What to Expect as Your Loved One Nears Death
Understanding and recognizing the signs of approaching death allows for preparation and planning to ensure that the dying person has a peaceful and dignified death, and for their loved ones to provide comfort and support.
Death is an inevitable eventuality in everyone's life. We all come to death in different ways, but unless it’s a case of sudden or traumatic death, there are some recognizable signs. Recognizing these signs can be critical for families, caregivers, and healthcare professionals as it guides them to prepare for the inevitable and helps the dying person to have a peaceful and dignified death. In this guide to end-of-life care, we will discuss some of the common signs of impending death that you should look out for.
1: Decreased Appetite and Thirst
The first sign you may notice is a decreased appetite. As the body prepares to shut down, it reallocates limited energy supplies to keep the essential systems of the body working. Digesting food requires a level of energy that the dying person may not have. Thus, their bodies lack the energy to digest food, making the presence of food painful or even intolerable. Forcing someone to eat or drink at the end of their life may prevent the buildup of ketones and reverse this metabolic process, causing increased hunger, thirst, and pain.
2: Mottled Extremities
The reallocation of energy supplies also involves shunting blood away from non-vital areas, such as the arms and legs, to preserve oxygen delivery to the brain and heart. This may lead to cold and mottled extremities, which it then travels up from. It is not painful, but giving the patient an extra blanket may help keep them warm. Research shows that this occurs late in the dying process and is a cardinal sign that death will occur within hours to days.
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3: Breathing Changes
As the body dies, respiration progressively becomes a solely involuntary act controlled by the brain stem. This primal part of the brain handles life-saving functions when the rest of the brain is unaware of what’s happening. Breathing often becomes irregular, and there might be periods in which a person is unable to breathe at all for as long as 10 to 20 seconds at a time. Administering oxygen does not help. In fact, due to these breathing patterns, oxygen is not likely to be taken deep into the lungs, which often results in drying the person’s nose and mouth. On top of this irregular breathing pattern, you may also hear a gurgling sound each time the patient breathes. This is because swallowing becomes more difficult, and secretions may pool at the back of the throat, causing the noisy breathing known as the death rattle.
4: Incontinence
When we’re alive, our brain constantly sends signals to tell different parts of our body what to do. At the end of life, these signals stop, and our muscles relax. The sphincter is in a constant state of contraction, so when there are no more brain signals to the bladder or bowels, they will relax. So it’s not uncommon for incontinence to occur just before death.
5: Agitation
The final sign is agitation. You may find your loved one, who is typically lethargic, trying to stand up, get out of bed, or change position. They may tug at their clothes or bedding. They may not recognize you or yell at you using language you’ve never heard from them before. These symptoms may be caused by reduced oxygen to the brain, dehydration, or pain medications. Although it may look distressing, this condition is not considered to be painful. Anti-anxiety medication can be given to alleviate the symptoms.
Final Words
Understanding and recognizing the signs of approaching death can be crucial for both the dying person and their loved ones. It allows for preparation and planning to ensure that the dying person has a peaceful and dignified death, and for their loved ones to provide comfort and support. The signs discussed in this guide to end-of-life care include decreased appetite and thirst, mottled extremities, breathing changes, incontinence, and agitation. By being aware of these signs, families, caregivers, and healthcare professionals can help ease the dying process for everyone involved.
Recognizing the 5 Signs of Approaching Natural Death: A Guide to End-of-Life Care (PDF)