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Signs that death is near

Changes to breathing

Drowsiness

Delirium

Eating and drinking less

Loss of bladder and bowel control

Changes to the skin

Temporary improvement

 

Most of us don’t know what to expect when a person is close to death. The unfamiliar is often very scary, so understanding what may happen can help ease the fear and anxiety of the dying person, family and caregivers.

 

In general, as a person gets closer to death, their body functions start to slow down. But it’s important to understand that every situation is different. Having one or more of the signs below doesn’t necessarily mean that the person is close to death.

Changes to breathing

Breathing changes as death approaches. It may slow down or become quick and shallow. Sometimes breathing may stop for several seconds at a time and then start again. An irregular breathing pattern, called Cheyne-Stokes respirations, is common in people who are dying. In this pattern, breathing is very deep and rapid, followed by short breaths, and then a period of not breathing.

 

Mucus can pool in the back of the person’s throat, causing a rattling or gurgling sound while breathing. This noise can be very upsetting to family members and visitors, but the person is usually not aware of the sound.

 

The following can sometimes make breathing easier:

  • Lying on the side or having pillows under the head and behind the back may help.
  • Oxygen therapy may help some people.
  • A humidifier may make breathing more comfortable.
  • Medicines may be used to reduce the amount of mucus.
  • The healthcare team may use suction to remove the excess mucus.

 

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Drowsiness

As people get closer to dying, they may sleep more, become drowsy or be difficult to wake. They may fall asleep while talking. A person may slowly lose consciousness in the days or hours before death.

 

When visiting someone with advanced cancer, it’s helpful to remember:

  • Visiting may be tiring and difficult for the dying person.
    • Plan visits and activities for times when the person is awake and more alert.
    • Keep visits short and have fewer people visit at a time.
    • Scheduling visits may help everyone get time with the person.
  • Be aware that it may be hard for the person to socialize or stay awake.
  • Sometimes a person may withdraw or be less social because they are mentally preparing for death. Let them know that this is okay.
  •  People may still be able to hear you even if they are unconscious and can’t respond.
    • Speak directly to them. You can also touch them lightly when speaking to them.
    • Talk about topics that might be upsetting outside of their room.

 

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Delirium

Sometimes, a person who is dying may become restless, anxious or confused. This confusion and disorientation is also called delirium.

 

People with delirium may not know loved ones or friends, what day or time it is, or where they are. Some people may see and speak to things that others can’t see (hallucinations), or start to worry about things. They may try to get out of bed or shift around in bed more. They may turn their sleeping cycle around so that they sleep during the day and are awake at night. A person with delirium may make jerking movements with their legs and arms, which they cannot control. They may also lose control of their bladder or bowels.

 

Delirium has many possible causes, including drugs, disease, brain metastases, changes in metabolism and infections. Delirium can develop quickly over a number of hours or days. If the underlying cause of the delirium can be found, the healthcare team will treat it.

 

Delirium can upset family members and caregivers, especially if the loved one becomes aggressive or unkind. Try to remember that people who have delirium aren’t aware of how they’re acting and their actions do not reflect their true feelings or beliefs.

 

It’s normal to feel uncomfortable or nervous around someone with delirium. Following these tips can help keep the person calm and safe.

  • Be calm and reassuring.
  • Speak slowly and quietly.
  • Gently remind them of the time, place and who people are.
    • Leaving a clock and a calendar that can be seen nearby may help.
  • Don’t hold or tie their hands down if they’re pulling at the bed linen or clothing.
  • Provide comfort by gently touching or stroking the person.
  • Leave soft, indirect lights on in the room that are similar to a day–night cycle.
  • Play music softly in the room to create a calming atmosphere.
  • Reduce the number of visitors to help with confusion.
  • If the person has a hallucination, remember it exists to them. You don’t have to pretend that you see the hallucination, but you don’t have to tell the person that the hallucination isn’t real.

 

The healthcare team may suggest medicines that can help reduce anxiety and make the person more comfortable.

 

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Eating and drinking less

As death nears, the body slows down. People don’t need as much food or fluids as before, so they don’t feel hungry or thirsty. It may go against your instincts, but try to let the person decide when and what they want to eat or drink.

 

A person nearing death may also have problems swallowing. Don’t force them to eat or drink if this is the case. Forcing them to eat or drink could cause choking or may increase their risk of a lung infection.

 

To keep your loved one comfortable, you can:

  • Offer liquids often, such as sips of water, ice chips or juice.
  • Relieve a dry mouth with mouth swabs or moisturizing sprays.
  • Keep lips moist with lip balm or lubricant.

 

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Loss of bladder or bowel control

Some people may lose control of their bladder or bowels because muscles in the pelvis relax. Sometimes a tube (called a catheter) that drains urine is used. Urine may become darker and they may urinate less.

 

To keep your loved one comfortable, you can:

  • Keep them dry and clean.
  • Protect bedding with protective pads and change these when dirty.

 

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Changes to the skin

As death nears, the skin can change. It may look pale, blotchy or bluish. It may become thin, dry and flaky. There may be reddened areas over the joints of the hands and legs. Hands or feet may feel cool to the touch.

 

To keep your loved one comfortable:

  • Use light covers or blankets.
  • Don’t use electric blankets or heating pads, which can cause burns.
  • Bathe them with warm water and a non-drying cleanser. Dry the skin completely.
  • Massage a gentle, non-perfumed moisturizer into the skin.
  • Avoid rubbing reddened areas or where skin is thin.

 

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Temporary improvement

Sometimes people who are near death have a brief and unexpected improvement. They are more alert and can interact with those around them. Family members might hope that this temporary improvement means that the person is going to get better, and that the prognosis was wrong. As hard as it is, it’s important to remember that these changes are only temporary and the person will get worse again.

 

This time could be used to share important feelings or thoughts with the dying person, and make a deeper connection in the final days or hours before death.

 

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References

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We can give information about cancer care and support services in Canada only. To find a cancer organization in your country, visit Union for International Cancer Control or International Cancer Information Service Group.