The changes you can expect in the end stages of life
The dying process is unique to each person. However, in many cases there are common characteristics or changes that help us to know that a person is dying. This page describes some of the changes that happen to people as they start to die, it anticipates some of the questions you may want to ask about what is happening and why, and it will encourage you to ask for further help or information if there is anything at all that is worrying you.
The following advice falls into four main categories
- Reduced need for food and drink
- Withdrawing from the world
- Changes in breathing
- Changes which occur before death
Reduced need for food and drink
When someone starts to die their body no longer has the same need for food and drink. This is because metabolism slows down and the body can’t digest food very well or take goodness from it. People may stop drinking and although their mouth may look dry, it’s not necessarily a sign they are dehydrated. Applying lip salve and artificial spray will give comfort.
Withdrawing from the world
For most, the process of withdrawing from the world is a gradual one. People spend more and more time asleep and when they are awake they are often drowsy and show less interest in what is going on around them.
This natural process can be accompanied by feelings of calmness and tranquillity. It can be hard to accept these changes, even when you know that the person is dying, as it’s a physical sign that they are not going to get better. Nevertheless, you can still show that you care about your loved one by spending time with them, talking to them and giving comfort through your presence.
Changes in breathing
Towards the end of life, as the body becomes less active, the demand for oxygen lessens. People who suffer from breathlessness are often concerned that they may die fighting for breath but, in many cases, breathing eases as they start to die.
Very occasionally breathing problems can be made worse by feelings of anxiety. However, the knowledge that someone is close at hand can be reassuring and help to prevent this form of breathlessness. Often sitting quietly and holding your loved one’s hand can make a real difference.
Occasionally in the last hours of life there can be a noisy rattle to the breathing. This is due to a build-up of mucus in the chest because the person no longer has the energy to cough. Medication may be used to reduce this and changes of position may also help.
Noisy breathing can be upsetting to carers but, in our experience, it doesn’t appear to distress the dying person.
Changes which occur before death
When death is very close (within minutes or hours) the breathing pattern may change again. Sometimes there are long pauses between breaths or the abdominal muscles (stomach) will take over the work – the abdomen rises and falls instead of the chest. If breathing appears laboured, please remember that this is likely to be more distressing to you than it is to the person dying.
Some people may become more agitated as death approaches. To help prevent this Dorothy House staff will talk to you about it and, having ensured that pain and other symptoms are controlled, will ensure that appropriate sedation is available for use, should it be required.
The skin can become pale and moist, and sometimes slightly cool prior to death. Most people do not rouse from sleep, but die peacefully, comfortably and quietly, and are reassured by the presence of family and friends.
How we can help
This is likely to be a difficult and painful time for you as you lose someone you love or have cared for. It can be hard to know what to say, how to help or what to do.
Your Nurse Specialist, doctor and other healthcare professionals are there to help you work through your worries and concerns and to offer you care and support. We hope you will come and talk to us if there is anything on your mind.