Most people die a slow death. By slow, we mean that there is no sudden heart attack or stroke, nor is there a traumatic accident. Instead, most of us die of a terminal or chronic medical condition or from old age, and the body’s inevitable fade into death. Understanding that death is a longer-term experience and what each stage of the dying process entails helps families and caregivers provide a more attuned and personalized care plan whether the age-in-place at home or in a facility.
When We Die: Months, Weeks, And Days Before
For this post, we’ll describe the most common things your loved one may experience as they get closer to their death date. Many of these may even start one or two years before when they die, but in most cases, families and caregivers notice these signs months and weeks ahead of time.
Again, we want to emphasize that this post describes what happens to the body when we die from natural causes – or slow death. This is not the same as it is for someone who has an acute health episode or fatal accident.
The Months (Or Years) Before
There are two things you’ll notice in a person who is a year – or months – away from death. The first is that they will have less and less interest in the outside world; the other is a decline in their appetite or interest in food.
The movement from outward to inward
In the months and weeks before death, most people go through their own life review and emotional processing – whether they vocalize it or not. This process is an inward experience, so it’s natural that seniors or those declining from diagnosed medical conditions begin to retreat from the outside world. While they may still be interested in family traditions and holidays, or major milestones, they may show declining interest in attending meetings or social groups.
It’s true that social engagement is essential to senior health and well-being. However, we also want to consider the reasons behind any social “retreat.” If you suspect depression is part of the picture, that’s worth addressing with your loved one and their healthcare providers. However, the retreat may actually be a sign that your loved one is turning inward and participating in a natural retreat from the world at large.
This may be a perfect opportunity to begin reviewing boxed photos and listening to the stories your loved one has to tell. Children, siblings, and grandchildren may appreciate helping your loved one to officially preserve these memories that, in turn, support their life accounting process.
A waning appetite
This is challenging for those of us who feel very much alive because food is associated with health, well-being, and comfort. However, it is not uncommon for a person’s appetite to wane significantly in the year and months preceding their death. For one, most aren’t expending as much energy as they used to, and their body requires fewer calories.
The other reason appetite wanes, and dramatically so in the weeks and days before death, is that the digestive system slows down. It doesn’t process food like it used to and so instinctually, those who are dying have less appetite and typically only want to eat foods that are easy to digest, like broths, soups, softer foods, smoothies, and hot soothing beverages. Eventually, even the ability to swallow and process liquids fade, at which point we provide moist sponges to wet the mouth without risking choking or digestive upsets.
Work with healthcare providers to determine if lack of appetite is something to be concerned about or whether it’s just a normal part of the death process. If it’s the latter, support your loved one by honoring their food refusals. If they eat to make others happy, they can wind up in extreme discomfort or even experience a medical event that diminishes their quality of life. Offer food but respectfully honor their wishes if they’d rather not eat.
Support loved ones in creating end-of-life plans
If they haven’t done so already, now is the time to gently support your loved one as they begin to make end-of-life plans. This includes things like:
- Creating an estate plan, will, and/or trust.
- Enlisting support from a local hospice care agency gives you access to all of the FREE benefits that come along with those services.
- Asking if there are any last requests regarding people they need to speak with or visit, places they’d like to go, etc. – all of which support the emotional and spiritual “life accounting” process we’ve mentioned above.
- Verifying their after-death wishes (what to do with the body, funeral/celebration of life plans, etc.)
Our culture is death phobic, and it doesn’t serve the dying well. They need people who can help them look at death head-on so they can speak about it, work with it, and process what they need to process without feeling responsible for others’ feelings. If that is challenging for you, contact home care services providers, spiritual counselors/ministers, or hospice/palliative care professionals who can fill that role.
The Weeks Before Death
In the weeks before death, people spend more time asleep than they are awake. If they aren’t already home- or bedbound, they will be around this time. It’s essential that primary spouse and family caregivers take advantage of respite care if they haven’t already, as caregiving is likely to be an around-the-clock event at this point.
The goal at this point is to keep your loved one as comfortable as possible. Make sure they:
- Are being turned regularly to avoid bedsores
- Are kept clean and in fresh clothes each day
- Have access to fluids and easy-to-digest foods that appeal to them (if there are any)
- Have plenty of time to sleep or be alone in between the stream of visitors that tend to arrive during this point in the dying process.
- Are in soft ambient light.
- Aren’t in an environment that is overstimulating or too loud (pay attention to their body language and cues).
- Have the ability to sit in comfortable silence with the ones they love, resisting the urge to fill the silence with talk or activity.
- Are supported if they begin speaking in metaphors, saying they see or hear their ancestors/loved ones who’ve passed or seem to see or interact with things you can’t see. Resist the urge to blame it on medication and open yourself to the mystery of the death and dying experience.
Never underestimate the power of “being there,” without any need to do or fix anything. This is one of the best gifts you can give to someone who is dying.
The Last Days And Hours
In the last days and hours before death, the body’s organs and systems begin to shut down. This has several marked effects on the body’s physical appearance and processes. Dying is not painful.
The only physical discomfort associated with death is the physical discomfort caused by any medical diagnosis leading to death. Use pain medications as a means of monitoring medical condition-related pain. However, the goal here should be to keep your loved one as lucid as possible so they are awake to their own process.
- They sleep far more than they are awake.
- Speech or interaction may stop completely as they become non-responsive.
- Eating and drinking may stop altogether, which is fine (just keep the lips moist using stick sponges in freshwater or a favorite lip balm).
- Breathing may be erratic, very slow, or very fast. They may not take breaths for a minute or more and then start breathing normally again for a bit.
- They may develop a “death rattle,” which is a very congested sound but is completely normal and doesn’t make them uncomfortable.
- Heart rate may also be erratic, and there is no need to take the pulse or blood pressure at this point.
- Disorientation is common, and there’s no need to be alarmed. The goal is to ensure they feel safe and as comfortable as possible.
- Skin color may change to very pale or grey in color as circulation slows down.
- Extremities may be cooler to the touch.
When they die, all movement and sound stop. There will be no pulse and no more breaths. Their eyes may be open, or they may be partially closed. They will not stay shut as they do in the movies unless they die with their eyes shut. Don’t let that alarm you. You are welcome to gently cover the eyes with a cloth if it’s hard for you to witness.
Take as much time as you need to sit quietly and be present with the sacred act that has happened. There is no need to rush around or do anything for a while. If there is a hospice nurse or other caregiver present, they can support whatever “needs to happen” so you can have the chance to be present with your loved one.
HomeAide Home Care Offers End-Of-Life Care Support
Is your aging loved one showing signs that the end may be near? HomeAide Home Care offers licensed, experienced respite and home care services to families around the Bay Area.
Contact us to schedule an in-home assessment, and let us know if you could benefit from extra support, allowing you to focus on more quality time with your loved one who is dying. In addition to providing respite care or companionship, our caregivers also support families with light housekeeping, meal planning and preparations, grocery shopping and errand running, laundry and linen changes, and more.
Speak Your Mind