For a non-healthcare professional who has never witnessed death before, it can be unsettling to be present with someone who is nearing the end of their life. However, there are certain signs and observations that you can make using your senses that may indicate that the person you are with may pass away within seconds, minutes, or hours. Understanding these signs can help you provide support and comfort to the individual and their loved ones during this grim time.
Changes in Breathing
One of the most noticeable signs that someone may be approaching death is a change in their breathing pattern. Pay attention to the following:
Cheyne-Stokes breathing: This is characterized by alternating periods of deep, rapid breaths followed by periods of no breathing. It may sound like the person is gasping for air.
Irregular breathing: The person's breathing may become erratic, with long pauses between breaths or shallow, rapid breaths.
Noisy breathing: You may hear gurgling or rattling sounds, often called the “death rattle.” This occurs due to the accumulation of secretions in the throat and chest.
Decreased Responsiveness
As the person nears death, they may become less responsive to their surroundings. Look for these signs:
Lack of response: The person may not respond to your voice, touch, or other stimuli.
Decreased consciousness: They may appear drowsy or in a deep sleep-like state.
Loss of facial expressions: Their face may appear relaxed or devoid of normal expressions.
Changes in Skin Color and Temperature
Observing changes in the person's skin can provide important clues about their condition:
Pale or mottled skin: The person's skin may become pale or have patches of discoloration.
Ashen or dusky complexion: The person's complexion may look ashen or dusky.
Coolness of extremities: As circulation decreases, the patient's hands, feet, and limbs may feel cool to the touch.
Cyanosis: The lips, fingertips, or other areas may turn bluish or purplish due to reduced oxygenation.
Decreased Urine Output
Monitoring urine output can be an indirect indicator of the body's declining function:
Reduced or no urine output: The person may produce very little.
Changes in Vital Signs
Although measuring vital signs accurately requires medical equipment, you can still look out for certain observable changes:
Weakening pulse: The pulse may become weaker or irregular.
Decreased blood pressure: The person's blood pressure may drop significantly.
Slowed heart rate: The heartbeat may become slower or irregular the closer one becomes to death, but there is often a faster period than normal heart rate (normal is 60 to 100 beats per minute).
Terminal Restlessness or Agitation
While not always present, some individuals may experience restlessness or agitation in their final moments (these signs can occur as close to three days before death or as far as two to four weeks before death):
Inability to find comfort: The person may have difficulty getting comfortable in bed or may repeatedly change positions.
Agitated movements: They may exhibit restless behaviors, such as picking at bedding or pulling at their clothes.
Remember, these signs are not definitive indicators; each person's experience can vary. It is essential to consult with healthcare professionals for an accurate assessment and guidance in providing care.
As a supportive presence, you offer comfort, reassurance, and a calming presence to the dying person and their loved ones. Be attentive, hold their hand, speak softly, and provide comfort measures such as adjusting pillows, moistening their lips, or playing soothing music.
Conclusion
The actively dying phase of the dying process can be a challenging and emotional time for both the individual and their loved ones. Understanding the signs and observations that may indicate that a person is nearing the end of their life can help provide support and comfort during this difficult time. Changes in breathing, decreased responsiveness, changes in skin color and temperature, decreased urine output, and changes in vital signs are some of the physical signs that may be observed. Additionally, terminal restlessness or agitation may also be present in some individuals. It's important to note that these signs are not definitive indicators, and each person's experience can vary. Therefore, consulting with your hospice provider for an accurate assessment and guidance in providing care is essential. As a supportive presence, offering comfort, reassurance, and a calming presence to the dying person and their loved ones is crucial. Being attentive, holding their hand, speaking softly, and providing comfort measures such as adjusting pillows, moistening their lips, or playing soothing music can help create a peaceful environment during this challenging time. Remember, the dying process is highly variable, and it's important to approach it with empathy, compassion, and understanding.
