It’s distressing to learn that a loved one is reaching the end of their life, but knowing what to expect can make it less upsetting for all involved. If you’ve hired hospice professionals, they can help make your loved one’s last months, weeks, and days as comfortable as possible, and also support you as you go through this difficult time.
Here are 12 common signs that often occur at the end of life.
Pain is probably the most feared symptom at the end of life. Dying of cancer is often painful, but this isn’t true for every terminal illness. Fortunately, there are many medications that can effectively manage pain. Whatever the illness is, the ability to recognize and help manage pain for your loved one is essential.
2. Shortness of Breath
Shortness of breath or breathing abnormalities are among the most common symptoms at the end of life. Some degree of breathlessness is common in most people as they near death. Luckily, there are a few simple and effective treatments that can bring quick relief, such as deep-breathing exercises, relaxation techniques, oxygen, and, if needed, medications.
Anxiety is perfectly normal and quite common at the end of life. Though it’s normal to feel some level of anxiety while experiencing pain or shortness of breath, anxiety can occur at any time in the dying process, independent of other symptoms.
4. Decreased Appetite and Thirst
As a person’s body naturally shuts down and prepares for death, it no longer needs the calories and nutrition that food provides. Despite the normalcy of decreased need for food and liquids nearing the end of life, this is a very distressing event for family members. Since feeding is such an intrinsic part of caregiving (and caring) it is often a contradiction for a loved one to care for the patient and not feed them.
The important thing to understand is that in the context of a terminal condition, decreasing intake of foods is a natural phenomenon and does not necessary accelerate the process of death. Most patients experience a dramatic decline in appetite. Furthermore, studies in which artificial nutrition was delivered through an IV did not yield significant gains in prolonging life or in quality of life.
5. Nausea or Vomiting
Illnesses, medications, and other treatments can lead to nausea with or without vomiting. This can be an extremely troubling symptom for your loved one, as well as for you. Fresh air, small meals, limiting odors, and nausea medications are among the treatments you can try to help your loved one manage these symptoms.
If you’ve ever been constipated, you know how uncomfortable it can be. Medications used to treat pain and shortness of breath can cause constipation, as can lack of activity, decreased fiber and fluid intake, and disease processes. Constipation is a symptom you have to stay on top of to prevent it from becoming severe. Ask your loved one’s doctor or nurse how best to manage it.
A dying patient may sleep excessively due to lack of energy, as part of the body shutting down, or as a result of medications that cause drowsiness.
Trouble sleeping is also common.
8. Withdrawal From Loved Ones
As someone nears death, they tend to focus inward and begin to detach from the world around them, including friends and family. Conversely, they may crave closeness with those they love. Either way, try to respect and meet their needs.
9. Delirium and Terminal Restlessness
Confusion, agitation, and sleeplessness can occur in some individuals at the end of life. Delirium can be caused by disease processes, decreased oxygen in the brain, medications, or for other reasons including constipation or dehydration. The person may pick at their sheets and clothing in a state of agitation, or hallucinate and claim to see people and things that aren’t there. Be sure to let your healthcare provider know if your loved one is exhibiting any of these behaviors.
Both urinary and bowel incontinence are common near the end of life. This can be a result of a surgery or illness, or because the person is simply too weak to use the bathroom. At the very end, when the muscles relax entirely, the patient will often release the contents of their bowels.
11. Cold Hands and Feet and Skin Mottling
Hands and feet may become colder and the skin may become blotchy and purplish (mottled). This mottling may slowly work its way up the arms and legs, and the lips and nail beds can turn blue or purple.
12. The “Death Rattle”
As undesirable as it is to call this symptom the “death rattle,” it’s a pretty accurate description. “End-stage wet respirations” is the medical term for secretions that build up in the airway when an individual becomes too weak to clear those secretions out. The accumulation of mucus and fluids causes a rattling sound with breathing, which can be distressing for those around them, however most of the times it is not a source of suffering for the actual patient.