Topic: 14

Signs of Approaching Death and What to Do

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What You Need to Know

No matter how much we prepare or no matter what we expect, the moment of death will arrive in its own time and in its own way. The experience of dying is different for every person and for every family.

  • Some deaths may take a long time, and this puts tremendous strain on everyone involved in the person’s care, especially you.
  • Some deaths are sudden, some are painful and some do not progress as expected. However, most people do slip into a state of unawareness. For example, many people die after being in a coma for several days or hours.
  • Some family members become troubled toward the end of a person’s life because they feel that they are not doing enough. Many exhausted family members, who have watched their loved ones struggle, will long to have the ordeal end. The expression of such a desire creates a lot of unnecessary guilt.

Signs that the End of Life is Near

Each person’s experience will be different. Some people will have all of these physical changes and other people will only have a few.

The person may:

  • Sleep longer and sometimes have difficulty waking up eventually slipping into a coma

Help by: Sit with the person; hold his/her hand, but don’t shake it or speak loudly, speak softly and naturally. Spend time with your loved one at times when he/she is more alert or awake. Avoid speaking about the person in his/her presence. Speak to him/her directly even if there is no response. Never assume that he/she can’t hear; hearing is the last of the senses to be lost.

The person may:

  • Become confused or agitated

Help by: Identifying yourself before you speak, rather than asking the person to guess who you are. Speak softly and clearly. Sit with the person; hold his/her hand, but do not shake it or speak loudly, speak softly and naturally. Spend time with your loved one at times when he/she is more alert or awake. Avoid speaking about the person in his/her presence. Speak to him/her directly even if there is no response. Never assume that he/she cannot hear; hearing is the last sense to be lost.

The person may:

  • Eat and drink less if at all and have no appetite or thirst

Help by: Although this is a normal part of the dying process, it is often a difficult time for family and friends. It is important to talk about feelings and fears. Do not force the person to take food or fluids. Feeding them may increase the person’s discomfort. Keep them comfortable by giving them the food and fluids they want and keeping their mouth moist with gentle mouth care. Hunger is rarely felt. The natural processes respond to taking in fewer fluids by the person having fewer problems with swelling, congestion, and the need to get up to go to the bathroom.

The person may:

  • Have cool hands and feet and pale bluish or mottled skin (dark and light patches)

Help by: This indicates that the blood flow is decreasing to the body’s extremities and is being saved for the most important organs. Keep the person warm with blankets, using just enough to keep the person comfortable. Avoid using an electric blanket.

The person may:

  • Have less urine output and/or lose bladder control
  • Have no bowel movement or have uncontrolled oozing of soft liquid or stool

Help by: The person may lose control of their bladder and bowels as the muscles in these areas begin to relax when end of life is very near. The person may not be able to pass their urine. This may cause agitation and pain for the person. Place protective pads or toweling under the person’s hips and change when necessary, use adult incontinence briefs if necessary and change as needed.

The person may:

  • Breathe shallowly and irregularly even stopping breathing for several seconds at a time
  • Make wet or moist breathing sounds or make a rattling gasp for air
  • May have difficulty swallowing or forget how to swallow

Help by: Turn the person’s head to the side and allow gravity to drain the saliva. You can wipe the mouth with a moist cloth. Raise the head of the bed or turn the person to the side. Hold the person’s hand and speak softly. Avoid suctioning, as this may cause sharp discomfort.

The person may:

  • Become unable to recognize familiar people or surroundings
  • Become profoundly weak
  • Have difficulty responding verbally

Help by: Sit quietly to provide a comforting presence. Reduce confusion by limiting distractions such as television, radio, or too many visitors. Gently bring the person to reality with reminders about where they are, who you are, what time it is, etc.If it is okay with the person you are caring for, the use of touch to connect with someone who is unable to respond may be helpful to let them know you are there. Soft music may be relaxing. Assume the person can hear everything you say on some level.

The person may want to be with just a few or only one person. This is a sign of preparation for release. If you are not part of this, it doesn’t mean you are not loved or are unimportant. It means you have already fulfilled your task with the person; it’s time for you to say goodbye. The person may speak or claim to have spoken to a person already dead, or to see places/people not visible to you. When death is near, some First Nations family members may see signs, for example, a bird flying in the house, hearing a knocking sound at the door, or the presence of an owl nearby. This isn’t a drug reaction or hallucination. The person is detaching from this life, and is being prepared for the transition so it will not be frightening. Accept what the person is saying. Avoid explaining away or arguing. The experience is real to your loved one and is normal and common.

The person may:

  • Develop a fixed stare

Help by: Moisten the eyes with eye drops especially if their eyes have been open for long periods of time. Pain management: Continue giving pain medication, if the person can’t swallow use a suppository or injection under the skin that the doctor will prescribe; provide reassurance, speak soothingly, massage the person gently, be alert to any needs the person communicates

Be present: Encourage reminiscing, prayers, tears, touching, hand holding, hugging 

When to Call for Help

Some situations that require assistance from health care professionals include:

  • The person has pain or other symptoms that are very difficult to manage or relieve.
  • The person is unable to take prescribed medications.
  • You are overwhelmed by the person’s needs and condition.

What to Do if You Think Death Has Happened

Do not call 911, the police, or the fire department. These calls are not necessary when the death is expected.

  • Call the person who will pronounce the death. It is important to talk about who will pronounce the death and sign the death certificate before death occurs.
  • Do what you feel is right for you and not what you may feel is expected of you. Please know that there is no ight or wrong way to be at this time.
  • Allow everyone as much time as they need to say good-byes. For some this may be hours, while others may not wish to stay. You or family members may want to wash and dress the person, and attend to any rituals that are important to the family.
  • Do not be afraid to touch, hug or kiss the person. Some people may wish to lie down beside their loved one. These reactions are normal. Be aware that others may have needs which are different from yours, so be sensitive to and supportive of their special concerns.
  • Crying is a personal reaction. For some this is a natural reaction to grief. Others may internalize their feeling and may not be able to cry. This doesn’t mean that one grieves more than the other; both reactions are normal.
  • Prayer: Prayers are very important for some, but unnecessary for others. Be guided by your inner self and do what is right for you.
  • Cultural rituals: It may be necessary for you to attend to special cultural ceremonies or prayers according to tradition at this time and what the person wanted.
  • Spirituality: For some this is very important, while others may have a lesser need.

(“Caring for the Terminally Ill: Honouring the Choices of the People Person/Family/Community, 3rd Edition August 2014)

 

1. Read this scenario.

Clarence and Lydia were suffering from shock and denial about the recent diagnosis of their son, Luke. With a rare form of cancer and a very poor prognosis they were having a great deal of difficulty coming to terms with the fact that their son was dying. Wishing to care for him at home, they made the decision to move forward with taking leaves of absence from their jobs and outfitting their home to ensure that Luke was still at the heart of the home.

2. Now that you understand more about the final weeks of life, do you think Lydia and Clarence should be told what to expect/what will happen? Why or why not?  Write down your thoughts before checking the sample answer.

Sample response:

Yes they should be told. If they want to care for Luke at home then they need all the information possible ahead of time to prepare them to handle what lies ahead. Once they understand what is going to happen they will be more prepared and more able to put supports in place to help them if and when they feel that might be necessary.

 

ADDITIONAL RESOURCES

Use these additional resources to learn more about the topic of the signs of approaching death.

Canadian Cancer Society: Signs that Death is Near
www.cancer.ca/en/cancer-information/cancer-journey/advanced-cancer/signs-that-death-is-near/?region=on

How to Say Good-bye When Someone You Love is Dying
www.caring.com/articles/how-to-say-goodbye