How To Recognize Someone is Actively Dying

Family, friends and caregivers tending to the needs of a loved one in his or her final stages of life often want to know how they may recognize that the end is near, the final days or hours are approaching or the person is "Actively Dying."

Some of the more common symptoms that occur during the last days or hours of life are listed below.

Here's How:

1. The body systems slow down.
   Decrease in urine output (amount), change in color of urine.
   Decrease in blood pressure.
   Inability to swallow food or fluids.
   Speaking decreases.
   Person stops responding to questions.

2. Decrease in appetite and thirst.
   Along with inability to swallow, decreases in appetite and thirst affects the amount of food or fluids taken by mouth.

3. Nausea and vomiting.
   Will also contribute to the decrease in appetite.
   Nausea and vomiting can be side effect of some of the pain medication, which can be managed by adjusting the medication or the dosing.

4. Change in breathing patterns.
   Breathing patterns may become becomes irregular--shallow breaths followed by deep breath, periods of panting
   Cheyne-Stokes breathing pattern develops - several rapid breaths, followed by time of no respirations.
   Difficult or painful breathing, shortness of breath (dyspnea)
   Gurgling - noisy and moist breathing
   Congestion - Building up of fluids in the lungs

5. Incontinence.
   Loss of bladder or bowel function in patient who was previously not incontinent.

6. Change in circulation, blood flow.
   Along with decrease in blood pressure, circulation or blood flowing out to extremities decreases, so hands and feet start to feel cooler to the touch.
   Person may complain of numbness in the legs and feet.

7. Restlessness, agitation and confusion.
   Restless, agitation such as jerking, twitching, pulling at bed linens or clothing.
   Disoriented and confused unsure about the time and place, identity of people even close family members.
   Hallucinations. Person may report seeing people who have already died.
   Acting in a manner that is nor normal for the person.

8. Withdraws and decrease interactions with friends and family.
   Withdraws from actively participating in social activities.
   Begins to progressively detach, slowly narrowing the circle of people and caregivers allowed to visit.
   Less verbal.
   Less communication.
   Less interested in surroundings.

9. Change in skin color.
   Change in skin color as circulation decreases the arms and legs cool and turn blue, purple (cyanosis) or mottled.

10. Change sleeping and in level of consciousness.
    Increased periods of sleeping.
    Decrease in consciousness and responsiveness.
    Difficulty rousing patient or only able to arouse with great effort.
    Eventually coma state occurs (unable to arouse at all) minutes to hours before death.

Tips:

1. Sources:
   DeSpelder LA. Strickland AL. 2002. The Last Dance: Encountering Death and Dying. 6th Ed. New York, N.Y.: McGraw Hill. p. 181.
   At the Bedside of a Dying Person in Palliative and End-of-Life Care. Beers MH. Ed. The Merck Manual of Health & Aging. 2005. Whitehouse Station, N.J.: Merck & Co., Inc. <http://www.merck.com/pubs/mmanual_ha/sidebars/sb16_2.html>
   Corr CA. Nabe CM. Corr DM. 2003. Death and Dying Life and Living. 4th Edition. Belmont, CA: Wadsworth, Thomson Learning Publishing Co.
   Hospice Patients Alliance. Signs and Symptoms of Approaching Death. <http://www.hospicepatients.org/hospic60.html>