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.
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.
Mottling is typically seen in the last week of life, although there is no exact timeline. It can occur in the final week or not until the final hours.
Delirium is common during the final days of life. Most people have a lower level of consciousness. They may be withdrawn, be less alert, and have less energy. Some people may be agitated or restless, and have hallucinations (see or hear things not really there).
“First hunger and then thirst are lost. Speech is lost next, followed by vision. The last senses to go are usually hearing and touch.”
End-of-life rallies are not fully understood, and no one can predict just how long a rally will last. In rare instances, it can last a week or more, but in most cases it's a very brief window to connect with your loved one. Families who understand this can spend that time chatting and making a final connection.
The brain lives on for 30 seconds after death.
Visions and Hallucinations
Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see.
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.
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.
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.
Pulse and heartbeat are irregular or hard to feel or hear. Body temperature drops. Skin on their knees, feet, and hands turns a mottled bluish-purple (often in the last 24 hours) Breathing is interrupted by gasping and slows until it stops entirely.
It is one of the post-mortem signs of death, along with pallor mortis, algor mortis, and rigor mortis. Livor mortis usually sets in 20 to 30 minutes after death and increases in intensity until it becomes fixed at about 12 hours.
Researchers believe that a person can live for up to three weeks without food as long as they have water to drink. Without both water and food, a person cannot survive for more than four days.
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.
Summary. Common symptoms at end of life may include pain, constipation, nausea, breathlessness, fatigue and delirium. Relieving these symptoms is a key aim of palliative care.
When an individual is approaching death, the systolic blood pressure will typically drop below 95mm Hg. However, this number can vary greatly as some individuals will always run low.
What happens when someone dies? In time, the heart stops and they stop breathing. Within a few minutes, their brain stops functioning entirely and their skin starts to cool. At this point, they have died.
Many people lose consciousness near the end of life. But they may still have some awareness of other people in the room. They may be able to hear what's being said or feel someone holding their hand.
Just before death some people become restless, agitated and confused. This is known as terminal restlessness. It often occurs within the last few days of life. Terminal restlessness can be caused by a range of things and sometimes calming drugs are needed.
“Our data shows that a dying brain can respond to sound, even in an unconscious state, up to the last hours of life.”
For the first few minutes of the postmortem period, brain cells may survive. The heart can keep beating without its blood supply. A healthy liver continues breaking down alcohol. And if a technician strikes your thigh above the kneecap, your leg likely kicks, just as it did at your last reflex test with a physician.
Hearing is widely thought to be the last sense to go in the dying process. Now UBC researchers have evidence that some people may still be able to hear while in an unresponsive state at the end of their life.