Your hospice team's goal is to help prepare you for some of the things that might occur close to the time of death of your loved one. We can never predict exactly when a terminally ill person will die. But we know when the time is getting close, by a combination of signs and symptoms.
They Know They're Dying
Dying is a natural process that the body has to work at. Just as a woman in labor knows a baby is coming, a dying person may instinctively know death is near. Even if your loved one doesn't discuss their death, they most likely know it is coming.
Periods of rapid breathing, and no breathing for brief periods of time, coughing or noisy breaths, or increasingly shallow respirations, especially in final hours or days of life.
“There is something most people say before they die, and it's usually 'I love you' or they call out to their mum or dad — who have usually already died,” Julie said. She added that it is hard to clarify what happens when people die as each individual is unique in their own way.
When a patient is transitioning, they are typically bedbound due to exhaustion, weakness, and fatigue. They are less responsive and sleeping most of the time. They may sluggishly rouse when you tap them on the shoulder. They may have a more difficult time waking up.
The life expectancy of a hospice patient is dependent on many factors. That being said, doctors do still make predictions about how long a patient is expected to live.
End-of-life transition refers to a person's journey to death, especially in those with a terminal diagnosis. This process occurs differently for everyone. For some, it takes days or weeks; for others, it occurs rapidly. Partnering with a trusted medical team during this time can limit pain.
A conscious dying person can know if they are on the verge of dying. Some feel immense pain for hours before dying, while others die in seconds. This awareness of approaching death is most pronounced in people with terminal conditions such as cancer.
Visions and Hallucinations
Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see.
Often, the words are brief because there is no energy for a full conversation. “Mama” is one of the most common last words that people speak. Some people's last utterances are curse words. Others may mumble a word that holds significance to them – but it may mean nothing to their families – for their final words.
How Long Does the Active Stage of Dying Last? The active stage of dying generally only lasts for about 3 days. The active stage is preceded by an approximately 3-week period of the pre-active dying stage.
When someone is dying, their heartbeat and blood circulation slow down. The brain and organs receive less oxygen than they need and so work less well. In the days before death, people often begin to lose control of their breathing. It's common for people to be very calm in the hours before they die.
Research suggests that even as your body transitions into unconsciousness, it's possible that you'll still be able to feel comforting touches from your loved ones and hear them speaking. Touch and hearing are the last senses to go when we die.
The important findings, along with observations of long-time palliative care doctors and nurses, show: Brain activity supports that a dying patient most likely can hear. Even if awareness of sound cannot be communicated due to loss of motor responses, the value of verbal interactions is measurable and positive.
Hospice has a program that says that no one should have to die alone, and yet this hospice nurse is telling me to take a break? Some patients want to die when no one else is there. Hospice professionals know that companionship while dying is a personal preference.
Summary: Hearing is widely thought to be the last sense to go in the dying process.
Many people lose consciousness near the end of life. But they may still have some awareness of other people in the room. They may be able to hear what's being said or feel someone holding their hand.
This difficult time may be complicated by a phenomenon known as the surge before death, or terminal lucidity, which can happen days, hours, or even minutes before a person's passing. Often occurring abruptly, this period of increased energy and alertness may give families false hope that their loved ones will recover.
Seriously ill patients encountered by hospice and palliative care clinicians are at risk for thirst due to dehydration, electrolyte disturbances, hypotension, xerostomia, and immobility which can impede access to water.
For the elderly, talking about death may truly be part of preparing themselves for the end of life. Whether your loved one has been diagnosed with a terminal illness or is grappling with advancing age and some chronic health conditions, they are likely facing many uncomfortable thoughts and difficult care decisions.
Eventually the patient will be completely unable to speak or move, which usually happens during the last few days of life. During the last stage of dying, you may notice disorientation or restlessness, decreased urination and bowel movements, and irregular breathing.
Hospice is comfort care without curative intent; the patient no longer has curative options or has chosen not to pursue treatment because the side effects outweigh the benefits. Palliative care is comfort care with or without curative intent.
The End of Life Care Pathway is a document that leads the care plan for the final weeks of someone's life. This is a holistic, 'whole-person' approach to end of life care and dying, recommended to be used wherever someone wishes to die, whether it be a hospital, care home, or in their own home.