Signs of Dying

The following are signs of dying that are often seen. Please know that every individual is unique and not all signs will be present with your loved one.

The Body

There are physical signs of dying

• Hands, feet and legs may feel cool or cold to the touch.
• Blood pressure gradually goes down and heart rate gets faster but weaker and eventually slows down.
• Fingers, earlobes, lips and nail beds may look bluish or light gray.
• A purplish or blotchy red-blue coloring on knees and/ or feet (mottling) is a sign that death is very near.
• Because the body no longer needs large amounts of energy and because the digestive system is slowing down, the need for and interest in food (and eventually fluids) gradually lessens.
• As eating and drinking taper off, the body naturally becomes dehydrated. When this occurs, the dying person becomes sleepier and may be less aware of pain or discomfort. This is a normal part of the dying process and there are ways to keep the person comfortable throughout this time.
• Fever may or may not occur, but is common nearer to death.
• Secretions usually thicken and build up in the lungs and/or the back of the throat.
• Breathing may sound moist, congested or like a rattle.  This may come and go and is rarely bothersome to the dying person closer to the time of death.
• Changes in breathing will occur – changes in the rate, depth and rhythm of breathing, periods of not breathing for 5-30 seconds or a distinct pattern of breathing that is slow and shallow, then becoming faster and deeper, then slowing down again to 10-20 seconds.
• Because the kidneys and bowels eventually stop working, there is a smaller amount of urine and it is darker in color.
• Bowel movements become less frequent, but not having one for three to four days could become uncomfortable.
• Vision may be blurred.
• Always assume the dying person can hear, even if they are unable to respond.
• Although verbal and nonverbal communication becomes more limited, gentle touch is an effective way to remain present.

 The Mind

There are mental and emotional-social changes that accompany dying

• Restlessness or agitation which­­­­­­­ may be a result of less oxygen to the brain, metabolic changes or physical pain.
• Occasional or constant confusion which may be related to separation from the normal routines of living.  It may also be the result of a disease, or the dying process.
• Levels of consciousness (being alert and aware) which may vary.
• Sleepiness, but being able to be awakened and have awareness of the surroundings.  The senses may be dulled and there may be little awareness of what is happening in the ­environment. Sleep may be so deep that the dying person cannot be awakened and is unresponsive.
• During the dying process, changes affecting a person’s inner feelings and interpersonal relationships may take place.  
  Looking back at one’s life in search of meaning and contributions – life review.
• Saying good-bye to people and places, forgiving and being forgiven, facing regrets – life closure.
• Acceptance or coming to terms with ongoing losses and eventual death.
• Some individuals may not want or be able to do these things.  Take cues from the dying person. Listen, share memories and find ways to say good-bye.

The Spirit

A person’s spirituality is unique and personal.  Early in the dying process, the person may face issues such as examining:

• The meaning of life, hope, suffering and death
• Acceptance of ongoing losses and eventual death
• Grieving these losses
• Forgiving and being forgiven

It is not unusual for a dying person to speak in metaphors about dying, for example speaking about death in terms of travel or a journey, getting to the door, or finding the key. It is not uncommon to see a dying person calling or reaching out to a deceased family member or to a religious figure or speak of visits from or dreams about those who have died before them.  These accounts are usually comforting to the dying person. Rather than deny or correct, it is important to listen and accept what is being said.

A person dies at just the right moment whether it is alone or surrounded by others. Some individuals may seem to “hold off” or “bring on” the moment of death…that is, dying just after a close relative arrives from out-of-town or after an anticipated event such as a birthday occurs. Death may come when everyone steps out of the room momentarily; thus, sparing loved ones from the actual dying event.