In many cases, the dying process begins well before death actually occurs.
Death is a personal journey that every individual approaches in his or her own unique way. Nothing is concrete or set in stone. While there are many paths one can take on this journey, they all lead to the same destination.
As the end-of-life process commences, an individual begins on a mental and spiritual path of discovery, recognizing his or her own mortality and comprehending that death will indeed occur. This journey ultimately leads to a departure from the body.
There are several milestones along this journey; each individual experiences these milestones in a different way. Because each person experiences death in his or her own way, not everyone stops at each milestone. Some people may visit only a few, while others stop at each one. Some people may take months to reach their destination, while others take only days or even hours.
Here we will discuss what has been found through research to be the journey experienced by most, while keeping in mind that the journey is unique to the individual traveller.
The Journey Begins:
One to Three Months Prior to Death Social Withdrawal:
As a person begins to recognize their mortality and realize that death is approaching, he or she may start to withdraw somewhat from their surroundings; they are beginning the process of separating from the world and those in it. They may decline visits from friends and neighbors, preferring to only spend time with family and those closest to them. When they do accept visitors, they may seem less interactive and visit for shorter periods of time. A person comprehending their mortality will often begin contemplating how they have lived their life and sorting through any regrets.
As the end-of-life process begins, a person may spend more time sleeping and less time participating in the activities they once enjoyed. The person’s sleep schedule may vary and become increasingly inconsistent.
As the body begins to slow down, a person may experienced a reduced appetite and weight loss; the body no longer needs the energy from food that it once did. The body does a wonderful thing during this time – altered body chemistry produces a mild sense of euphoria, so the person becomes less hungry and thirsty but is not suffering by not eating. This is an expected part of the end-of-life journey.
Difficulty swallowing is common as a desire for food and fluids decreases. Pushing food or fluids is not recommended as it may result in increased discomfort and aspiration. Because the body is malfunctioning, the balance of fluids in the body is not ideal, often leaving the mouth dry. If possible, the mouth should be kept closed and should be kept moist to aid in comfortable swallowing.
One to Two Weeks Prior to Death
Mental Changes: During this part of the end-of-life journey, a person may begin to sleep most of the time. Disorientation is common, and altered senses of perception can be expected. A person may occasionally pick at their clothing and bed sheets in an agitated state. Movements and actions may seem aimless and may make no sense to others.
In some cases, a dying person may report or demonstrate seeing or speaking to unseen others, who may be loved ones who have already passed on.
During the final one to two weeks of this journey, the body has a more difficult time maintaining itself. The body may experience some of the following symptoms during this time:
- Body temperature varies up and down by one or more degrees.
- Blood pressure lowers.
- Breathing changes may take place, with breathing often becoming more rapid and labored. Congestion may also occur, causing a rattling sound and cough.
- Skin color may change as circulation diminishes.
- Speaking decreases and eventually stops altogether.
- The pulse becomes irregular and may slow down or speed up.
- There is increased perspiration.
A Couple of Days to Hours Prior to Death
In the final days or hours preceding death, a person may experience a surge of energy. They may want to get out of bed and speak with loved ones, and they may ask for food after days of no appetite. This surge of energy is often a dying person’s final physical expression before passing on.
Following this surge, the previous symptoms become more pronounced as death approaches. Breathing becomes more irregular and often slower. Rapid breaths followed by periods of no breathing at all may occur as well.
Congestion in the airway can cause increasingly rattled breathing. Hands and feet may become blotchy and mottled (purplish). This mottling may slowly make its way up the arms and legs, and the lips and nail beds are often bluish or purple.
The person usually becomes unresponsive and may have their eyes open or semi-open, but they do not see their surroundings. It is widely believed that hearing is the last sense to go, giving loved ones an opportunity to quietly sit and talk to the dying during this time. Eventually breathing will cease altogether and the heart will stop. Death has occurred and the journey has ended.
Symptom Management: There are a number of ways to manage the above symptoms and make this journey as comfortable and smooth as possible. We encourage you to consult with your hospice team to determine the options that will work best for your loved one’s situation. Please also contact Dignity Hospice of Utah at 801-492-4892 when your loved one passes. Our nurse will then come to your home and assist in post-mortem care and coordination. You do not need to contact 911.
If you have any questions about hospice care in Utah and how we can make the end-of-life journey more comfortable, we welcome you to contact Dignity Hospice of Utah today.