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. Though the active stage can be different for everyone, common symptoms include unresponsiveness and a significant drop in blood pressure.
Transitioning is the first stage of dying. It describes a patient's decline as they get closer to actively dying. Generally, when one is transitioning, they likely have days — or even weeks — to live. I have seen some patients completely skip the transitioning phase and some stay in it for weeks.
For some people, the dying process may last weeks; for others, it may last a few days or hours. As death approaches, you may notice some of the changes listed below.
The phase of pre-active dying can last a few weeks or a few months, and there are common things a nurse or doctor is observing to make sure their patients are comfortable and at peace during this time.
Dying persons may try to hold on until they feel a sense of security and completion. Picking, pulling, and fidgeting behaviors may also be seen. This can result from medications, metabolic changes, or decreased oxygen to the brain.
The patient may have a buildup of fluid in their lungs that could lead to unusual gurgling sounds. The patient's breathing patterns might be irregular, and they may experience long pauses in breathing. The patient's skin may change color and their extremities might feel cold to the touch.
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.
Palliative and hospice experts refer to this as “rallying” or terminal lucidity and say it is a common occurrence but no one is sure why it happens. These bounce-backs generally last only a couple hours, but some go on for so long that the patients can take a break from a hospice for a few months.
Acceptance. The final stage is one of acceptance. The patient is no longer struggling against the reality of death. He or she has accepted the terminal diagnosis and the reality of the situation.
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.
It can be linked to emotional, physical or spiritual distress. Terminal agitation means agitation that occurs in the last few days of life. You might also hear terminal agitation being described as terminal restlessness, terminal anguish, confusion at the end of life, or terminal delirium.
Terminal restlessness is common at the end of life. Your loved one may seem confused, agitated, or angry. They may fidget with their clothes or become withdrawn. Many causes, including organ failure or the drugs used to treat their illness, may be at work.
Parenteral benzodiazepines, such as midazolam, can be used to relieve muscle spasm and spasticity in the last days of life (Table 3).
Two-Three Days Before Death
Your loved one may experience a bluish discoloration of their extremities. The skin of their legs and arms may feel cold to the touch. As the end draws near, the body loses the ability to control its temperature. Arms and legs will become cold and bluish in color as circulation slows down.
The second stage is the active stage of dying. The person will have psychological confusions, and their body will experience end-of-life symptoms, like extreme vital sign changes and lessened responses to stimuli. This stage lasts for about a week but can last up to three weeks.
When interviewed as research participants, health professionals – and nurses in particular – commonly say that no one should die alone. There are also many cultural references that suggest that to die alone is a bad thing.
You can hold your loved one's hand or offer very gentle massage as long as that seems to be soothing to her. In the last few hours of life it is sometimes better to stop touching the patient so that she can keep her awareness on the dying process rather than on the physical realm she is trying to leave behind.
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.
Your loved one should be turned and repositioned at least once every 2 hours. Try not to disturb your own sleep. The better way to manage nighttime turning is when you awaken to give medications or to use the bathroom. This opens in a new window.
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.
As your loved one's health declines, you may notice them develop bitterness or anger. This is called terminal agitation. Along with this, terminal delirium and terminal restlessness may also present themselves.
Their mouth may fall open slightly, as the jaw relaxes. Their body may release any waste matter in their bladder or rectum. The skin turns pale and waxen as the blood settles.
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.