Source: From various medical websites
We can’t predict the moment when death is at hand, but members of the medical community involved in final care recognize certain signs and symptoms that indicate the shutting down of bodily functions. While certain illnesses may exhibit obvious effects, other signs of impending death manifest themselves.
Not all dying symptoms will show up in every individual, but most people experience some combination of the following indicators during the final days or hours:
Excessive fatigue and sleep: The person will begin to sleep most of the days and nights as metabolism slows and they may decline food and water—thus contributing to dehydration. It may become difficult to rouse him or her from sleep. The fatigue is so pronounced that the individual loses awareness of immediate surroundings. Caregivers should permit sleep. Avoid jostling the person awake. Assume that everything you say can be heard, as the sense of hearing is thought to persist, even when the person is unconscious, in a coma, or otherwise unresponsive.
Loss of appetite: The person requires less energy and may begin to resist or refuse meals and liquids, or grudgingly accept only small amounts of bland foods. Meat, which is hard to digest, may be refused and even favorite foods hold little appeal. Near the very end of life, the dying person may be physically unable to swallow. Do not force feed and follow the person’s cues even though you may be distressed by this loss of interest in eating. Periodically offer ice chips, or sips of water. Use a moistened warm cloth around the mouth and apply lip balm to keep them moist and comfortable.
Mental confusion or disorientation: Organs begin to fail, including the brain. A higher-order consciousness tends to change. Few conditions leave people hyperaware when they’re dying, The person may not be aware of where he or she is or who else is in the room, may speak or reply less often, may respond to people who can’t be seen in the room by others things, may be confused about time, or may act restless and pick at bed linens. Some people have been known to remark that long-gone family members or friends are present. Respond by staying calm and offer reassurance. Speak to the person softly, and identify yourself when you enter the room
Labored breathing: Breathing intake and exhaling become raggedy, irregular, and labored. A distinctive pattern called Cheyne-Stokes respiration might be heard: a loud, deep inhalation is followed by a pause of not breathing (apnea) for between five seconds to as long as a full minute, before a loud, deep breath resumes and again slowly peters out. Sometimes excessive secretions create loud, gurgling inhalation and exhalation noises that some people call a “death rattle.” How to respond: The stopped breathing or loud rattle can be alarming to listeners, but the dying person is unaware of this changed breathing; focus on overall comfort. Positions that may help: the head slightly elevated with a pillow, sitting up well-supported, or the head or lying body tilted to the side slightly. Moisten the mouth with a wet cloth and moisturize with lip balm or petroleum jelly. If there’s a lot of phlegm, allow it to drain naturally from the mouth, since suctioning it out can increase its quantity. A vaporizer in the room might help. Some people are given oxygen for comfort. Be a calm, physical presence, stroking the arm or speaking softly.
Increased physical weakness: This natural part of the dying cycle occurs from the reduce food and water intake. Focus on keeping the person comfortable.
Social withdrawal: When the body begins to shut down, the dying person may gradually lose interest in those nearby. He or she may stop talking or mutter unintelligibly, stop responding to questions, or simply turn away. A few days before receding socially for the last time, the dying person sometimes surprises loved ones with an unexpected burst of alert, attentive behavior. This can last less than an hour or up to a full day. The best response is to be aware that this is a natural part of the dying process and not a reflection of your relationship. Maintain a physical presence by touching the dying person and continuing to talk, if it feels appropriate, without demanding anything back. Treasure an alert interlude if and when it occurs, because it’s almost always fleeting.
Changes in urination: Reduced liquid intake means little coming out. Dropping blood pressure, part of the dying process (and therefore not treated at this point, in tandem with other symptoms), also contributes to the kidneys shutting down. The concentrated urine is brownish, reddish, or tea-colored. Loss of bladder and bowel control may happen late in the dying process. How to respond: Hospice medical staff sometimes decides that a catheter is necessary, although not in the final hours of life. Kidney failure can increase blood toxins and contribute to a peaceful coma before death. Add a bed pad when placing fresh sheets.
Swelling in the feet and ankles: Prior to death, the kidneys are less able to process bodily fluids, they can accumulate and get deposited in areas of the body away from the heart, in the feet and ankles especially. These places, and sometimes also the hands, face, or feet, take on a swollen, puffy appearance. Usually no special treatment (such as diuretics) is given when the swelling seems directly related to the dying process. (The swelling is the result of the natural death process, not its cause.)
Coolness in the tips of the fingers and toes: Poor circulation often appears just prior to the final hours. As this happens, the extremities including the hands, feet, fingers and toes become notably cooler. Nail beds may also look more pale, or bluish. A warm blanket can keep the person comfortable, or he or she may be oblivious. The person may complain about the weight of coverings on the legs, so keep them loose.
Mottled veins: Skin that was previously uniformly pale or ashen develops a distinctive pattern of purplish/reddish/bluish mottling as one of the later signs of death approaching. This is the result of reduced blood circulation. It may be seen first on the soles of the feet. No special steps need to be taken.
Please Note: These general signs of impending death can vary in sequence and combination from person to person. If a person is on life support such as a respirator, feeding tube, etc., the process of dying can be different. The signs of death listed here describe a natural dying process.