Each person’s experience of the last few days of life will be different and it can be difficult to predict exactly what will happen or how quickly any changes will occur.
These changes fall into four main categories:
The following gives you an explanation about those changes but please ask us if you have any further concerns or need more information.
Less need for food and drink
When someone is no longer interested in eating and drinking, it can be very hard to accept even when you know it is because they are dying. The body’s metabolism slows down and is unable to digest food so well or take any goodness from it. The effort of eating and drinking can become simply too exhausting.
A small mouthful at a time may be all that can be managed or desired. Help with feeding and drinking at this time might be appreciated. Eventually, a person may stop drinking altogether. Their mouth may appear dry, so you can moisten it with a damp sponge, a baby toothbrush dipped in water, or a spray may be comforting. A lip salve will also help.
If there is little apparent response, this may be due to weakness not lack of appreciation. Simply caring and being together may be of great comfort to both of you.
Medication and treatment
Medication is reviewed when swallowing becomes difficult. Anything that is no longer helpful or cannot be taken in the normal way may be stopped, given by an alternative route or a new preparation prescribed to treat any physical or psychological symptoms such as pain, nausea, breathlessness, anxiety or agitation.
If someone is no longer strong enough to talk about symptoms they are experiencing, pain can be shown by becoming restless or grimacing. Anxiety or agitation may also be shown by restlessness but is sometimes associated with confusion, twitching or jerky movements as well. All these symptoms can be helped with medication. If you are worried about any of these, please talk to us.
Our care is focused upon comfort and dignity. You may wish to talk about measures which can be taken to promote comfort whilst lying in bed (such as positioning and pressure relieving equipment) or the need for regular mouth care. Please ask us if you have any concerns.
Withdrawing from the world
For most, the process of ‘withdrawal from the world’ is a gradual one. The person will spend more time asleep and will often be drowsy when awake and show less interest in what is going on around them. This is a natural process and may even be accompanied by feelings of calmness and tranquillity.
Eventually, this may lead into a state of unconsciousness which may last for a few minutes, a few hours or a few days. A person may still be aware of your presence and be able to hear what you are saying. Don’t be afraid to talk to them and explain any care given. You may wish to sit quietly and hold hands or recall shared memories and play some background music.
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 worried they may die fighting for breath but, often it is found that breathing eases as they start to die. Breathing can be easier than it has been for a long time.
However, any breathing difficulties can be made worse by feelings of anxiety or fear. Reassurance, medication or the comforting knowledge that someone is close at hand can make a real difference. A much loved pet may also play a major part in reducing breathlessness caused by anxiety or fear.
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 which the person is no longer able to cough up. Medication may be used to reduce it and changes of position can also help. The noisy breathing can be upsetting to hear but it does not appear to distress the dying person.
Changes which occur shortly before death
The dying process is unique to each person but in most cases, there are some common signs which help to indicate that a person is dying. The breathing pattern may change again. There are sometimes long pauses between breaths and/or the abdominal (tummy) muscles will take over the work. The abdomen rises and falls instead of the chest.
Breathing can appear laboured but this is more distressing to you than the person dying. Medication can be given if there are signs of distress but these changes in breathing are an expected part of dying.
Some people can become more restless and agitated as death approaches. Medication can be administered in the form of pain relief and/or a sedative to help ease any symptoms which may be causing the person distress.
The skin can become pale and moist and slightly cool prior to death. Most people do not rouse from sleep but die peacefully and comfortably. Their breathing will get slower and eventually stop. Sometimes it is difficult to pin point the exact moment of death. After a short time, the body may relax completely and look peaceful. Even though the death is expected, it can still be a huge shock when it actually happens.
What happens now?
When someone dies, there is no need to do anything immediately. You may need a few minutes (or longer) to understand what has just happened.
If the death happens at home, when you are ready, you will need to ring your doctor’s surgery (or the out of hours service) to inform them of the death. A doctor or community nurse has to visit to verify that the person has died. A death certificate is unlikely to be issued at this time. The visiting doctor or community nurse will provide you with further information regarding this.
You may phone the funeral director, if you wish, while you are waiting for the nurse/doctor to visit (or you can wait until afterwards). The funeral directors will provide further guidance at this difficult time.
You may also wish to ring a relative or a friend who can stay with you and offer their support for a while.
If you are at Searle House when your loved one dies, the nurses, doctors, chaplain and bereavement team are here to help you work through your worries and concerns, and to offer you care and support at this sad and challenging time.
