This period of time is one of the most difficult for the family to live through. Sometimes Afear of the unknown@ is greater than the fear of the known. This information is offered to help you prepare and to anticipate symptoms which indicate approaching death. Your doctor and/or your hospice nurse are available to help you clarify your concerns about this phase of life. Some of the possible symptoms that might occur are provided so that if one does appear you will understand what is happening. Included are some guidelines about what you can do to help comfort your loved one. The symptoms described are indicative of how the body prepares itself for the final stage of life. Not all of these symptoms will appear at the same time and many might never appear.

1. The arms and legs of the body might become cool to the touch and you might also notice a darkening in color. These symptoms are a result of the blood circulation slowing down. You may use warm blankets if the patient feels cool.

2. The patient will gradually spend more and more time sleeping and at times might be difficult to arouse. This is a result of a change in the body’s metabolism. Plan to spend more time with the patient during those times when they are more alert.

3. Your family member might become increasingly confused about time, place and the identity of people around him or her. This is also a result of changes in the metabolism. Remind him or her about what time it is, what day it is, and who else is in the room.

4. Loss of control of urine and bowel movements is often not a problem until death is imminent. Disposable pads, briefs and chux are available at most pharmacies. Ask your hospice nurse about what you might need. Disposable pads may be placed under the patient for increased comfort and cleanliness, or your doctor might order a catheter.

5. Oral secretions might become more profuse and collect in the back of the throat. You might have heard this referred to as the Adeath rattle.@ This is a result of the body’s inability to cough or to swallow normal saliva. Elevating the head of the bed, keeping the mouth clean might help. Remember that the sound might be difficult for you, but it does not cause the patient to suffer.

6. Hearing and vision might decrease. The patient might want all the lights on or he might want them off. Either way is OK. Remember never assume that the patient can’t hear you, hearing is the last of the senses to be lost.

7. You might notice your loved one becoming restless, pulling at the linens, or having visions of things which you do not see. These symptoms might be a result of a decrease of oxygen in the brain and a change in the body’s metabolism. Talk calmly and reassure the patient. Speak softly and do not upset the patient.

8. The need for food and fluid is greatly decreased at this time and the patient might not be taking any food or fluids. This is not an unusual occurrence. The systems of the body are shutting down and are not able to metabolize food or fluids. In fact the process of dehydration often makes the patient more comfortable as swelling is reduced and pressure eased, this also decreases the load on the other systems of the body while they are in the process of shutting down.

9. There might be a change in the breathing pattern. The patient=s breathing might become irregular with pauses of several seconds. this is very common and indicates a decrease in circulation and a build up of waste products in the body. this is not uncomfortable for the patient, but can be stressful for the family.

10. If the patient has a catheter in place, you might notice that the amount of urine decreases as death becomes closer. Consult with your hospice nurse to be sure the catheter does not become blocked or need to be irrigated.

 

How to know when death has occurred.

* No heartbeat

* No breathing

* Eyelids slightly open

* No response to touch or sound

* Jaw relaxed, mouth slightly open

* Loss of control of bowels and or bladder

 

What to do then.

Call your hospice representative or nurse.  Remember there is no hurry, if you need time first, it is okay, you can call later.