These statistics and others show that, in this country, we have about a one in five chance of having our households affected by caregiving responsibilities, according to the Centers for Disease Control and Prevention (CDC). The majority of us will be providing care for family, close friends or neighbors, and most of those will be women (about 66 percent of caregivers are women, according to the National Alliance for Caregiving, or NAC).
One of the most difficult tasks that caregivers will face is having to witness, up close and personal, the final stages in the life of a loved one, whether that loved one is a mother, father, sibling or close relative. As a caregiver, it is important to recognize the characteristic signs that the end of life is near - to prepare both mentally and physically for the passing of a loved one. Among those signs:
Loss of Appetite
As the body and body systems wind down, the nutritional intake we once needed to provide us with energy declines as well. In the last stages of life, a person may start refusing certain foods - such as meat and other hard-to-digest foods. He or she may rely solely on small amounts of bland foods and drink small amounts of liquids. This loss of appetite or change in appetite is a normal part of the dying process. Depending on the cause, in the final stages of life, the person may not be able to swallow, and may refuse food and drink altogether.
While this change may be distressing to you, you should not attempt to force feed or force liquids on the person. You should encourage periodic intake of ice chips or small sips of water to maintain hydration, and use lip balm, compresses and/or ice chips to keep the lips moist. Keep in mind that, in the final stages of death, forcing food can cause pain for a person whose systems are shutting down, and forcing liquids can cause fluids to be aspirated into the lungs, worsening health.
Fatigue and Long Periods of Sleep
As the body’s vital systems begin to shut down and metabolism declines, the dying person may begin to sleep for the majority of the day and night hours, becoming harder to rouse from rest, and he or she may begin to lose a level of mental alertness even when awake.
As the body shuts down, you should allow the dying person to rest. Avoid startling him or her or forcing them to wake up, unless absolutely necessary. Keep in mind that, even when a person appears to be in an unconscious or semi-conscious state, it is believed that the sense of hearing continues, so you should assume that the person can still hear what you’re saying.
Loss of Mental Function
As the other bodily organs begin to shut down, so, too, does the brain. As a result, many dying people enter a different state of consciousness, losing a sense of awareness of surroundings, lacking the ability to tell when others are in the room, and becoming confused and disoriented.
He or she may speak or respond with less frequency, or may begin to speak with people who can’t be seen by other people. The patient may also become restless and agitated as the disorientation worsens and they become confused about time, location, or what is happening. This happens because, in the last stages of life, the brain is getting less oxygen, the body is undergoing metabolic changes and becoming dehydrated as a result of the loss of appetite, and pain medication feeds the disorientation.
In the late stages before death, a person may become incredibly restless and agitated, a condition called “terminal delirium.” People who have entered this phase may begin picking or pulling at things, or fidget and appear uneasy.
If your loved one becomes confused or agitated, you should remain calm, speaking softly and taking efforts to not startle him or her. You should identify yourself when you enter the room or approach the bed to avoid confusing or agitating someone who has become disoriented. Avoid startling a dying person, and move slowly, offering reassurance.
In some cases, the dying may have unresolved issues that they may want to address - you should be mindful and sensitive to any such requests or confessions and offer the dying a sense of completion. You can also discuss with his or her doctor what medications may help ease those symptoms.
Difficulty Breathing
In the last stages of life, breathing becomes irregular, labored, and often marked by a pattern known as Cheyne-Stokes. Caring Magazine defines this as a loud, deep inhalation, followed by apnea, or a pause in breathing (which lasts from several seconds to a minute), before a loud exhalation. If there are body secretions in the respiratory tract that the dying person has difficulty expelling, they can create a gurgling noise during this breathing that has come to be referred to as a “death rattle.”
While these changes in breathing patterns are distressing for the caretaker, the dying person most often is unaware of the change in breathing patterns. You should focus on making sure that he or she is comfortable, elevating the head comfortably on pillows or raising the bed to help with breathing.
You can put a vaporizer in the room to help with the phlegm build up, or allow it to drain naturally or using a soft, wet cloth to wipe out the inside of the mouth. You should avoid panicking, so as to not add to any fear that he or she is already experiencing. Offer reassuring touch to ease anxiety, and alert a healthcare professional if you notice the Cheyne-Stokes breathing pattern, which indicates that death is near.
Coolness in Fingers and Toes
Another late-stage sign that death is near comes from the body’s circulatory system, which, in the hours before death, begins to limit blood flow from the periphery to help provide oxygen to the vital organs. During this period, the hands and feet, and, particularly the toes and fingers, will begin to be markedly cool. The nails may take on a bluish tinge as a result of lack of oxygen. There may also be bluish patches on the backs of the legs or arms, or on the underside of the body where blood is pooling.
If a person is shivering or complaining of cold, warm blankets may help keep him or her comfortable. Keep coverings loose so as to avoid making the person feel claustrophobic or uncomfortable. Keep in mind that as blood flow changes, a person may feel very hot one moment and cold the next.
As sad as it may be, dying is a part of life. These signs will help prepare you when the end is near.