What happens in the final days of life
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Knowing that you, or a loved one, is close to dying can be very difficult for everyone involved. People often ask us questions about how someone will die. Especially relatives and friends. They often worry that they won't be able to cope, or know what to do when the person they are caring for dies. We have written this information from the carer’s perspective.
It is very difficult to give exact details of how someone will die. Each person is different and will die in their own unique way. But we can give you some general information about what might happen and what you can do to support your loved one through their process of dying.
The body begins its natural process of slowing down all its functions. How long this takes varies from person to person and may take hours or days. The dying person will feel weak and sleep a lot. When death is very near the dying person may have
- Sleepiness and difficulty waking (semi conscious)
- Difficulty swallowing or not wanting to eat or drink at all
- Loss of control of bladder and bowel control
- Restless movements (as though they are in pain)
- Changes in breathing
- Noisy breathing
- Cold feet, hands, legs and arms
- Confusion and disorientation
- Complete loss of consciousness
You can read about all these changes below.
It can be emotionally very difficult to watch someone go through these physical changes. But they are part of a natural dying process and don’t mean that the person is uncomfortable or in distress.
The doctors and nurses looking after the person during this time will check regularly for these changes. They will do all they can to make your relative or friend as comfortable as possible during their death. If you are looking after someone at home while they are dying, you should have support from a specialist community nurse, district nurses, and the GP. They can answer your questions and help to make home nursing easier for you.
People who are dying often sleep a lot and might not respond when you try to wake them. But this doesn’t mean they can’t hear you. Hearing may be one of the last senses to be lost. So it is important not to stop talking to them and comforting them. You can sit close to them and hold their hand. It is important not to say anything that you wouldn’t want them to hear. It's also a good idea to tell them when you go into or leave their room.
There will come a time when the dying person won't want to eat or drink anything. It is important not to try and force them to eat or drink. This will make them uncomfortable. If they are still awake you can give them small pieces of ice to suck or sips of fluid to keep their mouth moist. You can put vaseline or lip balm on their lips to help stop them getting dry and sore.
If they really can’t take anything into their mouth, you can moisten their lips and mouth every 1 to 2 hours with lemon and glycerine swabs or water. Your GP or district nurse can get you the swabs.
The dying person might lose control of their bladder and bowel. This happens because the muscles in these areas relax and don’t work as they did. This can be distressing to see and you might worry that they may feel embarrassed. The nursing staff will do all they can to protect the bed and keep your relative or friend as clean and comfortable as possible.
If you are caring for someone at home, the district nurses and specialist nurses can arrange for you to have draw sheets or pads to protect the bed. They may also be able to arrange a laundry service for you, if necessary. As people become very close to death and are not eating or drinking, the amount of urine and stools they produce gets less and less.
Many people who are dying, and the people around them, worry that they will be in pain. Some people don't have pain. But if a person is in pain, it can usually be well controlled and people can be kept very comfortable. The doctors and nurses looking after the dying person will do all they can.
Sometimes restlessness is a sign of being in pain. If the dying person can’t communicate very well and you think they are in pain, the most important thing is to tell their doctors and nurses. They will want your relative or friend to be pain free, so do talk to them. This will help them plan the best way of controlling the pain.
When someone is dying their breathing often changes. It might get noisy and irregular. There may be times when they stop breathing for a few seconds. This is called Cheyne Stoke (pronounced chain stoke) breathing. They may breathe with their mouth open and use their chest muscles to help them catch a breath.
It can help to raise the head of the bed with pillows or cushions. Just sitting with them, speaking gently, and holding their hand can be very reassuring for them. If someone is having difficulty breathing, a doctor or nurse might suggest giving a small dose of morphine, even if they are not otherwise in pain. Morphine can help to make breathing easier.
You may hear gurgling or rattling sounds as the dying person takes each breath. This is coming from their chest or the back of their throat. It is because there is a build up of mucus and saliva and they don’t have a strong enough cough reflex to cough it up. Raising their head and turning it to the side can help gravity to drain the secretions.
Sometimes a nurse or doctor can suck the fluid out through a thin tube put down into the person's windpipe, but this is not usually needed. Hearing the gurgling sounds can be very upsetting, but they don't usually seem to cause distress to the dying person.
The dying person’s face, hands, arms, feet and legs often become very cool to touch. Their skin might also become pale and look blotchy or mottled. This happens because there is less blood circulation to these parts of the body. Keep them warm with blankets but don’t use an electric blanket as this may become too uncomfortable. Thick socks can help to keep their feet warm. Don’t overheat the room as this can make it stuffy. Just keep it at a comfortable temperature.
You might hear your loved one say things that make no sense. They may not know what day it is or may not appear to know who you are. They may even say things that are totally out of character. For example, they may shout at you or physically push you away. This can be very hurtful and upsetting. But try to understand that they don’t mean it and are not aware that they are doing these things. It happens partly because of the chemical changes going on inside their body.
At the end of life, the chemical balance of the body becomes completely upset. The dying person then slips into unconsciousness. This is usually right towards the end, maybe only a few hours or days before death. Breathing becomes irregular and may become noisy. You won’t be able to wake them at all. Their breathing will stay irregular for some time and will stop at some point.
Everyone will feel different emotions when they are dying. A lot depends on
- The type of person they are
- Their age
- How much support they have
- Their religious and spiritual beliefs
- The experiences they have had in life
Someone dying in their 20s is likely to feel very different to someone who is 80. If the person dying is leaving behind young children, they will have different worries from someone whose children are grown up and able to take care of themselves.
Before the final stages of death the dying person may talk about wanting to complete any unfinished business. This may mean
- Sorting out any problems with personal relationships, or deciding not to
- Visiting certain places
- Buying gifts for people
- Sorting out personal belongings and giving special things away to family and friends
- Getting their will and financial business in order
- Seeing a religious leader
As death gets closer they may begin to let go and seem more at peace with things. Others may become very anxious, fearful or angry. Some people may appear to withdraw even from the people they love and care about. But this doesn’t mean that they don’t care anymore. These events are all very normal and a natural part of dying.
Even if the physical body is ready to shut down, some people may resist death. They may still have issues they want to resolve or relationships they want to put right. It is important to understand these things. Let your loved one know you are there for them and will help them with any of these issues.
You are likely to feel some very strong emotions during the time your relative or friend is dying. You may feel that you want to try and change what is happening. Often all you can do is give them a lot of support and comfort during this difficult time. Allow them to share any memories or feelings they have. It is also important to reassure them that it is all right to let go and die whenever they are ready. Some people will hold on until they have heard these words from the people they love. So letting them go can be one of the most important and loving things you can do for them.
If you need some support when someone close to you is dying it may help to speak to
- The doctor or nurses on the ward
- A religious leader
- A counsellor
- Close friends and relatives
Try not to worry that you are going to do the wrong thing. Just being with your loved one and letting them know you love and care for them is the most important thing.
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