Signs of Active Dying

Signs of Active Dying

• Attention Turns Inward: The mind drifts, and engagement with the world diminishes.
• Withdrawal from Interaction: The individual engages less with others and may prefer solitude.
• Increased Sleep: There is a noticeable increase in sleep as energy levels decrease.
• Difficulty with Daily Activities: Routine tasks become more challenging.
• Physical Weakness: Increased weakness and a greater risk of falls.
• Frequent ER Visits: More frequent hospital visits for acute issues.
• Continence Issues: Difficulties with bowel and bladder control.
• Emotional Changes: There may be expressions of anxiety, restlessness, or emotional detachment as the individual grapples with their impending death.

• Facilitate Rest: Ensure the individual has a quiet, comfortable space to rest and sleep.
• Encourage Socialization: Gently encourage interaction with loved ones, but respect their desire for solitude if they prefer it.
• Assist with Daily Activities: Offer help with daily tasks to reduce frustration and ease their burdens.
• Monitor Health: Keep track of any changes in health or behavior and communicate with healthcare providers if needed.

• Medical Planning: Consult with healthcare providers about prognosis and available treatment options.
• Advance Directives: Ensure that the individual has completed advance directives, including a living will and medical power of attorney.
• Financial Affairs: Review financial documents and arrangements, including insurance policies and end of life costs.

• Prolonged Sleep: The individual sleeps or drifts much of the day.
• Decreased Appetite and Thirst: They eat very little or stop eating altogether and drink less fluid.
• Difficulty Swallowing: Swallowing may become increasingly challenging.
• Breathing Irregularities: Changes in breathing patterns, including periods of apnea.
• Increased Need for Physical Care: A growing requirement for assistance with daily activities.
• Disorientation and Confusion: The individual may exhibit signs of disorientation or confusion.
• Visions of Deceased Loved Ones: Some may report seeing or talking to those who have already passed.
• Conversations about Dying: They may start to express thoughts about their impending death.
• Physical Changes: Increased swelling in extremities and wounds that do not heal.

• Provide Comfort: Offer comforting foods or beverages as desired, even if the individual is eating less.
• Assist with Mobility: Help them move safely to prevent falls, providing physical support as needed.
• Offer Reassurance: Calmly reassure them that they are loved and that it is okay to let go when they are ready.
• Engage in Conversation: Be present and listen if they want to talk about their feelings, fears, or memories.

• Funeral Planning: Begin discussing funeral arrangements, including preferences for burial or cremation, and any specific wishes the individual may have.
• Legal Considerations: Ensure that wills and other legal documents are updated to reflect current wishes and that family members are informed of their contents.
• Financial Preparations: Address outstanding debts and make sure insurance policies and financial resources are organized to cover final expenses.

• Partially Open Eyelids: Eyelids may be partially open, but the individual is not seeing.
• Jerking or Twitching: There may be involuntary muscle movements.
• Reduced Urine Production: Little urine is produced due to decreased fluid intake.
• Open Mouth Breathing: Breathing may become labored and occur with an open mouth.
• General Unresponsiveness: The individual may appear generally unresponsive.
• Terminal Lucidity: A brief period of clarity or energy may occur, allowing the person to open their eyes or speak.

• Maintain a Calm Environment: Keep the surroundings quiet and peaceful, reducing stress and agitation.
• Provide Physical Comfort: Adjust blankets, pillows, or positioning to ensure their comfort and reduce discomfort.
• Be Patient: Allow time for the individual to respond, even if they seem unresponsive. They may still be able to hear and feel.
• Talk Softly: Use soothing tones and speak softly, offering reassurance and love.

• Final Wishes: Confirm that the individual’s final wishes regarding their care and end of life preferences are being honored.
• Family Meetings: Hold family meetings to discuss roles and responsibilities during the dying process and after death.
• Emergency Contacts: Prepare a list of emergency contacts and ensure everyone knows the plan for end of life care.

• Mottling: The appearance of mottled skin, a result of declining heart function and toxin build-up in veins and arteries.
• Cyanosis: A bluish discoloration of the skin, starting from the fingertips and toes, indicating poor circulation.
• Cardiac Shutdown: Weak or irregular pulse is typical as the heart function declines.

• Monitor Breathing: Observe changes in breathing and offer reassurance, letting them know you are there.
• Touch and Hold: While physical touch can be comforting, remain attentive and ready to adjust your approach if the dying person reacts negatively. Increased sensitivity to touch may occur as they progress through the active dying stage.
• Keep Communication Open: Even if they are unresponsive, talk to them, expressing love and support. Many medical researchers have discovered that hearing is the last sense for a dying person to lose. (www.hospicefoundation.org, www.nhpco.org)

• Notify Hospice or Care Providers: If applicable, inform hospice or other care providers of the situation to ensure they are prepared for the final moments.
• Prepare for Arrival of Family: Ensure that family members who wish to be present are informed and ready to arrive.
• Finalize Funeral Arrangements: Confirm details with the funeral home or burial service, ensuring that everything is in place.

• Nervous System Breakdown: The nervous system may begin to shut down.
• Pain Management Considerations: While some may no longer feel pain, it is crucial to consider that individuals with conditions like cancer may still experience discomfort. Administering pain medication remains important.
• Respiratory Shutdown: Breathing may slow to 4-5 times per minute, with shallow breaths and extended periods of apnea lasting 30-60 seconds.

• Stay Present: Remain close and attentive, providing comfort and presence as the individual approaches the end.
• Address Pain and Discomfort: If pain is present, consult with medical professionals to ensure appropriate pain management is in place.
• Encourage Final Goodbyes: Allow family and friends to say their goodbyes if the dying person is still able to hear or respond.

• Coordinate with Funeral Services: Ensure that transportation for the body and any necessary paperwork is organized in advance.
• Final Wishes Documentation: Document any final wishes expressed by the individual regarding their care, memorials, or legacy.
• Communicate with Family: Keep family members informed about the status and what to expect as death approaches.

• Intact Hearing: Hearing often remains intact even when the dying person is unresponsive, making it beneficial for loved ones to speak to them. Use a soothing voice to provide comfort.
• Sensitivity to Touch: Increased sensitivity may impact how they react to physical contact; adjust your approach accordingly.
• Communication Changes: Speech may become slurred, and the individual might communicate less frequently. Be attentive to non-verbal cues, gestures, and body language. If speech becomes difficult, consider communication aids to assist them in expressing their needs.

• Cultural Beliefs: Be aware of any cultural beliefs regarding dying, as these can influence behaviors and signs.
• Personal Preferences: Respect the individual’s personal beliefs and values regarding death.

Incorporate Spiritual Elements: Discuss meaningful spiritual or religious rituals that can be included in the dying process. Facilitate visits from spiritual advisors or loved ones who share similar beliefs.

• “Being Mortal: Medicine and What Matters in the End” by Atul Gawande
• “The Five Invitations: Discovering What Death Can Teach Us About Living Fully” by Frank Ostaseski

• Hospice Foundation of America Provides valuable end of life resources.
• National Hospice and Palliative Care Organization  Offers support for caregivers and information about hospice services.

• “The Dying Process: Understanding the Signs of Dying” Journal of Palliative Medicine
• “Caregiving at the End of Life: The Role of Family Members” Journal of Family Nursing

• Gawande, A. (2014). Being Mortal: Medicine and What Matters in the End. Metropolitan Books.
• Ostaseski, F. (2017). The Five Invitations: Discovering What Death Can Teach Us About Living Fully. HarperCollins.
• Hospice Foundation of America. (n.d.). Understanding the Dying Process. Retrieved from hospicefoundation.org