As a person nears the end of their life, their body will naturally start its process of shutting down. It does not happen all at once, nor do the symptoms experienced by one dying individual resemble another’s experience. Nonetheless, there are certain physical signs that hospitals and health care institutions, such as the NHS, identify during someone’s final days or hours of life.
While knowing about the process will not make the situation any easier emotionally, it can provide family members a better idea of what to expect when caring for their loved one. These signs may occur over several hours to days.
The biology behind “powering down”
In terms of the natural process of death as a biological phenomenon, it is the ultimate expression of self-preservation. Recognizing the body’s inability to continue its biological processes, it starts prioritizing, directing all the energy that remains toward core processes, such as keeping the heart beating and the brain active, rather than the periphery of limbs, skin, and the digestive system.
According to the World Health Organization (WHO), the goal of palliative care is not only to ease suffering but also to recognize when certain processes begin and address any pain with the aim of maintaining dignity throughout this difficult time. In essence, the body wraps itself up in order to maintain the light of life within for as long as it possibly can.
Here is a look at those common changes, explained with clarity.
Some of the first and most obvious signs include an increased amount of sleep. With the slowing down of body processes, there comes a significant decrease in the level of energy. The person sleeps all day long, and at times, it’s hard to wake them up. When they are awake, they show signs of confusion, drowsiness, and inability to hold a conversation for several minutes.
According to research done by Marie Curie, this phenomenon is quite common during natural retreat. It is not a sign of suffering since the body is now using less energy while shutting down different systems.
What can be done: Medical practitioners advise letting the person sleep as much as necessary. Nevertheless, you still can take care of them by carefully moving them to a new position after several hours. At the same time, you should always behave as if they could hear your voice. Hospice research reveals that hearing is usually the last thing a dying individual loses before passing away.
2. Loss of appetite and the “dehydration myth”
Another symptom people experience in the final days and hours of life is a decreased appetite for food and water intake. As the organs start to function slower and slower, there comes a time when the body does not need as much sustenance. Hunger and thirst will diminish, and they will start experiencing swallowing difficulties (dysphagia).
While this symptom can be highly disturbing to loved ones who view food as a sign of affection, studies conducted by VITAS Healthcare have shown that pushing someone to eat or drink can actually make them uncomfortable and even cause fluid retention in their lungs. On the other hand, mild dehydration at the end-of-life stage triggers the production of endorphins in the body.
Some comfort measures include: moistening the lips with balm to prevent cracking, keeping the mouth clean and moist with a damp sponge or swab, and offering tiny ice chips or small sips of water only if the person is alert and asks for them.
3. Changes in breathing: The rhythm of the room
Breathing is another physiological function which tends to change during the final stages of life. The changes include the alteration of breathing patterns which can range from being very slow to very fast. The patient may experience a phenomenon called Cheyne-Stokes breathing, where they breathe deeply and quickly before pausing (apnea). It can last for several seconds.
Another common symptom involves a “wet” or rattling noise. As highlighted by the NHS in the discussion about breathing changes, this is due to an accumulation of secretions, which the individual no longer possesses the strength to clear. This noise may be distressing to the caregiver, but most patients do not experience pain.
The expert perspective: Doctors from Liv Hospital confirm that this condition is related to the weakening influence of the brainstem on the breathing system. It indicates the shift towards the next phase. Turning the individual to the side is sufficient to stop making this sound and make breathing look easier.
4. Confusion, disorientation, and hallucinations
In the final stages, some individuals may have “terminal delirium,” such as failing to recognize familiar faces, speaking in sentences that don’t make sense, or seeing people who aren’t there. Terminal delirium can occur because of changes in brain chemistry, medications, or low levels of oxygen.
Studies on confusion show that, although frightening for loved ones, such experiences are quite common, and some even claim visions of dead family members, a condition referred to as “nearing death awareness.”
What should you do? Your primary objective should be to reassure them rather than correct their misconceptions. According to experts, we should speak calmly and soothingly, not argue with them, and just be there, because our presence can work as a tranquilizer.
5. Skin changes and temperature drops
With decreasing circulation, the body will concentrate its resources on sustaining the heart and the brain; thus, the flow of blood to the extremities like the limbs will be compromised. The skin could feel cold and clammy, while the hands or feet could appear cyanotic or mottled.
It is the body’s final attempt at conserving energy. Even though the individual is not feeling cold, putting a blanket over them gives a sense of security not just for them but for the family as well. Heating pads should be avoided because of the possibility that fragile skin can get burnt easily.
6. Changes in toilet habits
The decrease in fluid intake causes a slowdown of kidney functions as well as digestion. It results in infrequent urination, dark urine, and eventually leads to loss of control. It can be hard for families to see such a thing occur, but hospice professionals know how to approach the situation with extreme dignity and sanitation, keeping the patient dry at all times.
7. Muscle weakness and loss of mobility
Strength in the muscles begins to weaken, as the energy of the body focuses on other aspects. The individual will need help moving around and even with simple actions like changing position in bed or holding a glass. It is recommended for caregivers to be gentle in their movements, as the body is getting ready for the final stage of life.
8. The energy surge: the “Golden Hour”
Occasionally, individuals exhibit a sudden spike in their energy levels shortly before death. For instance, they might suddenly wake up, ask for their favorite meal, or have a completely clear conversation. While most of the family members are always hopeful of this change, palliative care literature shows that this is “the final surge.” This is a precious moment, one to do all the saying and connecting that needs to be done.
9. Final vital sign changes
During this phase, the heart rate becomes erratic or faint, and blood pressure steadily drops. These changes mark the last signs of the body working through its cycle.
Supporting yourself through the vigil
Sitting at the bedside during the final days of a dying person’s life is a tiring, sacred, and depleting experience. One should remember the following:
Your presence is all that the person who’s going through their final hours and days of life needs: Not everything requires an action; sometimes, being present is an act in itself.
Rest when necessary: It is common practice for those around their loved one to wait until they are alone in the room when taking their last breaths, as it is their final act to protect their families from suffering.
Rely on professionals: If the patient receives hospice or palliative care, do not hesitate to ask these professionals to deal with medical issues so that you can concentrate on your loved one.
Conclusion
The final days before death are associated with significant physiological symptoms. However, these days are also highly human. As the body becomes weaker, the main concern for everyone is providing care, respect, and comfort to the one who is about to leave this life soon. Learning about these signs does not help diminish grief, but it replaces the fear-filled silence with knowledge and comprehension. Most importantly, what really matters at this moment is the compassion that surrounds the sick person’s bed.
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Bored Daddy
Love and Peace
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