A conscious dying person may know that they are dying. They may exhibit certain signs when near the end of their life.
A conscious dying person may know that they are dying. They may exhibit certain signs when near the end of their life.

Death remains the only thing that man has not yet been able to conquer. Everyone will die at some point. But there is no certainty as to when or how it will happen.

A conscious dying person can know if they are on the verge of dying. Some feel immense pain for hours before dying, while others die in seconds. This awareness of approaching death is most pronounced in people with terminal conditions such as cancer. A person who is approaching death in the next few minutes or seconds will gasp for breath out of “air hunger” and have noisy secretions while breathing

It is hard to tell what a dying person experiences when they die because that “secret” goes with them. Even doctors accept the fact that it is difficult to predict when the person is entering the last days or weeks of their life. But what about people who are survivors of a near-death-like situation and have experienced what it feels like when they are about to die? A survey was carried out to find out the same.

Researchers asked 140 survivors of cardiac arrest (cessation of heartbeat and breathing) from the United States, the United Kingdom, and Austria about their near-death experiences. Here is what they found:

  • In total, 39 percent of survivors reported feeling some kind of awareness while being resuscitated. They felt a peaceful feeling with a sensation that time had slowed down or sped up.
  • A total of 13 percent said they felt that they were getting separated from their bodies
  • Only 2 percent said that they were fully aware of what was going on during the resuscitation procedure.

What things can be noticed in someone who is nearing death?

It is hard to see your near and dear ones in the last stages of their life. Here are the changes that you will notice in them and also a few things that you can do to comfort them.

  • Loss of appetite
    • A person in the final days of their life often refuses food and eats less. They may stop drinking water and other liquids.
    • Try giving them popsicles to suck on and apply balm on their lips. Do not force them to eat or drink. 
  • Excessive sleeping and difficulty in waking up
    • As their metabolism slows down with the nearing of death, the person may sleep for more hours than usual. You might also need more time to wake them up. But that’s OK. Let them sleep and get up whenever they want. Just encourage them to get up and move around a little.
  • Tiredness that worsens
    • Activity decreases in the final days of life as the person experiences fatigue. They will speak and move less and become confined to their bed until the end of their life.
    • Do not force them to move around. Let them do that when they desire. Ask what you can do for them.
  • Loss of interest in socializing
    • In the final days of their life, the person can stop talking with others and spend less time with people around them. They find ways to stay alone.
    • Let them be the way they want to be. You can try cheering them up by reminding them of happy memories. But do not push them to speak. If they feel like opening up, they will.
  • Change in bowel and bladder movements
    • As death approaches, the muscles and nervous system of the person weaken considerably. Their hold on the bowel and bladder weakens. This makes the person lose control over their bowel movements and urination. Because they eat and drink less, they may become constipated and pass less stool and urine.
    • You may have them use diapers. Talk to the doctor about a urinary catheter, a tube that drains the urine into a urine bag that can be placed outside near the bed.
  • Confusion, hallucinations
    • You may notice that the person is confused, restless, irritated, and agitated easily without the slightest reason. This condition in the final stages of life is known as terminal restlessness.
    • The person may hear unreal sounds and see images of what is not present. These are known as hallucinations.
    • You can calm them by offering a hug or playing soothing music. You can hold their hands and say comforting, reassuring words to them.
  • Change in vitals
    • As the person is hours away from their death, there is a large shift in their vital parameters.
      • Blood pressure lowers.
      • Heart rate becomes slow and irregular.
      • Body temperature drops and you can feel that their hands and feet are cold.
  • Changed breathing pattern
    • When someone is dying, you might notice their breathing often changes. It becomes noisy and irregular. It stops for a few seconds and starts again. This pattern, known as Cheyne-Stokes breathing, is common in the final days of life.
  • Loss of consciousness
    • When a person is a few minutes away from their death, they may become unconscious. It may be difficult and impossible to arouse them at this stage. They may hear you as hearing is the last sense to go. But they never wake up again.
    • Before the doctor confirms the person is no more, you can see some signs of death such as:
      • No heartbeat
      • No breathing
      • Fixed eyes
      • Partially opened eyelids

Is palliative care the same as hospice?

Palliative care and hospice care aim at providing comfort in chronic illnesses.
Palliative care and hospice care aim at providing comfort in chronic illnesses.

Palliative care and hospice care aim at providing comfort in chronic illnesses. Both have the goal of easing pain and helping patients cope with serious symptoms. The difference lies in the stage of disease management when they come into play.

  • Palliative care usually begins at the time of diagnosis along with the treatment.
  • Hospice care typically begins after the treatment of a disease has stopped or if a diagnosis is made too late; it is known that the person is not going to survive the illness.

What is palliative care?

Palliative care focuses on improving the quality of life along with curative treatment. They treat people suffering from the symptoms and stress of serious illnesses. It can be provided at any stage of a serious illness. It can help patients manage their symptoms and complications more comfortably with chronic, long-term diseases, such as cancer, an acquired immunodeficiency syndrome (AIDS), kidney disease, Parkinson’s, or Alzheimer’s disease.

  • Palliative medicine doesn’t replace other medical treatments. Even in cases where the illness is expected to be fatal, palliative care can help the individual be as comfortable as possible and live an active life.
  • Palliative care is designed based on the patient’s individual needs. Patients in palliative care lived longer and had a better quality of life than those who were not. The palliative care team also helps patients match treatment choices to their goals.
  • Palliative care is provided by a multidisciplinary team of doctors, nurses, trained caregivers, and counselors along with the patient’s family.

What is hospice care?

This is for people who are not expected to recover from their medical condition. The goal is to ease pain and help patients and their families prepare for the end of life. Palliative care is a part of hospice care. People who choose hospice care are generally expected to live for less than 6 months.

Hospice care may be given at home with the help of family/friends and professional caregivers or specialized hospice centers. Hospice care involves doctors, nurses, family, trained caregivers, counselors, and social workers. They can help address various issues associated with their illness, including grief and other negative emotions. Both palliative care and hospice care offer medicines that can ease your pain.

Pain medication could be over-the-counter drugs, such as Ibuprofen, and stronger prescription medications, such as opioid medications (Oxycodone or Morphine). There is often a concern of patients becoming addicted to opioid medications. This could be worrying if the person has had an issue with drugs or alcohol in the past. However, studies have shown that usage of opioids in these types of situations rarely causes addiction if they are taken as directed.

Since there are immense pain and suffering due to their medical conditions, it is okay to take prescription opioids. Their advantages outweigh the disadvantages. Opioids can cause drowsiness, nausea, and constipation. However, these problems usually disappear as the body gets used to the medication.

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Medically Reviewed on 3/7/2022
References
Medscape Medical Reference

Resuscitation https://pubmed.ncbi.nlm.nih.gov/25301715/

Hospice Foundation of America https://hospicefoundation.org/Hospice-Care/Signs-of-Approaching-Death

Care of Dying Adults in the Last Days of Life https://www.ncbi.nlm.nih.gov/books/NBK356012/

Healthy WA https://healthywa.wa.gov.au/Articles/U_Z/Understanding-the-dying-process

World Health Organization. Palliative Care. August 2, 2020. https://www.who.int/news-room/fact-sheets/detail/palliative-care

National Cancer Institute. Palliative Care in Cancer. https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet