Author: Jeanette G. Ferrer, DO
Each person's physical decline and death are unique experiences. Variations appear to be dependent on the individual's particular disease process. However, the following are objective signs that are commonly seen in patients closer to the end of life.
Early Stage of Dying
(weeks to months prior to death)
Middle Stage of Dying
- Decreased ambulation, loss of ability to transfer, bed confinement;
- Withdrawal from surroundings and relationships;
- Internal reflection of life and initiation of legacy activities;
- Decreased oral intake;
- Incontinence of bowel and/or bladder;
- Increased fatigue.
(days to weeks prior to death)
Late Stage of Dying
- Episodes of delirium which may include delusions, agitation, confusion, picking/restless behaviors, and alterations of sleep/wake cycle;
- Less communication: patient may cease to speak;
- Lower blood pressure;
- Pulse irregularities;
- Increasing episodes of sleep;
- Decreased oral intake and loss of thirst sensation and appetite;
- Decreased urine output.
(hours to days prior to death)
- A paradoxical surge of energy: patient may move/talk/eat when previously lethargic;
- Decreasing level of consciousness;
- Irregular breathing: a common respiratory pattern is Cheyne-Stokes respiration in which rapid breaths are followed by periods of apnea;
- Loud, rattled breathing (death rattle) from pooled secretions in the hypopharynx;
- Hemodynamic changes, weak/thready pulse, cool extremities, and mottling (purplish reticular discoloration of the skin) beginning from distal extremities;
- The neck may become hyperextended;
- The face may relax resulting in a loss of wrinkles, especially on the forehead and the nasolabial folds;
- Perioral, perinasal and periocular pallor is common, eliciting an almost yellow waxen appearance to the face;
- At a certain point, there will be cessation of cardiac and respiratory function necessary to sustain life.
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