What Will Happen Next?
We realize this particular time is very difficult for you and your family members. Our approach in all matters that effect you and your family is to be honest and straightforward. We realize that fear of the unknown is common when caring for a dying loved one. Because of this, we share the following information to help you understand and anticipate symptoms.
The information includes signs of the dying process and their general time frames along with signs of when death has occurred. Remember each person is different and the following information is offered only as a guide to the often asked question, “What’s going to happen next?” Your hospice team is always available to help clarify any of your concerns about this information. Not all of these symptoms will appear at the same time, in the order listed, or in some cases may never appear at all. Our goal is to share possible signs and symptoms to help decrease fear and anxiety should one or more appear with your loved one. These symptoms are how our bodies prepare us for the final stages of life.
One to Three Months before Death
•The patient becomes more aware that he/she is dying.
•The patient may lose interest in community events, friends, or family.
•The patient seems to emotionally “separate” from family and friends.
•The patient may become more internally focused (self or inner centered).
•Sleeping increases. This results as the body’s metabolism changes.
•Verbal communication may become less important.
•Touching and caring may become more important but the patient may not acknowledge it.
•Appetite decreases. The body will naturally begin to conserve energy which has up until now been spent on tasks like eating and drinking. Offer only what your loved one seems to tolerate. Avoid placing guilt on the patient for refusing to eat. We eat to live so when a body is preparing to die, it is perfectly natural that eating should begin to decline. While it is hard on you as family and friends, it is okay not to eat.
•The patient’s tastes may change. You may hear them say things like “nothing tastes good anymore”.
•Liquids may be preferred over solid food.
One to Two Weeks before Death
•Sleeping increases and at times it may be difficult to wake the patient. This is related to changes in the body’s metabolism. Try to arrange visit times to happen when the patient is usually awake.
•The patient may have difficulty holding eyes open or focusing.
•Some mild confusion may occur. The patient may not recognize everyone all of the time. Again, this is a result of metabolism changes. Gently remind the patient about the day and time and who is in the room.
•The patient may talk with people already dead or with religious figures. The patient seems to literally have one foot in each world. Focus may seem to change from this world to the next as the patient loses grounding to this life.
•The patient may pick at his/her clothing or bed linens. Talk calmly to the patient to reassure them.
•The patient may barely eat or drink at all.
•Lips may become dry and cracked and need moistening with a wet towel or a few drops of water.
•Changes in blood pressure and pulse may occur.
•Skin may become moist. It may become hot then cold. A drenching sweat can occur as the peripheral circulation fails and the body cools. The internal body temperature rises. Regardless of the room temperature, the patient is usually warm so use only light covering, like a sheet.
•Breathing may increase then decrease. It may appear to stop and then start again. •Chest and throat congestion may lead to a rattle that can be heard. Ask your hospice nurse how to help with this.
•Clarity of hearing and vision may decrease. Keep lights on as appropriate. The patient will hear what is distinctly spoken to him/her. Sit at the head of the bed to converse with the patient and don’t speak in whispers. Never assume that the patient can’t hear you. Hearing is believed to be the last of the five senses to be lost.
Two Days to a Few Hours before Death
•The patient may have a burst of energy. For example, the patient may awaken, talk clearly and be alert even though he/she was almost comatose before.
•Appetite may return and your loved one may ask for a favorite meal or drink.
•The patient may be keenly aware of imminent death and may want to express his/her feelings and even talk about death. Avoid telling the patient that he/she is not going to die. The patient needs for those nearby to listen and hear his/her awareness of impending death.
•The patient may not be able to talk, but hearing seems to remain very sharp. It is good to tell the patient that you love them and reminisce about good memories.
•The patient may become very restless. Some patients will talk about “got to get going” or other traveling language.
•Breathing may become very irregular with pauses for 10-45 seconds or longer. This is called “apnea” and is very common.
How Will You Know When Death Has Occurred?
Dying may take hours or days. No one can truly predict the time of death, even if the patient is exhibiting signs and symptoms of dying. Although you may now be prepared for this event, you may not be prepared for the actual death moment. It may be helpful for you and your family to think about and discuss what you would do if you were the one present at the time of death. The death of a hospice patient is not considered an emergency so please do not call 911. Instead, please contact us immediately at 1-888-3SOLARIS (1-888-376-5274) at any hour. A hospice nurse will come to the home and make the necessary phone calls to the doctor and other team members as well as to the funeral home. We will also arrange to have any equipment picked up.
Signs of death include:
•Release of bowel and bladder
•Jaw relaxed and slightly open
•Eyelids slightly open, pupils enlarged, eyes fixed on certain point
The patient’s body does not have to be moved until you are ready. If the family wants to assist in preparing the body by bathing or dressing, that may be done. Your hospice team members can talk with you about options at this time to best help you prepare.