Being a part of someone’s end-of-life journey can be both stressful and an honor for caregivers and family. You can offer comfort and support best when you have knowledge of what to expect during the dying process.
Each death is unique, but there are common signs many will share.
Withdrawing
Your dying loved one will spend more time sleeping and withdrawing. They may not show interest in things that they normally enjoyed. They may not want to talk or visit as much. They may be slow to recognize others. This is not a rejection of you, but the natural process of dying.
You can support your loved one by being a quiet presence and allowing them to take the lead on how much they want to interact. Identify yourself and avoid quizzing your loved one about who you are.
Not Wanting to Eat or Drink
One of the most distressing signs for family members is when their loved one doesn’t want to eat or drink. This is normal. Your loved one is not suffering if they don’t eat. The body knows how to die. Its systems are shutting down as well as its ability to process food. Forcing food and drink can make your loved one uncomfortable because the body doesn’t want to process these anymore.
You can support your loved one by offering ice chips or wet mouth swabs to help moisten their mouth.
Seeing Visions
At different stages of the dying process, your loved one may report being visited by deceased family members, pets or religious figures. This is a common phenomenon that can occur in the weeks and days leading up to death. As your loved one gets closer to death, they may reach into the air as if trying to grasp or pick at something.
You can support your loved one by validating their experiences. It isn’t helpful to tell them what they are experiencing isn’t real. After all, we can’t prove whether or not it is.
Loss of Bladder and Bowel Function
Your loved one may become incontinent, meaning they have lost bladder or bowel control.
You can support your loved one by making sure they are changed when wet. Keeping the skin dry of urine will help to avoid skin breakdown. Reassure your loved one that there is no shame in what they are experiencing. It is normal.
Consciousness Decreases
In the days before death, your loved one will probably become less conscious. Most people will experience a decrease in consciousness before death, unlike in the movies where people speak profound words before taking their last breath.
You can support your loved one by continuing to speak to them like you normally would. Hearing is retained up until death. Reading aloud and telling stories can be a comforting way to spend this time. Step out of the room if you plan to have conversations that you wouldn’t want your loved one to hear.
The Rally or Terminal Lucidity
Your loved one may have a period of alertness and mental clarity after declining or being unresponsive. This period is called terminal lucidity or the rally. It can last anywhere from moments to a full day. Your loved one may seem like their old selves again. This often gives family members false hope that their loved one has gotten better.
You can support your loved one by listening to what they have to say during this time. They may want to reminisce or tie up loose ends. Enjoy the gift of this moment.
Restlessness and Agitation
As your loved one gets close to death, they may experience terminal restlessness. This is a period of restlessness and sometimes agitation. It can be difficult to watch a loved one be distressed. There are medications that help manage these symptoms.
You can support your loved one by not startling them with bright lights, loud noises or harsh voices. Identify who you are even if you’re sure they know. Speak in a gentle, reassuring voice. Be open to the possibility there is something your loved one wants to resolve before they are willing to die.
Breathing Changes
When your loved one becomes less conscious, they will be unable to clear the secretions that normally occur in the mouth and throat. Air moving over these secretions during breathing creates gurgling that is sometimes referred to as the death rattle.
Breathing may become irregular. Your loved one may have rapid breaths and then stop breathing for periods that can last up to 45 seconds. This is called Cheyne-Stokes breathing. Short, rapid breaths may also occur. While these breathing patterns may be unsettling to see, they are not uncomfortable for the dying person. It is a normal part of the dying process. When Cheyne-Stokes breathing and noisy secretions occur, it is an indication that death is near.
You can support your loved one by gently wiping away excess secretions if appropriate. Turn their head so gravity can help to drain the secretions.
Skin and Temperature Changes
You may notice bluish purple blotches on your loved one’s skin, especially on the legs and arms. When the body is dying, blood moves toward the core making extremities cool. Fevers are normal in the dying process.
You can support your loved one by adjusting the room temperature to keep them comfortable. Use light blankets or a sheet when they have a fever. A cool washcloth to the forehead may be comforting.
Hopefully, you have gained more knowledge about the dying process and can support your loved one through their end-of-life journey.
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