Providing Care to Those We Love as Death Approaches

The mission of LMHPCO is to improve the quality of hospice & palliative care in Louisiana & Mississippi.

1. Our Body Temperature Decreases

As we approach death and our organs begin to shut down, our hands and arms, as well as our feet and legs become increasingly cool to the touch and may change in color. This is a normal part of the dying process, indicating the decreasing ability of our body to circulate blood to the body’s extremities. We are reserving energy in order for our most vital organs to function.

Suggestion to the Caregiver:
Keep me warm with a blanket; but do not use an electric blanket.

2. We Sleep More

Increasingly our time is spent sleeping and we may appear uncommunicative, unresponsive and even difficult to arouse. This is a normal part of the dying process, indicating changes in the metabolism of our body.

Suggestion to the Caregiver:
Sit and hold my hand.
Do not shake me or speak loudly.
Speak softly and naturally.
Spend time with me when I appear most alert and/or awake.
Never talk about me, in my presence, as though I am not present.
Speak directly to me (as you would normally), even when I appear non-responsive.
Never assume that I cannot hear you.
My sense of hearing is the last sense I will lose in life.

3. We Appear Increasingly Disoriented

As we progress through the dying process, we may seem confused about time, place and the identity of the people around us, including those closest to us and most familiar with us. This is normal due to the metabolic changes taking place within our body.

Suggestion to the Caregiver:
Always identify yourself when speaking to me. Never ask me to “guess” who you are.
Speak softly, clearly and truthfully when you need to communicate something important to my comfort.
Remind me: “it is time to take your medication” and even explain, “so you don’t begin to hurt.”
But never use this method to manipulate me to meet your needs.

4. We May Become Increasingly Incontinent

As the muscles in my body begin to relax, I may increasingly lose control of my urine and bowel movements. This is a normal part of the dying process but also one of the most difficult aspects of dying process to emotionally accept.

Suggestion to the Caregiver:
Consult with my hospice nurse about what can be done to protect the bed and keep me clean and comfortable.

5. Increasing Congestion May Make Breathing Difficult

As a result of decreasing amounts of fluid being put into my body and an increasing inability to cough up normal secretions, you may hear a gurgling sound come from my chest. Some people have reported that it sounds as though marbles are rolling around inside of my throat. This is a normal part of the dying process. These are sounds of congestion and do not necessarily indicate pain and/or discomfort.

Suggestion to my Caregiver:
Gently turn my head to the side and allow gravity to drain the secretions.
Please gently wipe my mouth with a moist cloth, and remember: “Suctioning the secretions in my throat usually only increases the amount secretions and can cause a great deal of discomfort.”

6. You May See Increasing Signs of Restlessness

I may appear restless and repeatedly pull at my bed linens and/or clothing. This is a normal and natural part of the dying process as less oxygen is circulating to my brain and my metabolism changes.

Suggestion to the Caregiver:
Do not try to stop me from doing this by restraining me.
To calm and reassure me, speak to me quietly, normally, and naturally.
You can lightly message my forehead, read to me or play soothing music.

7. My Output of Urine Will Decrease

The output of urine will decrease and may become tea colored. This is a normal and natural part of the dying process due to the decreasing intake of fluid, as well as decreasing circulation of fluids through the kidneys.

Suggestion to my caregiver:
Consult with my hospice nurse to consider whether I may need a catheter or if my catheter needs to be irrigated.

8. I Need Decreasing Amounts of Fluids and Foods

As part of the natural and normal part of dying, my appetite and thirst will probably decrease. I may not even want to eat and/or drink. As my body begins the process of “shutting down”, it becomes increasingly more difficult to process anything put into my body.

Suggestions to my Caregiver:
Never force me to eat or drink and do not use guilt to manipulate me into eating and/or drinking. (This only makes me feel more uncomfortable.)
Small chips of ice, frozen Gatorade or juice may refresh my mouth.
If I am able to swallow, small amounts of fluids may be administered with a syringe.
(Consult with my hospice nurse about using a syringe in this way.)
My hospice nurse can also supply you with glycerin swabs to keep my mouth and lips moist and comfortable.
A cool, moist washcloth on my forehead is usually comforting.

9. My Breathing Patterns Will Change

My regular breathing pattern will probably change. You may observe my breathing having a different breathing pace. My breathing may appear irregular. I may appear to be taking only shallow breath, with periods of no breaths for 5-30 seconds; maybe even up to a minute long. This is often called “Cheyne-Stokes” breathing. I may also experience periods of rapid, shallow pant-like breathing. These common signs of approaching death which indicate the decreased circulation of fluids through the internal organs.

Suggestion to my caregiver:
Elevate my head and/or turn me onto my side.
Hold my hand and speak gently and softly to me.

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