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SIGNS THAT END OF LIFE IS NEAR Death is a very individual process and many times looks different from one person to another. It can happen quickly over hours or last for a few days. There are certain things that your care team looks for that tell them when death is getting closer. Some people are very comfortable watching this process unfold but others can be apprehensive to watch their loved one progress towards death. If you have any questions or concerns, or if you need support, please reach out to your care team. We are here to support everyone involved in the process.
• Vital sign changes: decreased blood pressure and oxygen level, decreased or increased pulse • Decreased urine and bowel output *FOOD AND DRINK Food is a major part of our social fabric and, for many of us, a way to express love. Many people have foods or drinks that bring them joy and it is normal to want to continue giving pleasure to someone as their quality of life decreases. It is often the last comfort that someone experiences when dying. But it is not always the best thing for someone as death becomes closer. As the body begins to shut down, its need for food and fluids goes away. Many people are able to express that they just don’t feel like eating or drinking. This is a nor- mal process and usually not troubling to the patient. The ability to swallow safely (without going into the lungs) often changes as death approaches. Offering food and water at this time can actually cause harm to the pa- tient. Food can get stuck in the throat or go into the lungs, making the patient feel as though they are chok- ing, often causing panic. The body cannot process fluids like it used to, so giving fluids - either by mouth or IV - can cause fluid to move to the lungs and increase trou- ble breathing and/or secretions, sometimes called the “death rattle.” If you have any questions about how or if to give food or drink, please talk with your care team.
Your loved one may or may not experience: • Decreased desire to take food or water* • Unable to wake up patient or significant drowsiness (it is said that they can still hear you at this time) The natural dying process includes a decrease in con- sciousness. While some medications can cause drows- iness, it is usually not the only reason that someone is sleepy at the end of life. It is important to consider that without medication, your loved one could be very uncomfortable. Please ask your care team if you have questions or concerns about this. • Breathing pattern changes: irregular breathing, long pauses in breathing with or without gasps or “fish out of water” breathing These are normal changes in breathing patterns and typically do not cause any discomfort. Your care team looks for things like using abdominal muscles to breathe out, breathing rate, or a distressed look on the face to determine if a patient is having trouble breathing. • Congestion, also known as terminal secretions: can sound like a gurgle or need to clear throat This is often considered to be more disturbing to those observing it than it is to the patient. There are ways of positioning someone to help decrease this issue. • Hands and feet turn blue or purple and become cold. Knees, ankles and elbows become blotchy • Unexplained fevers that don’t get better with med- ication and are not necessarily related to infection
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