What to expect at the end of life

End of Life Changes

Changes in Appetite

As the body's needs change, the appetite frequently changes. During the dying process, the person will gradually stop eating and eventually may even refuse fluids.

It can be difficult watching someone refuse to eat and drink. Ask the nurse for suggestions about what foods and fluids the person may tolerate more easily during these changes. And remember, at this stage, offering touch, conversation or supportive silence becomes more important than offering food.

Decrease in Urine

When the dying person begins to drink less, he or she has less need to urinate. Urine color changes from yellow to tea color or dark brown. The odor may also become stronger because the urine is more concentrated.

Breathing Changes

A person's breathing changes as he or she draws closer to death. The person may experience periods of faster, shallow breathing followed by deeper, irregular breaths, including periods of up to a minute when no breaths are taken.

Sometimes a moaning sound occurs when the person exhales. This does not mean the person is in pain or is suffering. It is simply air moving over relaxed vocal cords.

You may raise the bed slightly to make the person more comfortable. If you have concerns, please share them with your nurse.

Temperature

The person's skin, especially on the hands, legs and feet, may become increasingly cool to touch and may appear darker or blotchy. The brain may send confusing messages to the body, causing the person to experience periods of hot and cold.

Put on or remove blankets according to what the person wants.

Loss of Bowel and Bladder Control

As weakness increases and muscles relax, the person may experience the loss of bowel and bladder control. This change may be upsetting to both the patient and the family. However, it is a normal response to changes that are occurring in the body.

Congestion

As the dying person becomes less responsive, congestion may occur in the chest and throat. Congestion causes a variety of gurgling and rattling sounds. These sounds cause little or no distress to the person, but they can be disturbing to the family. The nurse can tell you if medications or treatments would minimize congestion.

Although suctioning is not usually recommended because it can cause discomfort and increase congestion, you may help ease congestion by raising the head of the bed or turning the person on his or her side.

Restlessness

During the dying process, the person may become restless or agitated. Some of the reasons include changes in the body, a decrease in the body's oxygen level, fears, and physical or emotional discomfort.

During this phase, do not try to restrain the person's movements. Restraint may actually increase a person's restlessness. Speak softly in a calm, natural way. A light massage to the forehead, hands or feet may also soothe the dying person. The nurse may have additional suggestions for you to try.

Confusion

Changes in the body can cause the person to become confused. Confusion can also occur due to the person's medication. If you are concerned that medications may be causing confusion, speak to the nurse.

When approaching someone who is confused, always identify yourself. Use simple statements to tell the person what you plan to do, such as "I'm going to put this cool washcloth on your forehead."

Vision-like Experiences

As a person nears death, he or she may begin talking to someone who is not physically present. Often this someone is a family member or a friend who has died. Sometimes, the dying person will also report seeing the place where he or she will travel after death. These experiences are usually very comforting to the person and are a normal and natural part of the dying process.

Encourage the person to talk about visions and experiences he or she is having. Try to be open to hearing what the person is sharing. Let the person know that these experiences are normal.

Decreased Responsiveness

As the dying process continues, the person may sleep more. It may become increasingly difficult to awaken him or her.

The ability to hear continues long after the ability to respond is lost. Being spoken to and hearing familiar voices can be very comforting to the dying person during this phase.

Speak naturally to the person, knowing that you will be heard. Do not try to awaken the person, but notice if gentle touch soothes him or her.