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Hospice and Palliative Care: Signs and Symptoms of Approaching Death

Feb 5, 2009
Although we can never predict exactly when a terminally ill person will die, we know when the time is getting close by a combination of signs and symptoms. Not all of these signs will appear at the same time, and some may never appear at all.

Your hospice team's goal is to help prepare you for some of the things that might occur close to the time of death of your loved one. Although we can never predict exactly when a terminally ill person will die, we know when the time is getting close, by a combination of signs and symptoms. Not all of these signs will appear at the same time, and some may never appear at all. All of the signs described are ways the body prepares itself for the final stages of life.

  • Your loved one may sleep more and might be more difficult to awaken. Hearing and vision may decrease.

  • There may be a gradual decrease in the need for food and drink. Your loved one will say he or she doesn't have an appetite or isn't hungry. This is the body's natural response to the dying process. The body is indicating that eating and drinking are no longer helpful -- that the body can't use food and fluid properly anymore.

What to do: Allow your loved one to choose when and what to eat or drink, even if this means he or she will consume little or nothing at all. Your loved one will probably tolerate liquids more easily than solid food.

  • Your loved one may become more confused or restless, or experience visions of people and places.

What to do: Remind him or her of the time and the day and who is there with them. Be calm and reassuring.

  • Your loved one's hands, arms, feet, and legs may become cooler, and their skin may turn a bluish color with purplish splotches.

What to do: Use blankets for warmth. Do not use an electric blanket or heating pad.

  • Irregular breathing patterns may occur. There might be a space of time (10 to 30 seconds) when your loved one will not breathe at all. This is called apnea. There may be phlegm or increased secretions in the throat that are not painful, but are difficult to clear with a weakened cough. This is often more bothersome to the caregivers.

What to do: Position your loved one on his or her side, with the head elevated.

Contact your hospice team, or doctor or nurse, at any time if you have questions or observe changes.

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