CCS adapting to COVID-19 realities to support Canadians during and after the pandemic
Signs that death is near
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.
People may be less interested in the world around them. They lose interest in activities that they enjoyed and are not interested in talking or being social. Sometimes people become irritable or restless.
It’s normal to be upset when a loved one withdraws from you, but try not to take the withdrawal personally.
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, be aware that visiting may be tiring and difficult for the dying person. Keep visits short and have fewer people visit at a time.
People may still be able to hear you even if they are unconscious and can’t respond. Speak directly to them, and use their name. You can also touch them lightly when speaking to them. If you need to talk about topics that might be upsetting, leave the room so that they won’t hear.
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.
You can offer liquids often, such as sips of water, ice chips or juice. Mouth swabs or moisturizing sprays can help keep the mouth moist. Lip balm or lubricant can be used to keep their lips moist.
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.
Sometimes lying the person on their side or putting pillows under their head and behind their back may help make breathing easier. A humidifier to moisten the air may make breathing more comfortable.
The healthcare team may use suction to remove the excess mucus, give medicines to reduce the amount of mucus or give oxygen therapy.
Loss of bladder or bowel control
Some people may lose control of their bladder or bowels because muscles in the pelvis relax. This is called incontinence.
To keep your loved one comfortable, you can make sure that they are dry and clean. It may be easier to protect the bed with incontinence pads and change these when dirty.
The healthcare team may use a tube called a catheter to drain the urine (pee) into a bag. The urine may look darker than normal. If a person isn’t eating or drinking very much, there will be less urine and fewer bowel movements (poop).
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, but the person doesn’t feel cold.
Light covers or blankets might make your loved one more comfortable. Don’t use electric blankets or heating pads, which can cause burns.
When bathing, use warm water and a non-drying cleanser. Dry the skin completely. Massage a gentle, non-perfumed moisturizer into the skin, but avoid rubbing reddened areas or where their skin is thin.
Sometimes, a person who is dying becomes 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). They may try to get out of bed or shift around in bed more. Their sleeping cycle may change 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 that they cannot control.
Delirium can be upsetting to family members, especially if their 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.
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 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. But 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.