offering comfort, compassion, and empathy
By doing these things, we can help the person have a peaceful and dignified death and be with them until the end.
Sleeping as a Prognostication Tool
When someone is dying, they may sleep more and more and be awake less and less. This is because their body and brain need more rest to cope with the illness. Sleeping can help us estimate how close someone is to dying and how to plan for their final days.
We can use this table to see how much time someone has left based on how many hours they sleep per day:
Hours Sleeping
Estimated Time Left
12 to 16 hours
Six months or less
14 to 18 hours
Three months or less
20 to 21 hours
One month or less
22+ hours
Two weeks or less
This table is a simple and easy way to prognosticate a hospice patient, which means to predict their future. It is based on the experience of a hospice nurse who has cared for many dying patients. However, this table is not always accurate because every person is different, and some people may sleep more or less for other reasons.
Therefore, measuring and communicating sleeping as a prognostication tool is essential, which means checking and sharing their sleeping patterns. We can do this by:
Observing the person’s behavior and condition, and noticing how much they sleep and how well they sleep
Asking the person or their caregiver how they are feeling and coping and what they need or want
Recording the person’s sleep hours, such as using a diary, a chart, or a device
Comparing the person’s sleep hours with the table and seeing how much time they may have left
Adjusting the person’s care plan, such as changing their medication, equipment, or services, to match their needs and preferences
Helping the person with their sleep quality, such as making them comfortable, quiet, and dark
Respecting the person’s dignity, autonomy, and wishes and letting them sleep as much as they can or want
Communicating with the person and their family and providing information, education, and guidance
Supporting the person and their family emotionally, spiritually, and practically, and offering comfort, compassion, and empathy
By doing these things, we can help our loved ones have a better quality of life and prepare themself for their final days.
Conclusion
In this article, we have learned how to use sleep as a prognostication tool for a terminally ill patient in hospice. We have reviewed the research and evidence that support this method. We have also shared some tips and advice on caring for your loved one and yourself during this difficult time.
Our main argument is that sleep is a natural part of life but can signify death. When someone is very sick, their body and brain need more rest to cope. They may sleep more and more and be awake less and less. They may also have changes in their breathing, heart rate, and body temperature while they sleep. These changes can indicate how the body is shutting down and preparing for the end of life.
Our main objectives are to help you understand what is happening and what you can do to make the most of the time you have left with your loved one. We want to help you estimate how close someone is to dying and how to plan for their final days. We also want to help you improve the quality of life and comfort of your loved one and support your well-being and coping.
Our take-home message is that sleep can be a simple and easy way to prognosticate a hospice patient, but it is not always accurate or reliable. Therefore, it is essential to observe, ask, measure, adjust, help, respect, communicate, and support your loved one and yourself during this difficult time. We hope that this article has been helpful and informative for you.
