Family Issue: Signs that Death Is Near

As a person approaches the very end of life, two types of changes occur. There are physical changes that take place as the body begins to shut down its regular functions. And there are changes on the emotional and spiritual level as well, in which the dying person lets go of the body and the material world. You might find it helpful to become familiar with these changes as well as with the signs that death has actually occurred.


Physical changes

In some ways the process of dying is like the process of being born. Over nine months, a child goes through many stages of development that lead at last to labor and birth. In a similar way, a person with advanced illness goes through many changes over an extended period of time, with a set of clear changes occurring in the final stage. These are not signs of a medical emergency but parts of a natural process that does not need to be disturbed. You can expect the following physical changes to occur:


Cooling
Hands, arms, feet and legs begin to cool as the circulation of blood decreases. Changes in circulation also cause the skin to become discolored in spots.


Sleepiness and loss of consciousness
As death nears, people usually become very drowsy, sleeping more and becoming hard to wake. They might also be less able to communicate. Eventually, they may reach a point where they can no longer be awakened. We do not know, however, what their level of awareness might be. Even when your loved one seems unresponsive, he or she might very well sense your presence, whether you are sitting quietly nearby, holding hands, or speaking.


Confusion and delirium
A person near death may become disoriented or agitated. This can occur as less blood flows to the brain or because of other physical changes. You can respond helpfully with clear explanations and calm reassurance. If the situation does not improve, the healthcare team may be able to manage the symptoms with medications. When a person is no longer conscious, delirium can take the form of restlessness, moaning, groaning and grimacing. These signs of agitation are not usually signs of pain, however. Of course it’s appropriate for you to make sure that the healthcare team is continuing to provide adequate pain relieving medications. But as a rule, pain does not develop suddenly in the last hours of life when it has been under control up until that point.


Reduced intake of food and fluid
The person who is dying may want little or no food or drink, a change that may begin days or weeks before the final hours of life. No harm will come from this and there is no need to force the issue. In fact, forcing a dying person to eat or drink can actually cause discomfort.


Loss of ability to swallow
Swallowing becomes more difficult as weakness increases. As saliva and other secretions build up, you may hear a gurgling or rattling sound with each breath the dying person takes. Although it may sound like choking, that is not what’s happening. Changing the person’s position may improve drainage and reduce the disconcerting noises. The healthcare team may be able to use medications to deal with the problem as well.


Loss of bowel and bladder control
As muscles weaken, the person who is dying may no longer be able to control bowel and bladder functions. The healthcare team can suggest ways to maintain cleanliness and comfort.


Changes in breathing
Breathing patterns begin to change near death. Periods of shallow and deep breathing may alternate over short periods of time. During this time a person may not breathe at all for as long as ten to twenty seconds before beginning again. Twenty seconds may not sound like a very long time, but it will certainly seem so in this situation. It is long enough that you may mistakenly think the person has died and then be startled to hear a sudden deep breath. Breathing changes might also seem like a sign that your loved one is experiencing discomfort, but they are actually normal and not a sign of distress.


Emotional and Spiritual Changes

Withdrawal
In preparing to disconnect from the world we know, a person who is very close to death may want few people around or simply to be left alone much of the time. This is not a rejection of the loving family and friends who wish to be close to the person at this time. Rather, it may indicate the dying person has already taken all the support that’s needed from loved ones. If the person you care about becomes less sociable, respect the fact that this is a necessary and appropriate transition.

Visions
We all go through life relying on the evidence of our senses and we are quick to reject the things that do not fit with our experience. So when someone close to death says that a long-dead relative has spoken to them, we are likely to dismiss what they are saying. But it is helpful to accept that what the person sees is real to them whether we believe in it or not. These experiences are a common part of the spirit’s release from this life and often bring comfort, making the transition easier.

Confusing Statements
Sometimes people close to death say things that seem to make no sense, or indicate they are unaware of their true condition. But these statements are often very much about the fact of dying, although they may come in a sort of code. The dying person who asks where the car keys are hidden or worries about a train to catch may be talking about a different journey altogether, namely the departure from life to death. And they may be asking you to accept the fact that the departure time has come. If you unlock the code of a confusing statement and see your loved one is ready to let go of life, the most helpful thing that you can do is give them permission to let go.


When Death Has Occurred

When a person dies:
the heart stops beating
breathing stops
body color becomes pale
the body cools
muscles relax
urine and stool may be released
the eyes may remain open
the jaw can fall open
the trickling of internal fluids may be heard

If the death occurs at home, it is important to have a plan in place with the healthcare team so you know who to call at this point. There is no need to call 911 when death is expected.