When Death Looms – The Signs And Symptoms Of Final Moments On Earth

Death Signs And Symptoms Can Be Scary Unless You Understand What Is Happening

Note: I first wrote this article in 2012 as I sat by my own Mom who was actively dying. I’ve chosen to leave it in the present tense as I originally wrote it, mostly for myself.

Death is a natural progression of life. The truth hurts but there it is.

My mom is 95 and I’ve been her caregiver for about 5 years now. During a week-long hospitalization in November, 2010 for pneumonia, I had a lot of time to do some reading and writing as I watched her struggling for breath that first night in her hospital bed.

Per The Doctor In The ER, Her Chances Weren’t Good

The doctor in the ER had pretty much given us the word that death was looming – he gave her a 40% chance of making it through the night.

So, as I wiped her brow and watched her restlessly move about the bed and try to get up, I wondered what was causing these new actions as she’s generally a restful sleeper. I gently would settle her back in bed only to be back up in 5 minutes or so to re-settle. It was exhausting work!

When the nurse came in at 4 am to check vital signs (I waved her off), I asked her about the movement – she looked at me for a moment – I believe she was sizing me up. She then told me about what to expect when death looms.

This article is a result of that very first conversation and my further delving into the subject.

Although I write from the perspective of death in a senior citizen, the signs and symptoms of death are the same in people of all ages. However, like anything in life, your mileage may vary, meaning, you experience could well be different from what I saw.

BTW: My mom is fine. She’s home after 5 days in the hospital and better than she’s been for a while. Her pneumonia must have been around a while (asymptomatic) as her mental status decline was probably a result of the bacterial infection. Read more about sign and symptoms of pneumonia in the elderly by clicking Signs and symptoms of pneumonia in the elderly.

And, finally, here’s another great article about the emotions you might deal with when someone close to you dies: Death of a loved one.

Update October, 2011: Mom turned 95 on October 28, 2011 so what did we do? Head off on a cruise! Cruising with a 95 year old can be a bit of a challenge, and I’ve written about it in this additional article: Taking a cruise with the elderly; things you MUST know prior to embarkation. We had a blast and, in retrospect, I’m so glad we went. It was another good week together (well, minus the hellacious storm and my seasickness..).

Another update November, 2011: 1 short week after the cruise, Mom fell and broke a hip. She’s a trooper though – a full recovery is expected.

Update Feb 15, 2012: Mom died this morning at 7:11 am. The time was especially fitting as we are all gamblers and could be found around a craps table, if one was in the area….

Far from being tragic, her death was an easy end to a wonderful life.

Mom certainly deserved the sleep, having worked very hard at living the last two weeks. Her death followed the typical pattern outlined in this article, and, in fact, I’ve updated it from a (now) even more personal standpoint.

I miss my Mom greatly but am comforted by the best friends (both near and far) anyone can ever have. I am also so very glad that I had the resources to keep her at my home and to be with her when she died. She died surrounded by my friends and old brother, Mike, who took time from his busy life to be with us that last month. None of us could have asked for more.

The Typical Signs And Symptoms Of A Dying Patient

There have been times in the recent past where my Mom’s personality has shifted. Normally a cheerful, very funny woman, she would suddenly become agitated for little reason, become restless before bed, and become withdrawn from my friends who visit and family who come by.

I thought she was being difficult and told her so. Sure wish I hadn’t done that….

What my Mom was doing was signaling us (without anyone knowing it) that she was preparing to, one day, say goodbye. The fact that her personality was slowly changing was, I think, preparing me for missing her after death as, in a strange way, I sort of missed her even when she was physically with me because, sometimes, emotionally, she wasn’t.

I considered it a long goodbye.

The below are some of the signs and symptoms of impending death. Please note: death is a very personal experience so these signs and symptoms of death are generalized – not everyone will experience all of these symptoms and some may experience different symptoms of dying.

Please read through this carefully and share this article – everyone should be aware of these death signs so that they’re compassionate to those going through the stages of death.

I felt sorry for those family members who took Mom’s personality changes personally – they weren’t at all meant to be that way. But, those who don’t understand can frequently get their feelings hurt.

1. A Dying Patient May Withdrawal From Life In General

A person facing the last part of life on earth may withdraw from daily life. The withdrawal may be physical, such as sleeping most of the day or appearing almost to be in a comatose-like state or, the withdrawal may be emotional. The elderly loved one may not want to spend a lot of time talking with family and friends.

It’s best to remember that even loved one visits can be exhausting to those elderly with little resources. It sometimes took Mom a full day to recover from a visit.

It helps me immensely to remember that there are things that Mom cannot help – she’s not being difficult, she’s just helping me prepare to be alone one day.

Dealing With Withdrawal

Understand that the emotional or physical withdrawal is not a personal affront to anyone; it’s simply a sign of dying. And, dying is about those who are actually dying – it’s not about anyone else.

Try to schedule visits around the time when you most expect your elderly loved one to be alert – around meal times or after naps. Do not try to arouse the elderly loved one or force them into a conversation.

Talk to visitors and appraise them of the situation. Some people are more sensitive and may take the withdrawal personally. It’s best to limit visitation by these folks as they’re likely to be upset by the withdrawal which can, in turn, upset your dying loved one.

Again, emotional withdrawal is simply a sign of dying and is not to be taken personally. But, some people in my family either didn’t get it or were too involved with themselves to be of much help.

Those who visited when Mom was mostly comatose those last few days would sometimes talk about her as though she wasn’t lying right there. My solution was to put up a whiteboard behind her hospital bed in my living room with a message of ‘She can hear you!’ to remind them to be kind.

 Magnetic Dry Erase Board 11 OfficePro Ultra-Slim, Lightweight Magnetic Dry Erase Board & Accessories (Includes Whiteboard Pen & Pen Tray, 3 x Magnets & Eraser) – 24 x 36 Inch

2. Restlessness

Those in the last stages of life may appear restless for no reason. They may pull at the bed covers, try to get up from bed for no reason, or thrash around the bed.

They may pick at clothing or their skin.

This restlessness may occur as blood flow to the brain slows.

Restlessness, though, may also be a sign that your dying loved one has unfinished business to tend to.

Dealing With Restlessness In A Dying Patient

Make sure that the dying person has any medications needed to alleviate restlessness or agitation.

Contact a nurse or doctor as needed. If possible, if your dying loved one is aware, ask them if there is anything they’d like you to do after their gone (this is a difficult conversation).

Ask if there is anything they need or try and distract them from their condition by mentally painting a pleasant picture of something you’ve done in the past.

For the times at night when Mom was restless, I sat with her and spoke to her about how Dad would have liked the garden I’d planted, or how he would have loved the first tomato we had the other day. Frequently, she will calm down as I go deeper into thoughts of past times with my dad and her.

Sometimes, simply holding her hand will calm her down. I will speak to her in a light voice until she settles down.

The other thing I’ve done that I’ve found works for Mom is to put one of my lap dogs on her bed. Having a dog to place her hand upon usually stops any agitation.

To prevent the bedsheets from becoming tussled, you might consider buying a set of bedsheet suspenders which attach under the sheet to keep the sheet pulled down and straight. This can help shield against bedsores also.

And, for those who pick at things, a twiddle muff might be just what they need to hold. It has loads of different items with which to play and ‘pick.’

 TwiddlePup Fidget and Comfort Muff, Tan BetyBedy 4Pcs Adjustable Bed Sheet Fasteners Suspenders, Elastic Sheet Band Straps Clips, Cover Grippers Suspenders Holder for Mattress Pad Cover, Sofa Cushion (Black)

3. You Might See Changes In Appetite

This is probably the toughest symptom of dying that a caregiver has to endure as, well, what we do is provide nourishment for our loved ones.

And, in my Jewish upbringing, what do we do? We feed – they eat! So, my offers of my Mom’s favorite foods of past such as blintzes or matzo ball soup are frequently turned down.

I started to take this as an affront to my cooking until I started to research death and saw that refusing food is a typical way for the body to prepare for death. Not sure if I was pleased to find this little tidbit out but the cook in me did let go a sigh of relief.

Hospice workers also put this symptom in perspective for me. I was so concerned about Mom growing weaker but the excellent Hospice nurse told me that the body naturally slows down and forcing food is a bit cruel as the body can’t digest the food as it used to.

Bloating and uncomfortable feelings, such as constipation, can occur. Therefore, let the dying person dictate what they would like to eat. It’s tough but must be done.

On Mom’s last day of consciousness, we did enjoy a happy hour. After all, some things never change….

Dealing with Changed In Appetite

Accept that you’re still a great cook (!) and offer light meals of clear broth or a few crackers. Liquids are more important than solids so try to make drinks interesting.

Ensure plus is 350 calories and is a great thing to give the elderly once a day. Try to get your elderly loved one to sip water or offer small ice chips. Every bit of moisture counts. Even coffee is something.

Also, check with your senior citizen loved one’s doctor and ask about an appetite enhancer. My mom is on Megace and I can’t keep her full!

UPDATE: As my mom starts in on the last phase of life, we’ve withheld the Megace. This was the hardest thing for me to do as I knew she’s stop eating.

I talked this over with Hospice and found a new perspective. As we age, our digestion also slows. By giving Mom Megace, she’d eat more than her body could handle and would bloat.

Megace was no longer a good medication for her.

I now give her anything she wants which is usually coffee (!) and a bit of cereal in the morning, a very light lunch of broth, and a dinner of coffee (!) and cereal again. I also found a chocolate milk that she loves – Cocoa Metro Belgian Chocolate Milk. She was quite happy with her chocolate milk.

 Ensure Plus Nutrition Shake with 13 grams of high-quality protein, Meal Replacement Shakes, Vanilla, 8 fl oz, 16 count CCOMET, Cocoa Metro Chocolate Milk – Belgian – Case of 6 – 10 oz. – Pack of 6

4. Incontinence

Toward the end of life, the dying person may not recognize the body’s signals to urinate or defecate. In addition to not recognize the symptoms of needing to “go”, the body’s muscles relax and there might not be any control of these activities any longer.

For more about how to deal with incontinence in the elderly, read my article Incontinence in the elderly.

It was amazing to me how quickly I adapted to helping Mom stay clean and dry. The first few times were very difficult but, when I realized that it’s just a part of life and dying, I quickly got over the queasiness of the situation.

In order to keep Mom as comfortable as possible, we moved into adult protective underwear. These underwear (please don’t call them diapers….) were brought to us from Hospice but we didn’t like the quality of the undergarments. So, we headed to Amazon and bought some of the best incontinence pads and underwear we could find.

We also bought some very good, large (!) mattress protector which were washable. Again, they were much nicer than the disposables that Hospice gave us.

Dealing With Incontinence

Protect the surfaces your dying loved on uses by covering with plastic sheets, and bed chucks (disposable bed pads). I actually bought washable bed chucks which are much more comfortable than the plastic ones Hospice gave us. You’ll see them below.

Depends are also a great item to protect the environment from urine or feces. Just make sure to never call depends “adult diapers” or to degrade the elderly for soiling themselves or their surroundings.

At some point, it may be necessary to change to a different undergarment than traditional pull up Depends as it’s too difficult to change them. Instead, find undergarments with tabs on the side so they’ll fit snugly yet are still comfortable. I’ve placed a few choices below.

If your elderly loved one is able to walk, you might schedule bathroom visits. Sometimes, the elderly won’t even know they’re going so it’s best to try to stay ahead of the issue with scheduled visits. And, if your loved one has dementia, check out adding some red accents to the bathroom to help them see better.

Make sure to change the elderly into new clothing shortly after an accident.

 Depend FIT-FLEX Incontinence Underwear for Men, Maximum Absorbency, S/M, Gray (Packaging may vary) Depend FIT-FLEX Incontinence Underwear for Women, Maximum Absorbency, XL, Tan (Packaging may vary) Womens Washable Reusable Incontinence Pantie Brief (3X) Premium Quality Bed Pad, Quilted, Waterproof, and Washable , 34″ x 52″ The Best Underpad Sheet Protector for Children or Adults with Incontinence

5. You’ll Notice Changing In Breathing Patterns

As someone nears the end of life on earth, breathing patterns usually change. Instead of the slow, deep breaths of a sleeping person, the dying breaths may become shallow and rapid followed by pauses in breathing all together.

These pauses may last from 5 seconds to a full minute.

This is very difficult to watch so be prepared. But, changes in breathing in the dying person is very normal and not at all painful for them.

Note to caregivers: As you sit by the bed and watch your loved one strive for breath, you might find yourself meeting their pattern. Remember to breathe!

Dealing With Changes In Breathing Patterns In A Dying Patient

Turning the dying person on their side may help clear the airway and provide easier breathing. Ask the doctor or nurse about any troublesome breathing – morphine is frequently used to ease laborious breathing patterns.

Ask your loved one’s doctor or Hospice nurse if morphine would be a help for breathing. Morphine relaxes the muscles and allows air to be more fully processed. It’s helped my Mom a lot.

5. You’ll Hear Gurgling Sounds In The Back Of The Throat – Don’t PANIC!!!!

Although these gurgling sounds may sound painful, the dying person is not in any kind of pain.

The gurgling sounds occur because the dying cannot swallow so saliva gathers in the back of the throat.

And, in addition, depending on the medications the dying person is on, the gurgling may worsen as the kidneys stop producing urine so there is more water present in the body.

6. Those Dying May Experience Changes In Body Temperature

The dying body naturally will try to keep the internal organs warm so the extremities of a dying person may feel abnormally cool to the touch.

But, a fever may also exist as the body’s natural regulation of temperature weakens. Sweaty or clammy skin may occur with or without a fever.

With changes in body temperature come changes in the look of your loved one. The lips may take on a bluish cast, the skin may pale or become blotchy or purplish as circulation slows. These changes are normal signs of dying and are not painful to the your elderly loved one.

Dealing With Changes In Body Temperature

Cover chilled extremities with warm blankets but do not use electric blankets! Electric blankets are a no-no around the elderly as they simply cannot tell when they’re too hot and they can actually overheat under an electric blanket.

Same goes for heating pads. I used a heating pad a few years ago on my Mom’s aching back and didn’t realize it was burning her. A trip to the doctor and some silvadene cream and she was back in action but I’d learned a painful (for her and me!) lesson.

To easily check a senior citizen’s temperature, consider purchasing one of the new forehead thermometers – makes it much easier to take a temperature.

If a fever is evident, place a cool cloth on the head and wrists (the pulse points) and, perhaps, consider reducing the room temperature.

 Metene Digital Infrared Non-Contact Forehead Thermometer. Suitable for Baby, Toddlers and Adults And Object with Instant Results Attmu Classic Rubber Transparent Hot Water Bottle 2 Liter with Knit Cover – Blue

7. Your Love One May Suffer Delusions, Confusion, Or Full On Dementia

As blood supply to the brain slows, the dying may become delusional. They may start talking out loud to others we can’t see (and, who is to say those others aren’t surrounding our loved one?).

Frequently, those close to dying will utter words about “Going home.” Some see this as a physical need where the loved one is yearning for their home – could be an ancestral home, their last home, etc. This is open for interpretation.

‘Going home’ to me had a symbolic meaning for my own Mom; I believe that my Mom was signaling me that she was about to go ‘home.’ She died shortly after uttering those words.

When we were in the hospital, my Mom mumbled in her sleep one night. All I could really catch was “I can get up and walk out of here if I want to.” After I started looking into the signs and symptoms of death, I now realize that she was signaling me that her death was near. Thankfully, it wasn’t that near as she’s drinking coffee and eating a freshly made biscuit right now…

Dealing With Confusion

Identify yourself when you first speak to the elderly and tell them what tasks you’re going to do before you do them. When visitors approach, say hello and the visitor’s name as a clue for your elderly loved one of who is coming.

AND, THIS IS REALLY IMPORTANT:

As caregivers, we need to realize that our elderly loved ones are entering a mental world into which we cannot follow. And, they might never come back to our world.

So, the very best thing you can do when confusion strikes, is to step right into their world. That’s right: Step right into THEIR world.

If your elderly loved one starts talking about, for example, the bugs she’s seeing, act like you’re scooping them up and throwing them out. It’s so much easier for us to get into their world than to expect a demented loved one to come back to ours.

Mom never confused me with anyone but there were times when she’d ask where Dad was after he had died. I’d usually say he was at the store and would be back soon. That always soothed her. There was absolutely no reason to tell her again that he had died – why make her relieve that pain again?

For the times when my Mom was disoriented, I’ve just sat by her bed, held her hand, and told her that she didn’t have to worry about anything – I was going to be there to handle everything. She seemed to calm down after hearing these words.

I also told my Mom every single day that I was glad she was there living with me and I was. To this day, those five years I cared for her were the best of my life.

I honestly would not have wanted her be anywhere else than in her bed and in my arms when her time came.

8. You May Witness An Energy Surge In Your Loved One

Your loved one may be lying in their deathbed and suddenly sit up and ask you something mundane – like, “Did you feed the dogs?”

Now, this can be a bit unsettling but, if you’re there, consider this time a blessed memory. Take a moment to talk with your loved one and ask them if there’s anything they’d like or need you to do.

It could be that your loved one arose after a cerebral need to finish something or make amends. Speak softly to them and remember to cherish the moment.

Important note!: If your loved one is in a hospital bed, make sure to lower the bed towards the floor to its lowest setting if no one is in the room with them. My hospice nurse mentioned to me that people who have been bed bound for months may suddenly “make a break for it” and fall to the floor.

9. You Might Smell Something Known As “The Sweet Smell Of Death”

It seems that some people report smelling a sweet odor just prior to death of a loved one – one person noted it to be like old pancakes with a bit of syrup. Hmmmm…interest analogy.

Anyway, the scientific reason for this odor seems to be many fold:

1. The shut down of the organs, particularly the liver and kidneys, produces chemical that are exuded in sweat of the dying. Some of these chemicals may have a slightly sweet smell to them.

2. Some doctors believe the sweet smell of death is the result of a change in hormones of those dying.

3. Some think that the sweet smell comes from the breath of dying people and is attributed to acidosis.

Whatever causes the sweet smell of death, there’s no disputing that it does, indeed occur with some who are dying. And, some people may be able to detect the smell while others cannot.

There’s a thought that this is why the animals (usually cats) who live in nursing homes go and sit on the bed of those about to die. Whatever the reason, I’m glad God made cats…

Additional information on Hospice
Montgomery Hospice was truly a blessing to me and my friends as we eased Mom towards her last moments. I’m sure those last moments would have happened with or without Hospice but, for my sake, Hospice saved my sanity.

The Hospice personnel were not only very knowledgeable (which I was not back then) but they always took the extra step of educating me. Death can be scary but, with Hospices’ guidance, it wasn’t at all.

The Timeline For Signs And Symptoms Of Death

The below information was gleaned from the Montgomery Hospice booklet we were given when Mom was enrolled in hospice. For more information about hospice, click and read my article Hospice: is it the right choice?

One to three months pre-death

• Withdrawal from people and activities
• Less communication
• Appetite changes – generally reduced appetite
• Resting more – you might see your loved one sleep all day.

One to two weeks pre-death

• Increase or decrease in pulse – decrease in blood pressure
• Changes in skin color – paling, blotchiness or a blue or purple tinge to the skin
• Changes in breathing patterns
• Changes in body temperature – either clammy/cool or a fever
• More changes in appetite – usually refusing food and having a problem even drinking water (use those ice chips)

Days to hours pre death

• Increased sleepiness
• Possible surge of energy – remember to enjoy these times!
• Restlessness or agitation
• Difficulty swallowing
• Further changes in breathing – gasping with periods of no breathing between
• Rattling breath sounds
• Weak pulse
• Decreased urine or feces output as the kidneys shut down
• Eyelids may be slightly opened

Minutes to death

• Shallow breathes with longer pauses
• Mouth open
• Unresponsive
• Eyes may remain open or half closed

Remember though: even during this last period of life, the dying loved one may be able to hear you. Now is the time to tell them how much you have loved having them as your mother, father, brother, sister, etc…

Tell them how much you have admired them, how you will always keep them in your heart and how you hope to one day see them again.

Now, some might find this calloused but, during what I thought might be my Mom’s last moments, I leaned in and said all of the above and ended with “Tell Dad to send money….” Mom laughed…

Update 3/29/12: I wanted to update this section by saying that the very last moments of the dying may be difficult to watch. Some liken the breathing to “a fish out of water” and that’s what I thought when Mom took her last breaths. Please be assured that your loved one is not suffering while exhibiting this type of breathing – it’s simply what happens. Mom went quite peacefully, surrounded by friends and family in my own home. She won the game at 7:11 am on Feb 15, 2012.

She is missed.

Extra: A Beautiful Story Of Dying

One of my online friends sent me a PM through Facebook to tell me this beautiful story. It really touched me. I immediately asked if I could post it on my lens – she asked to remain anonymous which I will certainly respect. Read on, dear readers…it’s a beautiful story…

Lori – I’ve been reading your articles. They are very good and spot-on advice (from my nurse prospective).

After reading the article on death and dying, I wanted to share an experience that I was so fortunate to witness.

I had a resident (in her late 90’s) who was really in good health for her age. She was deeply religious and quiet natured. She told one of my staff nurses one day that she would like for us to call her daughters to come as this was her last day. \

She told me that she had a dream the night before and in it, she and her late husband had reviewed their life together. Then, this morning, God had spoken to her to tell her that it was her last day.

We assessed her carefully – everything looked fine. As I helped her into her bed to rest until her daughters arrived, she pulled me down to her face and whispered in my ear “if I could only tell you how beautiful it is.” She had such a look of peace and happiness.

Her daughters came and then she wanted them to call the sons from Atlanta to come up right away – she wanted to say goodbye to them. She told her boys that.

I checked on her and her daughters frequently that afternoon. Much of the time was spent reading scripture and talking family topics.

One of the daughters came to my office at one point and said that her mom wanted to go out for ice cream – would that be OK? I went with her back to her mom’s apartment and told her “sure you can go! ” She replied that she wanted to go in her daughters red convertible!

Before I left that day, I asked her “will I see you tomorrow?” Her response was “sure you will.” Her daughters all kind of rolled their eyes and laughed like – so what is today all about?

Her sons and all the families did get there that evening and they had a nice visit. At bedtime they left.

The aid helped her into bed right at 10pm. Her grandfather clock chimed the hour. This beautiful woman closed her eyes and left this world. This experience was such — I can’t describe the feeling I had except that I felt blessed. That God would let me witness this.

And you know – I did see her that day, but in my heart. Some of my nurses didn’t “get it”. All of her family did.

I am so grateful that I did.

This article is dedicated to the most wonderful parents anyone could ever have. I’ve been truly blessed to call Joe and Gertrude Burdoo my parents. And, it is also dedicated to the most amazing man I could ever have imagined; a man who stepping into our lives right after my Dad died and helped me care for my Mom.

This article is dedicated to that man – the man I married. My husband, John.