All people are different, therefore it’s not always easy to know precisely when someone will be approaching the end of life. That being said, usually it’s typically to go through certain things.
If you’re not ready to read this information yet, feel free to come back to it later.
The End of Life: What to Expect
When you are caring for a dying loved one, you’ll see that sometimes there are things you are able to relate to. But sometimes you’ll see that you pick up on these things at alternating times – it’s different for everyone.
Knowing about these things makes the future less scary and gives you better preparation. It will reassure you to let you know that most of these problems can be mitigated by solid hospice care. These doctors and their nurses have expert knowledge in caring for the terminally ill.
When someone is in the process of dying, the human body will slow down and begin manifesting signs the individual is nearing end-of-life, though not all people manifest symptoms. The symptoms can also be prompted by different factors, especially if a person has more than one change. If they’re having other treatments and/or have other conditions, this can further confuse things regarding symptoms.
It’s challenging to know precisely what happens next, but knowledge of some possibilities will give you the opportunity to plan ahead.
Some individuals begin to lose weight and will gain a frail appearance because of this. Others will put on weight, gaining a puffy appearance (this is frequently called oedema, which refers to a buildup of fluid. Illness and/or medicines can cause this condition.
The change in appearance can be very disturbing and upsetting for both friends and family.
Fatigue and tiredness
Some individuals have to have additional time sitting down or in their bed, as their daily activities become too straining. Wanting to have more sleep is also very common at this point. At this point people often require more help doing daily activities like eating and going to the bathroom.
Feeling more hot or cold
This occurs as the body isn’t handling temperature regulation properly as it usually does. People should be given blankets or have a window opened (or A/C increased) when this occurs.
Reduction in Hunger and Thirst
Eating and drinking less food and water is normal; the body is utilizing less energy. Food taste is going to change as well, and this is normal. Some will start eating at different daily times, and a hard time swallowing/feeling ill is common.
The loved one’s friends and family are able to give support eating and drinking if the loved one desires to. It may help to give small portions. If they have high thirst and continue having difficulty swallowing, they can try having them sip and/or experiment with cups, consuming ice chips, etc. Individuals who have a hard time consuming food may want to try softer food like yogurt and ice cream.
Some individuals won’t want to eat nor drink, and won’t be able to near the end of life. This is to be expected for many, and is normal. You should not force them to. The doctor and nurse should look into whether or not more fluids and nutrition are necessary, and discuss the benefits and drawbacks. Please read our info on hydration and assisted nutrition for more information on feeding via tube or drip.
Issues with Bladder and/or Bowels
People may lose the ability to control their bladder and/or bowels near end of life, as their muscles tend to relax.
Other ways exist to ensure the loved one is comfortable throughout all this. Talk to the doctor and/or nurse to see what they think would assist with this process. If the individual has mobility, they might be able to go to the bathroom on a commode (a type of portable bathroom toilet). If they aren’t as mobile, they may be able to utilize pads and/or wipes. Some utilize a catheter, which is a little tube that drains out the urine into a bag. Talk to the doctor, nurse(s), and your loved one to determine what exactly is necessary and who will be able to provide the care.
Medicines can cause your loved one to become constipated, move around less, and consume less food and water. Some medication also creates problems passing urine. Talk to the doctor to see what can assist with this problem.
Being Out of Breath
Some will experience breathlessness or being out-of-breath. A name for this is dyspnoea, which can be worse if the individual is experiencing anxiety. The doctor and/or nurse might give medication for this or give some practical tips on how to deal with it, such as putting a fan inside the room or opening up a window.
Breathing will be loaded if mucus has been built up inside their throat/airway. This happens because they haven’t coughed or cleared the airways enough. This is called, by some, the “death rattle” (though this is not a proper medical term). This can be mitigated by adjusting how the person is sitting or lying down. Ask the doctor and/or nurse for assistance with this.
It really can make one upset when they hear a loved one make these types of noises, though it’s not likely painful/distressing to the actual patient.
End-of-life pain is often a point of concern that loved ones worry about, though not everyone experiences it. With proper treatment and proper support, it can be managed or entirely avoided. Inform the doctor and/or nurse about any kinds of pain, and they can look into medical treatments and/or ways to manage the pain.
Vomiting and Nausea
The doctor and/or nurse can look into the causes of any nausea/vomiting, and what they can do to help with it. They may be able to adjust medication levels if they believe it’s causing it. They may also give medical treatments to help out with it further.
Other things often assist with the nausea, including different foods/drinks, consuming smaller portions, and doing other things that are relaxing/distracting.
The mind/emotion connection
Everyone’s thoughts and emotions are unique to them, and so are an individual’s mindset at the time nearing death.
Bodily changes can also affect the way our mind sees and perceives the world around us.
Common types of changes include:
- Being more calm/detached – being less present will people around them
- More confusion and difficulty concentrating
- Restlessness/agitation and difficulty relaxing
- Deliriousness/confusion (example: seeing things around that are not there)
- These can be very hard for loved ones to see. These can all be triggered by different things, including medications and bodily processes.
It helps for someone to be there to give reassurances, hold their hand, and stay nearby to help if needed. Having a quiet and calm environment also usually helps.
The doctor and/or nurse may be able to suggest different medicines for treating the underlying cause of many of these things. They might give medication to help calm them down – it is important to know about the possible side effects of all of these.
Look more into confusion/memory issues. Some may also have reassuring dreams/visions near the end of life – a common example is seeing people who have already died (usually loved ones).
All individuals’ experiences are different, but there are some common experiences that all people have as they approach the end of their life. Your hospice care team can help with any of these issues that come up for your loved one.
Making plans for the end: Hospice or Palliative Care
If you are looking after a loved one, you want to be thinking about precisely where and how they want to be looked after in the last days of their life. The term for this is “advance care planning”. You might have looked into any additional treatment(s)/intervention(s) they don’t want in their future. There is a term for this as well: “advance decision to refuse treatment”, or ADRT. This is a living will and/or advance directive.
You can talk to them and their doctors/nurses to determine what they want. This really helps for future time where they can’t tell others what they want to have done. Look into planning care in advance