12 Signs That Someone Is Near Death

Pain

Pain is a common symptom experienced near the end of life, although it can vary from person to person. Pain is not only determined by medical conditions that cause pain, like cancer or lung disease, but also by factors like emotional distress, interpersonal conflicts, and the non-acceptance of one’s own death.

Pain control near the end of death should involve addressing all of these factors as part of hospice or palliative care. If medications are needed for severe pain, opioid analgesics like morphine are typically the first-line option.

Shortness of Breath

Shortness of breath, also known as dyspnea, is one of the most common end-of-life symptoms. Even if a person doesn't have lung disease, dyspnea can occur because the organ systems of the body are interconnected.

For example, if your heart is slowing down due to heart failure and less oxygen is being delivered to the body, you can become breathless with minimal physical activity.

Deep breathing exercises and relaxation techniques can help in the early stages. As the condition progresses, medications and oxygen therapy may be needed.

Anxiety

Anxiety is normal at the end of life as a person contemplates their own death or struggles through the stages of dying. This is commonly expressed as agitation, worrying, sweating, stomach upset, nausea, sleeping problems, shortness of breath, and heart palpitations.

Counseling and therapy can go a long way toward easing anxiety. Medications like antidepressants, anxiolytics, and benzodiazepines can also be prescribed.

Decreased Appetite and Thirst

As a body starts to shut down, it no longer needs as many calories and nutrition to function at such lowered levels. Although it is normal for people to refuse food and drink near the end of life—either because they have no desire for it or find the effort of eating or drinking to be too much—it can still be upsetting for families.

The important thing to remember is that when someone is dying from a terminal illness, a disinterest in food is natural and does not really speed up the process of death.

Nausea or Vomiting

There are many reasons a person may be nauseous near the end of life. It may be due to constipation, having a reduced appetite, or certain medicines they are taking. It could also be caused by emotional distress.

Anti-nausea medications may help, but it's important to pinpoint the underlying cause to help make your loved one more comfortable. Getting fresh air, eating smaller meals, sipping ginger tea, and avoiding off-putting smells from foods like cabbage or fish can also help.

Constipation

Medications used to treat pain and shortness of breath can cause constipation. Other causes include a lack of physical activity, dehydration, decreased fiber intake, and the progression of the underlying terminal illness.

Changes in diet, increased fluid intake, and simply taking short walks can help. The use of stimulant laxatives as well as a low enema can provide relatively fast relief.

If constipation caused by opioid painkillers is severe, an injection of a drug called methylnaltrexone can help.

Fatigue

Fatigue near the end of life is not a surprising symptom for most people to grasp but one that can be increasingly worrisome when watching a loved one spend more and more time in bed.

As much as illness, medications, and sleep problems can cause fatigue, so can emotional issues such as depression. To this end, it is important to not only ask your loved one what they are feeling but how they are feeling emotionally.

Providing a loved one with sunlight and fresh air, and keeping their living space cheerful and clean can help lift fatigue to a certain degree.

It is equally important to accept fatigue as a natural part of the dying process. You shouldn't force your loved one to do things that may only add to their tiredness.

Isolation and Drifting Away

As someone nears death, they naturally start to focus inward and may separate from the world around them, including friends and family. While this may be a reasonable response, it can be of concern if it amplifies feelings of anxiety or depression.

It is important to remember that any and all emotions are normal when someone is dying. This doesn't mean that you should back away.

By just being there, you may find that certain feelings are causing your loved one to drift away. There may be unspoken regrets or worries. Or, they may simply be emotionally worn out.

While you may not be able to help them sort out these feelings, studies show that being there almost invariably makes end-of-life care less complicated and taxing on your loved one.

Incontinence

Both urinary incontinence (loss of bladder control) and fecal incontinence (loss of bowel control) are common near the end of life.

Incontinence can be a result of surgery or illness, or because the person is simply too weak to go to the bathroom. At the very end, when the urinary and bowel muscles relax entirely, the person will have no control over these functions.

If a loved one soils or pees on themselves, it is important to clean them immediately to prevent irritation, sores, and infections that cause pain.

Skin Changes

Hands and feet may become colder and the skin may look blotchy, purplish, and mottled as a person nears. These changes happen because the heart is no longer able to pump blood as effectively to the limbs.

Over time, the mottling may work its way up the arms and legs, while the lips and nails may turn bluish due to the lack of oxygen (referred to as cyanosis). The swelling of the legs and ankles (peripheral edema) is also common.

Oxygen therapy may help ease cyanosis, while compression socks may help reduce edema and possibly pain as well.

Delirium

Confusion, agitation, and restlessness are common near the end of life. Delirium (sudden confusion and disorientation) can be caused by the progression of the terminal disease, a failing respiratory system (providing less oxygen to the brain), or medications they are taking.

There may even be episodes of hallucination where they see or hear things that are not there

Kidney failure common near the end of life can also flood the body with chemicals that affect the brain. Even constipation and dehydration can trigger delirium in people approaching death.

Delirium is often a sign of impending death. Effort is typically placed on making your loved one as comfortable as possible.

The "Death Rattle"

The "death rattle" is a sign that death is near. Also known as "end-stage wet respirations," it is when saliva and mucus build up in the airways due to the weakening of the muscles in the lungs and trachea (windpipe). With each breath, the passing of air through these fluids causes a rattling sound.

At this stage, the focus will be placed on preventing your loved one from choking, This may involve turning them on their side or elevating their head.