Often, people's skin colour changes in the days before death as the blood circulation declines. They can become paler or greyer or their skin can become mottled. With the loss of oxygen to their brain, they might become vague and sleepy. Some people have hallucinations and talk to 'people' who aren't there.
Irregular breathing, panting and periods of not breathing may occur. Changes in breathing are very common and indicate a decrease in circulation to the internal organs. While these changes are not usually bothersome to the patient, they can be distressing to family members. Elevating the head may provide relief.
This surge of energy is usually short, lasting anywhere from a few minutes to several hours, and may occur one to two days prior to death. This is unique to each person, and not everyone will experience such a noticeable burst of energy.
Breathlessness and shortness of breath are also common symptoms at the end of life. Additionally, as dying patients get closer to their last day, they may experience what's known as the death rattle. Over time, mucus and fluids get trapped in your airways and lungs, causing a rattling sound when you breathe.
The brain is the first organ to begin to break down, and other organs follow suit. Living bacteria in the body, particularly in the bowels, play a major role in this decomposition process, or putrefaction. This decay produces a very potent odor. “Even within a half hour, you can smell death in the room,” he says.
Individual experiences are influenced by many factors, including the person's illness(es) and medications, but there are some physical changes that are common. For some people, the dying process may last weeks; for others, it may last a few days or hours.
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.
Your loved one may become restless and pull on bed linens or clothing, hallucinate, or even try to get out of bed, due to less oxygen reaching their brain. Repetitive, restless movements may also indicate something is unresolved or unfinished in the person's mind.
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.
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.
Body temperature can go down by a degree or more as death nears. Blood pressure will also decrease, contributing to reduced blood flow to the hands, feet, nose, and lips. You may notice the patient's skin turning pale, bluish, or mottled. Some people may fluctuate between being hot and cold.
Mottling of skin before death is common and usually occurs during the final week of life, although in some cases it can occur earlier.
24 Hours Before Death Symptoms
You can use a normal speaking voice when talking to them. Many of the physical changes they have experienced for the past few months will become more pronounced. Their skin becomes increasingly mottled and blotchy, especially on the hands, feet and knees.
Final Weeks of Life
Increase in the need to sleep, having to spend the large majority of the day in bed/resting. Difficulty eating or swallowing fluids. A decrease in the patient's ability to communicate and/or concentrate. A general lack of interest in things that used to interest them, and a strong feeling of apathy.
Stage One: Stable
The first phase of palliative care involves designing and creating a treatment plan suitable for the patient's specific condition. The patient and their family will work closely with the care team to identify the physical and medical needs of the patient and who can best provide the necessary care.
Reduced or restricted blood flow can become very serious if cells and tissue begin to die. If there is little or no circulation to the feet you may notice feet turning black, especially in the elderly.
Medical issues such as dehydration or anemia. Sudden change in function. Emotional issues, such as fear, anxiety, depression or guilt, as patients try to cope with terminal illness and end-of-life. Inadequate oxygen to the brain (often caused by heart or lung failure), brain swelling or brain tumors.
Cool Extremities. As blood flow begins to slow, the far reaches of the body, such as the fingers and toes, will begin to cool. This is typically an extremely late sign, often occurring just hours or even minutes before death. This is frequently paired with mottled, discolored skin.
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.
“First hunger and then thirst are lost. Speech is lost next, followed by vision. The last senses to go are usually hearing and touch.”
It is best to think of the decedent's belongings, paperwork, and assets as “frozen in time” on the date of death. No assets or belongings should be removed from their residence. Their vehicle(s) should not be driven. Nothing should be moved great distances, modified, or taken away.
Decompensation progresses over a period of minutes even after the pulse is lost. Even when vascular collapse is the primary event, brain and lung functions stops next. The heart is the last organ to fail.
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.
During the final stage of dying, disorientation and restlessness will grow. There will be significant changes in the patient's breathing and continence.