Patient education: How to tell when death is near (The Basics)

What should I know about dying and the end of life? — 

Sometimes, death happens suddenly, like with an accident or medical crisis. Other times, a person has an illness that eventually leads to death. The process of dying can actually start weeks to months before a person dies.

People often want to know how they can tell when a person is dying. No one knows exactly when a person will die. However, doctors and nurses have worked closely with people at the end of life. They have found some signs that often happen as a part of the natural dying process, in the days before death.

Learning more about the process of dying might help you better care for and support a person who is dying. It is important to remember not all these signs happen to everybody.

What happens during the natural dying process? — 

People who are dying tend to let go of their senses and body functions. This is a normal process. A person who is dying might seem to improve for a short time, but this is temporary. This can be upsetting to others, since it seems like the dying person is getting better.

As a person approaches death, they might:

●Lose the desire to eat or drink – This can be hard to deal with. The person's body processes are shutting down, so they do not require energy from food or drink. They do not feel hungry or thirsty. So IVs and tube feedings usually do not help them.

●Speak less – They might speak more slowly or have trouble having a conversation. As they spend more time sleeping or unconscious, they will stop speaking completely.

●Have trouble seeing – They might not look at you like they used to, and their eyes might often be closed or look glazed over. Or they might only close their eyes part of the way because they have less muscle tone. Sometimes, people hallucinate or see things that are not really there.

●Lose their sense of touch – It is possible they will still feel your touch, but not respond like they used to.

●Still be able to hear – Studies have shown hearing is the last sense to go. Even if the person cannot respond to you, they can likely hear your voice and the sounds around them.

What changes should I expect when a person is dying? — 

A person who is dying might have changes to their:

●Breathing – It might be slow and shallow, almost like they are barely breathing. After that, they might take faster, deeper breaths. This pattern can repeat. Their breathing might be noisy or congested. They might make gurgling or rattling sounds when they breathe. This is due to a buildup of mucus in their mouth and the back of their throat.

●Mental state – It is common for the person to sleep most of the time. They might not be aware of their surroundings, or seem confused and restless. They might pick at clothes or sheets. It is also normal for them to be unconscious, not be able to be woken up, and not move on their own.

●Skin – The person's skin, especially their hands and feet, might feel cool. Their skin color might change and be blotchy or mottled. Their skin, lips, or nailbeds might be pale, blue, or purple. They might sweat a lot.

●Bowels and bladder – When a person is dying, it is normal to lose control of their bladder or bowels. This is called being "incontinent." They might make less urine or become constipated.

How do I care for a person who is dying? — 

Ask the doctor or nurse what you should do to care for the person. Ask questions if there is anything you do not understand.

Here are some ways you can help someone who is dying:

●Offer ice chips, or wipe their mouth with a wet washcloth or mouth swab. Use lip balm to keep their lips moist and comfortable. Use lubricating eye drops to help with dry eyes.

●Change their position every few hours. Keep them comfortable. Raise the head of their bed slightly. This might help with breathing. Adjusting their position or adding pillows to raise their head might help with noisy breathing.

●Enjoy any brief moments of alertness. It is OK to still talk with them even if they are not responding to you.

●Keep the temperature in the room comfortable. Turn on a fan, or offer them a warm blanket.

●Keep them clean. Change bedding as needed. Use disposable, waterproof pads to protect the bed. This keeps them comfortable. It will also help to remove any unpleasant smells.

●Honor their desire to speak with clergy or meet other spiritual needs, if they wish it.

●Speak softly and calmly. Reassure them, and help them know where they are.

●Offer a light massage, put lotion on their skin, or hold their hand. Remember, even if they appear to be asleep, they might still be able to hear you and feel your touch.

What else should I know? — 

A person who is dying might need medicines to help with pain, anxiety, or other problems. Many medicines can be given as a liquid or suppository. The doctor or nurse will make sure you know what medicines to give and how often. Ask questions if there is anything you do not understand about the medicines.

If possible, get support for yourself, too. It can be difficult caring for someone at the end of life.

More on this topic

Patient education: Palliative care (The Basics)
Patient education: Advance directives (The Basics)
Patient education: Medical care during advanced illness (The Basics)
Patient education: Coma (The Basics)