- Cancer Information
- Advanced cancer
- Facing end of life
- Caring for someone nearing the end of life
- Providing physical support
- Signs that someone is dying
Signs that someone is dying
Some family and friends find that information about the physical process of dying helps ease their fear and anxiety. Others prefer to take one day at a time and ask health professionals for explanations as the need arises. If you would like to know what to expect, this section describes the physical changes in the last days and hours of life.
Each death is different, but as a person nears the end of life there are often common signs. These physical changes don’t occur in any particular order. In medical terms, the dying process is viewed as the body’s systems closing down.
Sleeping more – The dying person has less energy, and often they may spend most of the day sleeping or resting.
|Eating and drinking less – As the body slows down it uses less energy and the person doesn’t need to eat or drink as much. The person may begin to resist or refuse food or drink, and weight loss can occur. Giving fluids at this time doesn’t improve symptoms.|
|Little interest in the outside world – The dying person may gradually lose interest in people nearby. They may find it hard to concentrate and they may stop talking. Withdrawing is part of letting go. Near the end, some people have a sudden burst of alert behaviour.|
Breathing changes – Breathing may become rattly, irregular and laboured. You may hear an irregular breathing pattern known as Cheyne-Stokes. This is a loud, deep breath followed by a long pause (may last from five seconds to as long as a minute), before a loud, deep breath starts again.
If mucus builds up in the throat, it can create loud, gurgling sounds, which some people call a “death rattle”. Medicines can help dry up any mucus or you can try changing the person’s position in the bed. Listening to this change in breathing pattern can be upsetting, but it is thought that it is not painful for the person.
|Bladder and bowel changes – As the body’s systems slow down, the person may have trouble emptying their bladder. A catheter may be inserted into the bladder to drain urine and avoid a blockage. Medicines may be prescribed for constipation, a common side effect of some pain medicines. As the person eats and drinks less, they will produce less urine and faeces. Loss of bladder and bowel control sometimes happens in the last stages of the dying process, but does not always happen.|
Disorientation and confusion – Carers are often unprepared for the person becoming disoriented and confused. This is known as delirium. It can involve a lower level of consciousness; memory loss; hallucinations (seeing or hearing things that aren’t there); delusions (false beliefs); mood swings; and sleep disturbances. A person who is dying may not be aware of where they are or who else is in the room, may speak or reply less often, or may respond to people who can’t be seen by others in the room. The person may drift in and out of consciousness and eventually become unresponsive.
Delirium may occur when waste chemicals (toxins) build up in the brain as vital organs begin to shut down, but it can also have a range of other causes, such as fever or constipation. Talk to the palliative care team about how delirium can be controlled.
Restless moving, twitching, groaning or calling out – These symptoms are part of terminal restlessness, a type of delirium that may include agitation, anxiety, anguish and anger, all of which can be very distressing for carers to see. These symptoms are common and not necessarily uncomfortable for the dying person.
Cool skin, especially the hands and feet – As circulation slows down, the hands, feet, fingers and toes (the extremities) become cooler and turn a bluish colour. It’s thought that the person will be unaware of feeling cold.
Dry mouth and dry or cracked lips – This can happen if the person is dehydrated or has been breathing through their mouth, or it may be due to some medicines.
Dr Megan Ritchie, Staff Specialist Palliative Medicine, Palliative Care Service, Concord Repatriation General Hospital, NSW; Gabrielle Asprey, Cancer Support Consultant, Cancer Council NSW; Rosemary Cavanough, Consumer; Louise Durham, Nurse Practitioner, Metro South Palliative Care Service, QLD; Tracey Gardner, Senior Psychologist, Cancer Counselling Service, Cancer Council Queensland; Karen Hall, 13 11 20 Consultant, Cancer Council SA; Linda Nolte, Program Director, Advance Care Planning Australia, VIC; Rowena Robinson, Clinical Advisor, Palliative Care Australia, ACT; Helena Rodi, Program Manager, Advance Care Planning Australia, VIC.
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