Carers are often concerned that death will be a painful experience for the person. However, the time before death is usually peaceful. There is a gradual winding-down that might take several days, as if the body is ‘letting-go’ of life. If restlessness does occur, it can be treated.
Not all of these signs will occur in each person. Nor is there a particular sequence in which they will occur. Sometimes these signs will appear a few hours before death, sometimes a few days. These physical signs are part of the normal, natural process of the person’s body gradually slowing down.
Apart from the signs described here, you might notice other changes that worry you. The palliative care team is there to assist you by providing information and support.
Please ask for help at any time. The team expects to have increased contact with you in the last stages of the person’s life.
You can bring enormous benefit to the person you are caring for simply by sitting with them, holding their hand and speaking in a calm and reassuring manner. Even when the person does not respond, they can probably hear you.
Don’t underestimate the value of these simple things. ‘Being with’ can be more important than ‘doing for’.
Changes you may notice and what you can do to help
Appetite and thirst
The person’s appetite and thirst may decrease and they may have little desire to eat or drink. This concerns many carers, but is a natural process and is not painful for the person. Sips of water or a moist mouth swab will help them. You could ask the nurses to assist with mouth care. Attempting to feed someone who is unable to swallow may make them distressed.
Sleep and alertness
Changes occurring in the person’s body mean that they may spend a lot of time asleep, may be drowsy and difficult to wake up. It is best to talk to the person when they seem most alert, and to allow them to sleep when they want to. There is no need to shake the person or to speak loudly. It is best to speak softly and naturally.
The body’s temperature may change. At one time the person’s hands, feet and legs may be increasingly cool to the touch, and at others they may be hot and clammy. Sometimes parts of the person’s body become blotchy and darker in colour. This is due to the circulation of the blood slowing down and is a normal part of the dying process. If the person indicates that they feel cold, use light bedding to keep them warm. Too many bed clothes or an electric blanket may make them hot and restless. Provide good ventilation. A fan to circulate the air and cool damp towels can help if the person seems hot.
The amount of urine that the body is producing decreases due to the reduced amount of fluid the person is drinking. The urine may become stronger and darker in colour. Many carers are concerned that the person will lose control of their bladder and bowels. This doesn’t happen to all people, but if it does then pads and absorbent sheets should be at hand. A member of the team will advise you about what is needed.
As coughing and swallowing reflexes slow down, saliva and mucous may collect in the back of the person’s throat, causing a gurgling, bubbling or other noise. This noise can be a concern to carers, but does not usually cause distress to the person. To help improve the situation you can lift the person’s head and support them with pillows so that their head is turned to one side. Medications can also be given to slow down the production of saliva and mucous and to improve comfort.
Regular breathing patterns may change. Sometimes the breathing may be fast, and at other times there may be long gaps between breaths. Breathing may be shallow or noisy. This too is due to blood circulation slowing down and a build-up in the body’s waste products. It is not painful or distressing for the person.
Due to the decrease in circulation of blood to the brain and to other changes happening in the body the person may become restless or agitated. To have a calming effect, speak with quiet calm, lightly massage the person’s hand or forehead, or softly play familiar music. Let a palliative care team member know if the person becomes restless or agitated. Medications can be given to reduce this.
How will you know when death has occurred?
- Breathing stops
- No heartbeat or pulse can be felt
- The person cannot be woken-up
- Eyelids may be half open
- Sometimes their mouth may also be open
- Pupils are fixed