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This information has been written for the caregiver, but many patients want this same information for themselves. It gives some signs that death may be close and gives the caregivers some ideas about ways they may be able to help.The signs of death being near can be different for each person. No one can really predict what may happen at the end of life, how long the final stage of life will last, or when death will actually happen. Sometimes death comes quickly due to an unexpected event or problem. Other times the dying process moves slowly and the patient seems to linger.If possible, it’s important to have a plan for what to do just following a death, so that the caregivers and other people who are with the patient know what to do during this very emotional time. If the patient is in hospice, the hospice nurse and social worker will help you.
If the patient is not in hospice, talk with the doctor so that you will know exactly what to do at the time of death.Just like the timing of the dying process cannot be predicted, it's also hard to predict what exactly will happen in the final stage of life and especially near death. The following symptoms are examples of what may happen in some people with cancer who are dying. While not all may happen, it may help you to know about them. Nursing care at the end of life: Optimizing care of the family in the hospital setting. Clinical Journal of Oncology Nursing. 2019; 23(1):13-17.Eues SK. End-of-life care: Improving quality of life at the end of life.
Physical changes are likely to occur when you're dying. You can read more about our cookies before you choose. This can last hours or days.
Prof Case Management. 2007; 12(6):339-344.Hui D, dos Santos R, Chisholm G, et al. (2015), Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study. 2015;121(6):960-967.National Cancer Institute (NCI). End of life care. Accessed at on April 2, 2019.Rodgers D, Calmes B, Grotts J. Nursing care at the time of death: A bathing and honoring practice.
Oncology Nursing Forum. 2016; 43(3):363-371. Nursing care at the end of life: Optimizing care of the family in the hospital setting. Clinical Journal of Oncology Nursing. 2019; 23(1):13-17.Eues SK.
End-of-life care: Improving quality of life at the end of life. Prof Case Management. 2007; 12(6):339-344.Hui D, dos Santos R, Chisholm G, et al. (2015), Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study. 2015;121(6):960-967.National Cancer Institute (NCI). End of life care. Accessed at on April 2, 2019.Rodgers D, Calmes B, Grotts J.
Nursing care at the time of death: A bathing and honoring practice. Oncology Nursing Forum. 2016; 43(3):363-371.
Please note: This is a general picture. Individual experiences are unique and influenced by many factors, such as the particular illness and the types of medications being taken, but there are some physical changes that are fairly common.For some, this process may take weeks; for others, only a few days or hours. Physical Changes: weight loss, drop in body temperature and blood pressure, change in skin tone.For most, activity decreases significantly in the final days and hours of life. You will notice:. they will speak and move less,. they may not respond to questions or show little interest in their surroundings,. they have little, if any, desire to eat or drink,.
their body temperature can go down by a degree or more, so as you hold his or her hand, they may feel cold,. their blood pressure will also gradually lower and blood flow to the hands and feet will decrease, and. the skin of their knees, feet, and hands may become purplish, pale, grey, and blotchy. These changes usually herald death within hours to days. When death does occur, the skin turns to a waxen pallor as the blood settles.Breathing Changes: periods of rapid breathing and no breathing, coughing or noisy breaths.When a person is just hours from death, you will notice changes in their breathing:. The rate changes from a normal rate and rhythm to a new pattern of several rapid breaths followed by a period of no breathing (apnea).
This is known as Cheyne-Stokes breathing—named for the person who first described it. Coughing and noisy breathing are common as the body’s fluids accumulate in the throat. This breathing is often distressing to caregivers but it does not indicate pain or suffering. The secretion that causes this sound can often be dried up with the use of certain medicines, such as atropine or scopolamine. Sometimes a vaporizer can ease breathing. You may also want to try repositioning your loved one to his or her side, which can help diminish the sound of noisy breathing.Changes in Consciousness: decrease in consciousness, unresponsive periods; patients may experience hallucinations, illusions and delusions.Because the central nervous system is directly impacted by the dying process, your loved one may sometimes be fully awake and other times be unresponsive.
Caregivers, family, and physicians should always act as if the dying person is aware of what is going on and is able to hear and understand voices. In fact, hearing is one of the last senses to lapse before death.Often before death, people will lapse into a coma. A coma is a deep state of unconsciousness in which a person cannot be aroused. Persons in a coma may still hear what is said even when they no longer respond. They may also feel something that could cause pain, but not respond outwardly.Sensory ChangesIt is not unusual for dying persons to experience sensory changes, which are misperceptions that can be categorized as illusions, hallucinations, or delusions:. Illusions - They may misperceive a sound or get confused about some physical object in the room.
They might hear the wind blow but think someone is crying, or they may see the lamp in the corner and think someone is standing there. Illusions are misunderstandings about something that is actually in their surroundings. Hallucinations - Dying persons may hear voices that you cannot hear, see things that you cannot see, or feel things that you are unable to touch or feel. Delusions of persecution and delusions of grandeur - Some dying persons confuse reality and might think that others are trying to hurt them or cause them harm. Or, they can come to believe that they are much more powerful than they really are and think that they can accomplish things that are not possible.Helpful Next Steps:Learn more about hospice:.If you'd like more information about the sequence of events leading up to the moment of death, we suggest the book (New York: Knopf, 1993).' Signs of Approaching Death' by William Lamers, MD., was revised in part for clarity by Hank Willner, MD, Hospice Foundation of America's Medical Adviser in 2017.About William Lamers: William Lamers, MD, died in 2012 at the age of 80.
Lamers was a long-time consultant to HFA, where he answered questions from families and patients as part of the organization's 'Ask HFA' service. A pioneer in U.S. Hospice care, Dr.
Lamers founded Hospice of Marin (now Hospice by the Bay) in Northern California. Lamers was a frequent panelist on HFA's Living with Grief ® programs and contributor to its Living with Grief ® books.About Hank Willner: Hank Willner, MD, is Medical Adviser to Hospice Foundation of America, Chief Medical Director at Holy Cross Home Care and Hospice, and Palliative Care Consultant at Holy Cross Hospital in Silver Spring, Maryland. Certified in both Hospice and Palliative Medicine and in Family Practice, Dr.
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Willner is a Clinical Assistant Professor of Family Practice at Georgetown University Medical School and is a member of the Maryland State Advisory Council on Quality Care at the End of Life.
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