The end-of-life period—when body systems shut down and death is imminent—typically lasts from a matter of days to a couple of weeks. Some patients die gently and tranquilly, while others seem to fight the inevitable. Reassuring your loved one it is okay to die can help both of you through this process.
End of life care should begin when you need it and may last a few days or months, or sometimes more than a year. People in lots of different situations can benefit from end of life care. Some of them may be expected to die within the next few hours or days. Others receive end of life care over many months.
For some people, the dying process may last weeks; for others, it may last a few days or hours.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
Pulse and heartbeat are irregular or hard to feel or hear. Body temperature drops. Skin on their knees, feet, and hands turns a mottled bluish-purple (often in the last 24 hours) Breathing is interrupted by gasping and slows until it stops entirely.
If the patient's experience of breathlessness does not improve, oxygen therapy should be stopped.
Some people can become restless in the last few days of life. They will usually become calm again before they die. They may appear confused and not recognise familiar faces, and even see or hear people or things that are not actually there - for instance, they may see pets or people who have died.
There are three main stages of dying: the early stage, the middle stage, and the last stage. These are marked by various changes in responsiveness and functioning. However, it is important to keep mind that the timing of each stage and the symptoms experienced can vary from person to person.
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.
In summary, Kubler-Ross and colleagues developed a five stage model of death and dying. These stages have different emotional responses that people go through in response to the knowledge of death. They are commonly referred to by an acronym of DABDA and are denial, anger, bargaining, depression and acceptance.
You can receive palliative care at any point after a terminal diagnosis. Some people receive palliative care for years. Your doctor or nurse may mention or suggest palliative care because they want to make sure you have all the support you need.
As a person is dying they will have less energy and become easily tired. They are likely to become weaker and may spend more time asleep. They may become detached from reality, or unaware of what is happening around them. They may be less interested in eating and drinking.
Even if someone is unconscious, they may still be able to hear or feel you. If you are worried that they are distressed or in pain, speak to their doctor or nurse. They may be able to prescribe medicines or look at other ways to make them more comfortable.
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.
Body System Shutdown
The body shuts down as the end gets closer. The heart doesn't pump normally which leads to lower blood pressure and less blood going to the arms and legs and other organs like the kidneys. With less blood going to the kidneys, the kidneys stop working which leads to smaller amounts of urine output.
Researchers believe that a person can live for up to three weeks without food as long as they have water to drink. Without both water and food, a person cannot survive for more than four days.
As a result of discontinuing eating, patients can die in as early as a few days. For most people, this period without food usually lasts about 10 days, but in rare instances, it can last several weeks.
Terminally ill cancer patients near the end of life can experience refractory symptoms, which require palliative sedation. Midazolam is the most common benzodiazepine used for palliative sedation therapy.
Common anticipatory medicines include the following: Medicine for pain in palliative care – an appropriate opioid, for example, morphine, diamorphine, oxycodone or alfentanil. Medicine for breathlessness – midazolam or an opioid. Medicine for anxiety – midazolam.
A bystander hands a medicine bottle to the attending paramedic frantically saying, “They drank this! They drank this!” The bottle contains digoxin 100 mg, diazepam 1,000 mg, morphine 15,000 mg, amitriptyline 8,000 mg and phenobarbital 5,000 mg.
There are no specific best practice guidelines on the use of oxygen at the end of life. The first distinction that must be made is between the use of oxygen in unconscious and conscious patients. Frequently, oxygen is continued in patients who are deeply unconscious and in their final hours of life.
The median survival time was 1.9 years (IQR, 0.7 to 4.0 years). Main causes of death included respiratory disease (68%), cardiovascular disease (20%) and cancer (6%). In the cohort, 539 (24%) patients were prescribed LTOT 24 h/day, 1,231 (55%) were prescribed 15 h/day and 470 (21%) had other daily durations prescribed.
If a patient with advanced disease is breathless and hypoxic, oxygen is the preferred treatment; if they are breathless and not hypoxic, oxygen is not recommended.