How to Know and What to Do

The very end of life can be a very uncertain time for family and caregivers. People tend to cope better when they have an understanding of what is happening and what to expect. Fear of the unknown is sometimes much worse than the reality. The following information is offered to help you understand symptoms which may indicate that death is approaching. Not all dying persons have all of the symptoms, but possibilities are presented in order to decrease fear if one should appear suddenly. The symptoms are how the body prepares itself for the final stage of life.

Signs of Approaching Death and Helpful Ways You Can Respond

The person may: Sleep more and, at times be difficult to awaken: Plan conversation times for when the person seems more alert, or when they have more energy. Be very fatigued when they are awake. Restrict the number of visitors at one time; encourage activity in small increments. Lose his or her appetite and may “forget to swallow”: Offer small servings of a favourite food or drink without forcing. The person does not need food at this point, but it may be offered for comfort. Become confused about time, or may not recognize familiar people: Speak calmly so as not frighten. Remind the person of the day, the time, and who is in the room. Experience impaired hearing and vision, and may have a fixed stare: Leave a soft light on in the room. Never assume the person cannot hear you. Speak as if each of your words can be heard. Become restless, pull at the bed linen, have hallucinations or see things that we are not able to see: Provide reassurance, be there to talk to, do not deny what they are experiencing, and avoid physical restriction when possible. Lose control of urine and bowels: Usually this does not occur. A nurse can suggest proper padding, or advise a catheter for urine if ordered by a doctor. Breathe irregularly or stop breathing for 10 to 30 seconds at a time. Sometimes the person moans intermittently, although this does not indicate pain or discomfort and does not seem to bother them. The pulse/heart rate may also get faster, weaker and more irregular: This is a normal occurrence. Occasionally after death there may be a last sigh or gurgling sound. Collect secretions at the back of the throat; this can sound like a “rattle”: This happens because the person cannot swallow saliva, but does not mean that there is discomfort. Turn the person onto his or her side, or raise the head of the bed. At home you can gently prop up the upper part of the body with a pillow. Have cool arms or legs, a pale face and a purple-blue mottled appearance on the feet and legs. The underside of the body may become a darker colour: This is normal, and indicates the person’s circulation is slowing down. Use just enough coverings to keep the person comfortable, adding blankets means extra weight and might feel restrictive and overpowering. When death occurs you will notice: the person is entirely unresponsive Breathing has stopped Heartbeat and pulse has stopped Eyes will be fixed in one direction Eyes may be open or closed Complete loss of bladder or bowels “You matter because you are you. You matter to the last moment of your life…..” — Cecily Saunders, St. Christopher’s Hospice What to do if you think death has occurred: Do not call the ambulance, police or fire department. These calls are not necessary when death is expected. Your physician may have indicated calling him or her to have the death certified, or if you are uncertain about what to do and home care nurses have been involved as caregivers call the Home Health Nurses at: 250-364-6224. Call your family, a friend, or a spiritual advisor who you would like to have present with you. Call the funeral home when you are ready. Take the time you need with the person who has died. The Trail Hospice Society will support your care at home before and up to the moment when your loved one passes. We offer respite, support and companionship for you and your family member. For hospice care call 250-364-6204