As a person is dying they will have less energy and become easily tired. They are likely to become weaker and may spend more time asleep. They may become detached from reality, or unaware of what is happening around them. They may be less interested in eating and drinking.
In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before.
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.
Final Weeks of Life
Increasing weakness and/or exhaustion. 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.
Someone with a terminal illness may live for days, weeks, months or years. It often depends on their diagnosis and any treatment they are having. It can be difficult for healthcare professionals to predict exactly how long someone with a terminal illness will live (their prognosis).
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.
There are three main stages of dying: the early stage, the middle stage, and the last stage. These are marked by various changes in responsiveness and functioning. However, it is important to keep mind that the timing of each stage and the symptoms experienced can vary from person to person.
Although it can include end of life care, palliative care is much broader and can last for longer. Having palliative care doesn't necessarily mean that you're likely to die soon – some people have palliative care for years. End of life care offers treatment and support for people who are near the end of their life.
“First hunger and then thirst are lost. Speech is lost next, followed by vision. The last senses to go are usually hearing and touch.”
A conscious dying person can know if they are on the verge of dying. Some feel immense pain for hours before dying, while others die in seconds. This awareness of approaching death is most pronounced in people with terminal conditions such as cancer.
Changing vital signs
As a person approaches death, their vital signs may change in the following ways: blood pressure drops. breathing changes. heartbeat becomes irregular.
Active dying is the final phase of the dying process. 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.
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.
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.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
Dying patients experience fear of pain, fear of indignity, fear of abandonment, and fear of the unknown. Open and direct discussions can ease many of these fears.
Pain is common in terminal illnesses -- more than 70% of patients with advanced cancer experience severe pain. A conservative estimate is that over 300,000 cancer patients suffer pain daily. It has been estimated that at least 25% of all cancer patients die without adequate pain relief (AHCPR).
The emotional discomfort and interpersonal conflicts go hand in hand in causing suffering at the end of life. Financial instability, marital discord, conflicts with family members, and an inability to get one's affairs in order before death are common causes of total pain.
Terminally ill cancer patients near the end of life can experience refractory symptoms, which require palliative sedation. Midazolam is the most common benzodiazepine used for palliative sedation therapy.
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.
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.
Some argue that a rise of neurotransmitters could be released from the brain in response to deteriorating health. Others suggest that the body might be attempting to prepare for the final stages of life or that the surge is connected to the patient's emotional state.