This stage of the active dying process may last up to three weeks. The second stage is active dying. During this stage, the body begins to exhibit signs of death or imminent death.
The three most common signs of active dying are moist and noisy breathing, restlessness and agitation, and pain. Urinary retention or incontinence are nearly as common. Abating this distress is often possible with a mild degree of sedation or painkilling drug. Both are commonly used for people who are approaching death, helping to provide as much comfort as modern medicine can allow.
The dying process is highly variable and can last up to several weeks in some instances. Actively dying or imminent death represents the last week of life and has characteristic clinical signs detailed in the table below. The expression of clinical signs varies substantially between patients, but a greater number of clinical signs present within an individual increases the likelihood of death. The identification of a patient transitioning to imminent death is important, so that clinicians can help educate patients and families about the natural dying process to inform decision-making as well as prepare the patient and family for death as much as feasible.
A higher level of care may be needed on occasion for a period of crisis or uncontrolled symptoms not responding to initial treatments. Clinical signs are based upon study in cancer patients but are generalizable to other causes of death e. The list is not exhaustive but includes some of the more common symptoms. Useful resources Key points. Last days and hours of life The last days or hours of a person's life are sometimes called the terminal phase.
These include: getting worse day by day or hour by hour becoming bed-bound for most of the day extreme tiredness and weakness needing help with all personal care little interest in food or drink difficulty swallowing oral medication being less responsive and less able to communicate sleepiness and drowsiness reduced urine output new urinary or faecal incontinence delirium, with increased restlessness, confusion and agitation changes in their normal breathing pattern noisy chest secretions mottled skin and feeling cold to the touch the person telling you they feel like they're dying.
If you think someone is in their last days of life It can be difficult to know whether someone is entering the last days of their life. Consider reversible causes of decline Some conditions can cause the signs and symptoms of dying but can be treated.
Be aware of reversible causes of decline, which may include: hypercalcaemia high level of calcium in the blood renal kidney failure infection side effects of medicines such as strong painkillers.
Communicate with the patient and those involved in their care Even when someone has been living with a terminal illness for a while, it can be a shock for the patient and the people around them when they reach the last days of their life. Download My Learning form. Be aware of reversible causes of decline in a person living with a terminal illness. Communicate with the health and social care team to ensure the patient gets the best care in their last days of life.
Talk to the patient and those close to them about what is happening and encourage them to express any concerns. Let us know what you think Email your feedback to knowledgezone mariecurie. Disclaimer This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals. Did you find this page useful? Your feedback will help us improve our information and support resources. What were you looking for today? Was this page useful?
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However, some patients with these symptoms can suddenly recover and live a week, a month or even longer. Low blood pressure alone or long periods of pausing in the breathing apnea are not reliable indicators of imminent death in all cases.
God alone knows for sure when death will occur. Although all patients do not show all of these signs, many of these signs will be seen in some patients. Always remember that your loved one can often hear you even up till the very end, even though he or she cannot respond by speaking. Your loving presence at the bedside can be a great expression of your love for your loved one and help him to feel calmer and more at peace at the time of death.
If you have questions about any of the changing signs or symptoms appearing in your loved one, ask your hospice nurse to explain them to you. The body is beginning to shut down and does not need nourishment. People commonly feel it is necessary to encourage the person to eat in the hope of sustaining life; however, food and fluid may cause discomfort. The person may ask for ice chips, popsicles, ice cream or some other food choice.
Do not be surprised if only a mouthful or two is taken. When swallowing is no longer possible, mouth care provides moisture and comfort. Do not offer a fluid if swallowing is not possible. Urine and stool may also change color, be passed less frequently and in smaller amounts. Other factors such as immobility and medication may contribute to this.
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