Know What To Expect
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Understanding the Dying Process

Providing Comfort

Our philosophy of care is that the "fear of the unknown" is always greater than the "fear of the known." The following information is intended to help you prepare and anticipate changes that occur near death. Your physician, hospice nurse or social worker can answer any questions that you might have about this information. Not all these symptoms will appear at the same time and some may never appear. All the symptoms described indicate how the body prepares for the final stage of life...death.

What You May See As Death ApproachesWays You Can Comfort Your Loved One
The arms and legs of your loved one may become cool to your touch. The underside of the body may become much darker in color. These changes occur as blood circulation slows down. Keep warm blankets on your loved one to prevent him/her from feeling overly cold. You may want to put socks or slippers on their feet. Do not use an electric blanket!
Your loved one will gradually spend more time sleeping during the day. There will be times when they are difficult to wake up. This symptom is a result of a change in the body's metabolism. You can help by planning to spend time with your loved ones for those times that he/she seems most alert. Continue to talk to your loved one and offer reassurance; they can hear you.
Your loved one may become increasingly confused about time, place and identity of close and familiar people; This is another result of metabolism change. You can help reduce the sense of isolation and confusion that your loved one may be experiencing by reminding him/her frequently: what day it is; what time it is; and who is in the room.
Incontinence (loss of control) of urine and bowel movements is often not a problem until death becomes imminent. Your hospice nurse or home health aide can help you prepare the bed linens to prevent soiling. You can also help your loved one by learning hygiene techniques for body cleanliness from your hospice nurse. You will also want to know how to clean your loved one's mouth.
Saliva may become more profuse and collect in the back of the throat. You may have heard references to a "death rattle." This symptom is the result of a decrease in the body's intake of fluids and inability to cough up normal saliva production. You can bring comfort to your loved one by providing a cool mist humidifier to increase the humidity in the room when oral secretion builds up. You can also help by elevating the head with pillows. Ice chips, a straw, and cool, moist washcloths will relieve feeling of dehydration. You may also want to apply "chapstick" to the lips.
Clarity of hearing and vision decrease. Never assume that your loved one cannot hear you. Hearing is the last of the five senses to be lost. You can help your loved one feel less disoriented by keeping the lights on in their room as vision decreases. Continue to talk to your loved one in a comforting tone.
Your loved one may become restless, pull on bed linens and have visions of people or things, which you cannot see. These symptoms may be a result of a decrease in the oxygen circulation to the brain, a change in the body's metabolism or a side effect of medication. These experiences may also be encounters with a spiritual realm that we do not comprehend. Talk calmly and assuredly with your loved one. If he/she appears to be frightened continue to speak calmly. You may also use music or familiar songs to bring comfort. Do not try to correct or argue with your loved one's perceptions.
Your family member will have decreased need for food and drink because the body has naturally begun to shut down. You can help your loved one by keeping the mouth clean and the lips moist. Think of ways to nurture other than with food such as a gentle hand or foot rub. Offering food or fluids at this time can actually cause discomfort.
As your loved one sleeps you may notice breathing patterns become irregular. There may be 10-30 second periods of no breathing. These periods are referred to as "apnea." Apnea is very common and indicates a decrease in circulation. You can help by positioning your loved one so that he/she appears more comfortable.
If your loved one has a bladder catheter in place, you will notice that the amount of urine will decrease as death comes closer. It may be necessary to irrigate the catheter.

This is the time to say what is in your heart to your loved one. Don't worry about tears or about saying things the "right" way.

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