Signs and Symptoms of Approaching Death and How to Bring Comfort
“Death is not the ultimate tragedy.
The ultimate tragedy is depersonalization –dying
in an alien and sterile arena, separated from the spiritual nourishment that
comes from being able to reach out to a loving hand.”
(Norman Cousins, “A
Celebration of Life” Harper & Row, New York City, 1974.)
We of hospice understand and support your desire to aide your loved one in
dying in familiar surroundings. We also realize that this period of time may
be very difficult for you and your family to live through. We want to be as
open and honest with you as we possibly can. We give you this sheet of information
to help you prepare for, anticipate and understand symptoms that you may observe
as your loved one approaches the final stages of life. Not all these symptoms
will appear at the same time, and some may never appear. You Hospice Staff
is always available for information, support and service. We encourage you
to call if you need us.
The experience we call death occurs when the body completes its natural process of shutting down, and when the “spirit” completes its natural process of reconciling and finishing. These two processes need to happen in a way appropriate to the values, beliefs and life-style of the dying person.
Therefore, as you seek to prepare yourself as this event approaches, the members
of your Hospice Care Team want you know what to expect and how to respond in
ways that will help your loved one accomplish this transition with support,
understanding and ease. This is the greatest gift of love you have to offer
your loved one as this moment approaches.
The physical and emotional-spiritual-mental signs and symptoms of impending
death which follow are offered to you to help you understand the natural kinds
of things which may happen and how you can respond appropriately. Not all these
signs and symptoms will occur with every person, nor will they occur in this
particular order. Each person is different and needs to do things in his/her
own way. This is not the time to try to change your loved one, but the time
to give full acceptance, support and comfort.
The following signs and symptoms described are indicative of how the body
prepares itself for the final stage of life, death.
1. Coolness. The person’s hands, arms and feet and then legs may be
increasingly cool to the touch, and at the same time the color of the skin
may change. The underside of the body may become darker (bluish) and the skin
become mottled. This is a normal indication that the circulation of blood is
decreasing to the body’s hands, arms, legs and feet and that it is being
reserved for the most vital organs. Keep the person warm with a blanket, but
do not use an electric one.
2. Sleeping. The person may spend an increasing amount of time sleeping, and
appear to be uncommunicative or unresponsive and at times be difficult to arouse.
This normal change is due in part to changes in the metabolism of the body.
Sit with your loved one, hold his/her hand, do not shake or speak loudly, but
speak softly and naturally. Plan to spend time with him/her during those times
when he/she seems most alert/awake. Do not talk about the person in the person’s
presence. Speak to him or her directly as you normally would, even though there
may be no response. Never assume the person cannot hear; hearing is the last
of the senses to be lost.
3. Confusion of Mind (Disorientation). The person may seem to be confused about
time, place and identity of people surrounding him/her including close and
familiar people. This is also due in part to the metabolism changes. Identify
yourself by name before you speak rather than to ask the person to guess who
you are. Speak softly, clearly and truthfully when you need to communicate
something important for the patient’s comfort such as “ it is time
to take your medication,” and explain the reason for the communication,
such as “so you won’t begin to hurt.” Do not use this method
to try to manipulate the patient to meet your needs.
4. Loss of Bladder and Bowel Control (Incontinence). The person may lose control
of urinary/bowel functions as the muscles in that area begin to relax. Discuss
with your Hospice nurse what can be done to protect and keep your loved one
clean and comfortable.
5. Congestion in the Lungs and Throat. The person may have gurgling sounds
coming from his/her chest as though marbles were rolling around inside—these
sounds may become very loud. This normal change is due to the decrease of fluid
intake and an inability to cough up normal secretion. Gently turn the person’s
head to the side and allow to drain the secretions. You may also gently wipe
the mouth with a moist cloth. The sound of the congestion does not indicate
the onset of severe pain or pneumonia.
6. Restlessness. The person may make restless and repetitive motions such
as pulling at bed linen or clothing. This often happens and is due in part
to the decrease in oxygen circulation to the brain and to metabolism changes.
Do not interfere with or try to restrain such motions. To have a calming effect,
speak in a quiet natural way. Lightly massage the forehead, read to the person,
or play some soothing music.
7. Fluid and Food Decrease. The person may have decrease
in appetite and thirst, wanting little or no food or fluid. The body will naturally
begin to conserve
energy which is expended on these tasks. Do not try to force food or drink
into the person, or try to use guilt to persuade them into eating or drinking
something. To do this only makes the person much more uncomfortable. Small
chips of ice, frozen Gatorade or juice may be refreshing in the mouth. If the
person is able to swallow, fluids may be given in small amounts by syringe
(ask the Hospice nurse for guidance). Glycerin swabs and toothettes may help
keep the mouth and lips moist and comfortable. A cool, moist washcloth on the
forehead may also increase physical comfort.
8. Urine Decrease. The person’s urine output normally decreases and
may become “tea” colored –referred to as concentrate urine.
This is due to the decreased fluid intake as well as decrease in circulation
through the kidneys. Consult with your Hospice nurse to determine whether there
may be a need to insert or irrigate a catheter (a tube into the bladder).
9. Breathing Pattern Change. The person’s regular breathing pattern
may change with the onset of a different breathing pace. A particular pattern
consists of breathing irregularly i.e., shallow breaths with periods of no
breathing of 5 to 30 seconds and up to a full minute. This is called “cheyne-stokes” breathing.
The person may also experience periods of rapid shallow pant-like breathing.
These patterns are very common and indicate decrease in circulation in the
internal organs. Elevating the head, and/or turning the person on his/her side
may bring comfort. Hold his/her hand. Speak gently.
10. Temperature Elevation. The person’s regular temperature may become elevated. This is common and comfort measures should be taken. Consult with your Hospice nurse to determine what is the best treatment. A cool, moist washcloth on the forehead may help to provide comfort.