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End-of-life symptoms vary from person to person. For some, they may end quickly, and for others, they may linger for days, weeks, or even months
End-of-life symptoms vary from person to person. For some, death may approach suddenly, whereas for others, end-of-life symptoms may linger for days, weeks, or even months.
Symptoms also vary. Some people become physically weak, even though their cognitive functions are strong, and for others vice versa. For still others, all functions decline at the same time.
What are typical end-of-life symptoms?
1-3 months before death
- Reduced appetite
- Feeling tired
- Talking less
- Isolating from people and family
- Losing interest in activities that they used to enjoy once
1-2 weeks before death
- Feeling tired and drained all the time
- Little appetite and thirst
- Limited bowel movements and urine
- More pain
- Different sleep-wake patterns
- Changes in blood pressure, breathing, and heart rate
- Temperature fluctuations, leaving their skin cool, warm, moist, and pale
- Confusion or being in a shock
- Congested breathing
- Hallucinations and visions of long-gone loved ones
Within days or hours
- No appetite or thirst
- No urinating and bowel movements
- Groaning or scowling from pain
- Dropping of body temperature
- Irregular heartbeat and pulse
- Teary or glazed eyes
- Mottled bluish purple skin on the knees, feet, and hands
- Gasping breathing that slows down and stops completely
Last hour
- Restless and confused
- Upsetting hallucinations, causing them to cry out or strike out
- No measurable pulse
- Pale and waxy skin
- Dilated pupils
- Tears falling from the eyes
- Small movements of the arms, legs, or larynx
Decreased blood flow
- Skin may become spotted and discolored
- Mottling and bluish discoloration of the hands and palms (may indicate impending death)
- Provide good skin care
- Turn the person every 2-3 hours if it does not cause them discomfort
- Apply lotion to the back and hands
- Support extremities with soft pillows
Decreased blood flow to the brain
- Decreased level of consciousness or confusion in final days or weeks
- Drowsiness or disorientation
- Bring the person to their senses gently if tolerated
- Allow them to rest
Decrease in the cardiac output and blood volume in the vessels
- Irregular heart rate
- Low blood pressure
- Bluish discoloration of the body, as well as the hands and legs
- Cold hands and feet
- Comfort measures
- Rest
Decreased urine output
- Possible loss of bladder control
- Concentrated urine
Keep the person clean and dry. Place a Foley’s tube in the following conditions:
- If there is a skin ulcer or an infection over the skin
- If the person is big enough to change diapers
- If the caregiver cannot provide diaper and linen changes
Decreased appetite and thirst
- Weight loss
- Dehydration
- Do not force fluid or foods
- Maintain good oral hygiene
Swallowing issues
- Pocketing food in the cheeks or mouth
- Choking after eating
- Coughing after eating
- Provide soft foods and thickened fluids (nectar) as tolerated
- Stop feeding the person if they pocket food or if the food chokes
Skin may become spotted or discolored
Purplish or dark pinkish patches on the back and arms/legs
- Keep sheets clean and dry
- Do not use chux mat or chux towels directly on the skin
- Apply lotion as tolerated
Bedsores may develop due to the pressure of being bed bound.
- Red spots to bony bumps are the first signs of bedsores
- Open sores may develop
- Turn the person every 2 hours to relieve the pressure in the bony area if tolerated
- Use a special mattress as needed
- Apply DuoDERM or specialized skin patch to the sores
- Consider the application of specialized products such as charcoal or metronidazole paste (compounded) if odor is present
Collection of secretions in the pharynx and upper respiratory tract
Noisy respiration—usually no cough or weak cough
- Elevate the head of the bed at 45 degrees
- Fold a small soft pillow or towel behind the neck for extra support
Dyspnea
Shortness of breath
Supplementing 2-3 liters of oxygen may support the person’s breathing
Cheyne-Stokes respiration (breathing rate changes from rapid breathing to periods of no breathing)
Notable changes in breathing
- Turning on a gentle fan blowing toward the person may provide relief
- This is normal part of the dying process
Profound weakness and fatigue
- Drowsy for extended periods
- More sleeping
Normal part of the dying process
Disoriented to time and a severely limited attention span
- More withdrawn and detached from surroundings
- May appear to be in a coma-like state
Normal part of the dying process
People may speak to long-gone loved ones or see places others cannot see
The family may assume these are hallucinations or a drug reaction
If a person appears frightened, they may need to be treated with medication
