People have differing levels of knowledge about dying. They also have differing views about how much they want to know. Some want to know what to expect; others prefer not to know.
Unlike other big events in life such as birth, a new house, or a new job, dying is not often discussed. Talking about dying can be hard. There is no right or wrong way to deal with death and dying. Your beliefs, values, culture, experiences, and circumstances will shape your own view.
The oldest and frailest in our society are becoming less visible as many who need the most support, such as those with dementia, are either in care homes or less able to get out and about. But their voices are crucial to shaping end-of-life care services.
Death was part of life for many of the older people who often said they were taking each day as it comes and not worrying too much about tomorrow. “It is only day-from-day when you get to 97,” said one woman. Most felt ready to die and some even welcomed it: “I just say I’m the lady-in-waiting, waiting to go,” said one.
Others were more desperate in their desire to reach the end. “I wish I could snuff it. I’m only in the way,” was a typical sentiment in those who felt they were a nuisance. Others begged not to be left to live until they were a hundred, saying there was no point in keeping them alive.
Most were concerned about the impact on those left behind: “The only thing I’m worried about is my sister. I hope that she’ll be not sad and be able to come to terms with it.”
The dying process itself was the cause of most worries. A peaceful and painless death, preferably during sleep, was a common ideal. Interviewees mainly preferred to be made comfortable rather than have treatment, wishing to avoid going into hospital.
Signs That Someone Is Near the End of Their Life.
It’s distressing to learn that a loved one is reaching the end of their life, but knowing what to expect can make it less upsetting for all involved. If you’ve hired hospice professionals, they can help make your loved one’s last months, weeks, and days as comfortable as possible, and also support you as you go through this difficult time.
Here are 16 common signs that often occur at the end of life:
The following describes the physical symptoms you may observe. Here are end-of-life signs and helpful tips:
Hands, arms, feet, and legs may be increasingly cool to the touch.
The color of the skin may change and become mottled.
How you can help: Keep the person warm with comfortable, soft blankets.
The patient may not know time or place and may not be able to identify people around them. How you can help: If this end-of-life sign is occurring, Identify yourself by name before you speak. Speak normally, clearly, and truthfully. Explain things such as, “It’s time to take your medicine now.” Explain the reason for things, such as, “So you won’t start to hurt.”
An increasing amount of time may be spent sleeping. The person may become unresponsive, uncommunicative, and difficult to arouse. How you can help: Sleeping more frequently is normal. You can sit quietly with them. Speak in a normal voice. Hold their hand. Assume they can hear everything you say. They probably can.
They may lose control of urinary/bowel functions. This is a common end-of-life change that can occur during the process of passing on. How you can help: Keep your loved one clean and comfortable. Ask your hospice nurse for advice.
The person may make repetitive motions such as pulling at the bed linen or clothing. This is due in part to A decrease in oxygen. How you can help: Do not interfere with these movements or try to restrain them. Speak in a quiet, natural way. Lightly massage their forehead. Read to them. Play soothing music.
There may be gurgling sounds inside the chest. This is also sometimes referred to as a “Death Rattle.” These may be loud. This end-of-life symptom does not indicate the onset of severe pain. How you can help: Gently turn their head to the side to drain secretions. Gently wipe their mouth with a moist cloth.
7) Urine decrease:
Output may decrease and become tea colored. How you can help: Consult your hospice nurse.
8) Fluid and food decrease:
Your loved one may want little or no food or fluid. The body will naturally conserve energy required for the task ahead. Food is no longer needed.
How you can help: If this end-of-life symptom is present, do not force them to eat or drink if they don’t want to. It only makes them more uncomfortable. Small chips of ice or frozen juice chips might be refreshing. A cool, moist cloth on their forehead might help.
9) Change in breathing:
The person may take shallow breaths with periods of no breathing for a few seconds to a minute. They may experience periods of rapid, shallow panting. These patterns are common and indicate a decrease in circulation. How you can help: Elevating their head or turning them on their side may bring comfort. Hold their hand. Speak gently.
An increase in temperature is common. How you can help: Consult your hospice nurse. A cool, moist cloth on their forehead may bring comfort.
As end-of-life physical changes occur, your loved one is completing important work on another level. Emotional and spiritual changes may be manifested. The next section describes the appearance of these tasks.
Emotional and spiritual end-of-life signs:
1) Giving away belongings and making funeral plans:
Some people want to maintain control over their life, so they want to participate in making final decisions about their belongings or their person. How you can help: Although it is emotionally hard for families to talk about final arrangements, it is important to let your loved one do this if they want. Everyone, especially the dying, appreciates having their choices honored.
The person may seem unresponsive, withdrawn, in a comatose-like state. They are detaching. It is a typical end-of-life symptom. How you can help: Know that hearing remains. Speak in a normal voice. Identify yourself. Hold their hand. Say what you need to say. This helps them let go.
3) Vision-like experiences:
The person may say they have spoken to people who are already deceased. They may say they have been places or seen things not visible to you. This is not a hallucination or a drug reaction. It is a common symptom of the end-of-life process. How you can help: Do not contradict, explain away, or discount this experience. Affirm them. If the experience frightens your loved one, reassure them it is common and natural: “Yes, these things happen.”
Repetitive and restless tasks may indicate something unsolved or unfinished is preventing them from letting go. How you can help: Talk with your hospice chaplain. Help the person recall a favorite place or good experience. Read to them. Play soothing music. Give reassurance that it is okay to let go.
5) Communication and permission:
Your loved one may make statements or requests that seem out of character. They may be testing you to see if you are ready to let go. They may want to be with a few select people. Maybe they only want one person. If you are not included, it does not mean you are not important or not loved. It means your task with the person is fulfilled. If you are selected, it may mean the person needs your affirmation, support, and permission to let go. How you can help: Let your loved one know you will be alright. Say whatever words of love and support you need to say. Give them permission.
6) Saying goodbye:
This is their final gift. How you can help: Listen. Hold them. Say whatever you need to say. It may be just, “I love you,” or recounting favorite memories you have shared. It may be an apology, or saying, “Thank you.” There is no need to hide your tears. Tears express your love and help you let go.
Remember, all these end-of-life signs and symptoms are common. Your loved one may be as unique during this time as they have always been, so they may show some of these signs and not others. Or they may be different altogether.
Preparing for the end of someone’s life
You can do things to prepare yourself as someone approaches the last few weeks and days of life. You may want to sit with the dying person, sometimes for hours. This does not mean that you will be there when they die. The person may die when you are out of the room. This happens a lot. You shouldn’t feel guilty about this.
Often there are signs that death is imminent and you can get family and friends together. Sometimes, a person will die quickly without some of the warning signs.
You may have seen someone die before but every death is different and you cannot predict what will happen. You may feel that you just want it all to be over. This doesn’t mean that you wish the person dead. It may mean that you just want them to be relieved of their distress.
Sometimes the person says they are bored or depressed or are tired of being a burden or just want it to end. Comments like this can cause concern for others but are very common. Often just acknowledging your relative’s feelings can help. If unsure what to say or do, ask a palliative care team member; they have good skills at dealing with this stage of life.
If this information stirs up emotions for you, ask for support from those around you, or contact your doctor or the palliative care team for further information about support.