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.
The dying process is highly variable and can last up to several weeks in some instances. Actively dying or imminent death represents the last week of life and has characteristic clinical signs detailed in the table below.
Nearing the end of life
Everyone's experiences are different, but there are changes that sometimes happen shortly before a person dies. These include loss of consciousness, changes to skin colour, and changes to breathing.
For some people, the dying process may last weeks; for others, it may last a few days or hours.
The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours.
These end-of-life breathing patterns can happen very quickly, or it can occur over many hours or even days. This is a normal part of the dying process as the body begins to slowly shut down.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
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.
Considering the many variables, people may wonder how long someone can live without food in hospice. 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.
During the final stage of dying, disorientation and restlessness will grow. There will be significant changes in the patient's breathing and continence.
Activity usually decreases significantly in one's final days and hours and it's natural to sleep more, even during the day. Another common end-of-life change is that people may not respond to questions and may also show little interest in their surroundings. Let your loved one sleep and remain peaceful.
As the moment of death comes nearer, breathing usually slows down and becomes irregular. It might stop and then start again or there might be long pauses or stops between breaths . This is known as Cheyne-Stokes breathing. This can last for a short time or long time before breathing finally stops.
Visit with the person. Talk or read to them, even if they can't talk back. If they can talk, listen attentively to what they have to say without worrying about what you will say next. Your presence can be the greatest gift you can give to a dying person.
This stage is also one of reflection. The dying person often thinks back over their life and revisits old memories.4 They might also be going over the things they regret.
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. Patients appear comforted by the sounds of their loved ones (in person and by phone).
Your loved one should be turned and repositioned at least once every 2 hours. Try not to disturb your own sleep.
A reduction in appetite is one sign that someone may be in the last days of their life. They may no longer wish to eat or drink anything. This could be because they find the effort of eating or drinking to be too much. But it may also be because they have little or no need or desire for food or drink.
For most people with only hours or days to live their body systems shuts down and thirst is not a problem. Strange as it may sound there are definite advantages to taking less food and drink at this time. The loss of appetite and thirst is nature's way of helping the body prepare for a peaceful death.
Terminal restlessness generally occurs in the last few days of life. Around 42 percent of hospice patients experience agitation during their final 48 hours. But even more develop symptoms before then, which may not subside until death.
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.
While the pre-active stage lasts for about three weeks, the active stage of dying lasts roughly three days. By definition, actively dying patients are very close to death, and exhibit many signs and symptoms of near-death.
In that circumstance, palliative sedation doesn't accelerate death, he said. “For other patients who are not actively dying, it might hasten death to some extent, bringing it on in hours rather than days.” He emphasized, however, that in all cases the goal isn't death but relief from suffering.
Physical signs
Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing. Towards the end, dying people will often only breathe periodically, with an intake of breath followed by no breath for several seconds.
Your loved one may seem to be working hard to breathe -- even making a moaning sound. The moaning sound is just the sound of air passing over very relaxed vocal cords. This indicates that the dying process is coming to an end.