Signs of Death, What to Look For And What to Do.

How do you tell is someone is going to die or getting close to dying?

It is always hard when a person has a terminal illness.  Knowing death is near can make it difficult to cope in an already stressful situation.  However, knowing the signs and symptoms that may be coming before they happen can make it a little easier.  Knowledge of what is expected can help you be prepared.  Being prepared to provide loving care to your loved one with confidence and without anxiety is exactly what your loved one needs.

When a person is declining they may be in the hospital, at home or in a facility.  They may be receiving palliative care or hospice.  Knowing the signs listed below will help you be prepared and be ready for when that time comes.  This is always a difficult topic, but educating yourself shows how much you care for your loved one.

Being Less Social

It is normal for a dying person to have lower energy levels.  The body is not processing things the way it normally did, and the end result is increasing weakness, and decreasing energy levels.  This can manifest as being less social, spending less time with loved ones.  Loved ones should not take offense to this as this is part of the normal dying process. 

Your loved one also may not want to show you how weak they are now, or want others to know they are losing their strength.  It may be beneficial to allow family and friends to have specific times or arranged visits to allow your loved one to rest prior to the visits.

Decreasing Appetite

It is normal for a dying person to become less active and require less food.  The body needs less energy than it once did. As a result, individuals can stop eating or drinking as much as they use to.  Allow your loved one to eat when they are hungry, and encourage sips of water or ice chips to allow them to stay hydrated.

A few days to a week before death, a person may stop eating or drinking completely.  This is normal, and if this occurs use a sponge to keep their lips moist or use lip balm to keep them comfortable.

Artificial nutrition and forced feedings can make things worse.  As the body shuts down, the brain will in itself cause the dying person to eat less.  If we force feed individuals, this food can not be processed properly, and can lead to abdominal distension, nausea, vomiting with possible aspiration.   Forcing fluids by mouth or IV can lead to fluid imbalances causing fluid to build up in the arms/legs leading to skin breakdown or fluid build up in the lungs causing shortness of breath and cough.  It is best to allow the dying person to tell us how much they want to eat and drink.  It can be difficult to watch, but knowing that forcing the issue can make things so much worse is important to understand.

Weakening Muscles

It is normal for a dying person to become weaker.  You may notice their clothes getting looser, notice muscle atrophy as the body prepares to die.  This is normal and expected.  Weakness can cause the dying person to have trouble with even simple tasks they could easily do before.  They may no longer be able to turn in bed, or drink from a glass or feed themselves.  If this happens, caregivers should be prepared to support their loved ones as needed.  Discuss with your hospice team, who can show you to properly transfer/move patients in bed and assist with activities of daily loving.

Changes in Vital Signs

It is normal for a dying person to have changes in their vital signs.  You may note changes in normal body temperature, especially as the dying person is within days of dying.  Changes in heart function and blood flow can cause less blood being pumped to the skin and arm and legs.  This will manifest as cooler, pale looking skin.  The skin may mottle (purple/blue patches on the skin), which is normal and happens as death approaches.  Covering your loved one with blankets and keeping them warm will keep them comfortable.

You will also notice that blood pressure will drop, breathing may slow down or speed up (or alternate between each), heartbeat can become irregular and the pulse may be difficult to detect.  You may notice that the dying person may have decreased bowel movements and urinate less. They are usually eating less, and things are slowing down in the gut, so this is expected.  The urine color may change to reddish/rust color.  The dying person’s kidneys are shutting down and urine is not being processed the way it normally is.  This is normal, and there is no reason to be alarmed.

Breathing may change as they dying person transitions.  The rate of breathing may change, speed up or slow down.  It may alternate between both.  They may appear to gasp for air or have long periods of pauses between breaths.  This is part of the normal process, and is expected.  The hospice team will spend time educating you on this and provide you with medications if needed to help control any discomfort that may be noted.  In general, changes in breathing rate are not bothersome to patients and usually do not cause distress.

Pain, Hallucinations, Confusion

It is normal for a dying person to have changes in their pain.  This is something no one wants to see or witness, but does happen as the person proceeds in the dying process.  If you notice expressions of pain, grunting, or anything else that looks like pain talk to your hospice team.  We know this happens to a lot of patients and have pain medications available to help care for your loved one.   The hospice team will educate you on how and when to use certain medications to help with your loved one’s suffering.  Our goal is to make them as comfortable as possible.

Hallucinations and confusion are not uncommon.  Patient may experience visions or speak to dead relatives or pets. Even though this can be concerning, it is best to not be alarmed or contradict or argue with the dying person.  Try not to correct the visions, but to acknowledge you heard your loved one and move on to another topic of conversation.  If your loved one is getting more confused, keep talking to them, explaining to them what is happening around them, where they are.  Introducing all visitors, no matter how long they have known them (including children/family) is important.

The Final Hours

It is normal for a dying person to have their organs shut down and body to stop working before they die.  This is a very difficult time for everyone.  It is important to have loved ones close to your loved one, holding their hand and talking to them if possible.  Our goal should be to make the last few hours as comfortable as we can.

It is a good idea to keep talking to a dying person until they pass away.  They can hear and are aware of what is going on around them.  If you run out of things to say or get emotional, start talking about your favorite memory with them, and share it with them one last time.  Tell them you love them, and you are there for them.

Your Hospice team remains available during this time.  If you see changes happening, call the hospice team to allow them to be there for your loved one and for you.

Stages of Imminent Death