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Palliative care - what the final days are like

End of life - final days; Hospice - final days

What it is

Dying is a process. Sometimes the process takes time. For a while, signs that death is near may come and go. Family and friends may need help understanding the signs that mean a person is close to death.

What you might see

As a person gets closer to death, the person might:

  • Have less pain
  • Have trouble swallowing
  • Have blurry vision
  • Have trouble hearing
  • Eat or drink less
  • Lose control of urine and stool
  • Hear or see something and think it is something else, or experience misunderstandings
  • Talk to people who are not in the room
  • Talk about going on a trip or leaving
  • Talk less
  • Moan
  • Have cool hands, arms, feet, or legs
  • Have a blue or gray nose, mouth, fingers, or toes
  • Sleep more
  • Cough more
  • Have breathing that sounds wet, maybe with bubbling sounds
  • Have breathing changes: breathing may stop for a bit, then continue as several quick, deep breaths
  • Stop responding to touch or sounds, or go into a coma

What you can do

  • If you do not understand what you see, ask a hospice team member.
  • Let family and friends visit, even children -- a few at a time.
  • Help the person get into a comfortable position.
  • Give medicine to treat symptoms.
  • If the person is not drinking, wet his or her mouth with ice chips or a sponge.
  • If the person is hot, put a cool, wet cloth on his or her forehead.
  • Keep a light on. If the person has blurry vision, darkness can be scary.
  • Play soft music that the person likes.
  • Touch the person. Hold hands.
  • Talk calmly to the person. Even if you get no response, he or she may still hear you.
  • Write down what the person says. This may comfort you later.
  • Let the person sleep.

When to call the doctor

Call the doctor if your loved one shows signs of pain or anxiety.

References

Balducci L. Death and dying: what the patient wants. Ann Oncol. 2012;23 Suppl 3:56-61.

O'Leary N. Diagnosis of death and dying. In: Walsh D, Caraceni AT, Fainsinger R, et al., eds. Palliative Medicine. 1st ed. Philadelphia, PA: Elsevier Saunders; 2008:chap 177.

Rakel RE, Strauch EM. Care of the dying patient. Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 5.

Update Date: 5/11/2014

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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