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Signs of approaching death

When death is imminent

Physical death is a progressive process, during which there are some signs that usually indicate that death is imminent. Not all of the following changes occur, nor do they necessarily occur in any particular order, as the body shuts down during the dying process. In general, the following information may help anticipate and understand changes that appear as an individual approaches death and is “actively dying.”

• The dying individual may become increasingly tired and sleepy, and may be difficult to arouse (lethargy).

• The individual may become confused much of the time and may no longer recognize familiar persons, places, or objects.

• Hearing and vision may become impaired, and speech may be slurred, difficult to understand, or nonsensical.

• A few dying individuals become restless or very anxious and move about frequently in the bed, pull at the bed clothes or bedding (linen clutch), and reach out.

• The person may experience hallucinations.

• Less nourishment will be required, and the person’s intake of food and water will diminish. Difficulty in swallowing (dysphagia) may also occur.

• The person may sweat profusely.

• The dying person may lose control of his/her urine or bowels (incontinence), necessitating that the individual be kept especially clean and dry in order to prevent bed sores (decubitis ulcers).

• Urine may become darker, and urination may diminish or stop.

• The mouth of the dying individual may become dry, and then secretions may accumulate in the back of the throat. Breathing may become noisy because of the gurgling or rattling of the secretions in the mouth or chest (death rattle).

• The pattern of breathing may change; become slower or faster, deeper or shallower, or irregular. Often the dying individual will have periods of rapid breathing followed by periods in which breathing is very slow or is even absent for as long as 15 seconds.

• The legs, and then arms, may become cold and nonreflexive as the circulation slows down.

• The skin may be pale or mottled, and some parts, particularly the underside of the body, may become a dark color as the blood pools, usually a deep blue or purple.

When death occurs

• Breathing ceases entirely.
• Heartbeat and pulse stop.
• The person is entirely unresponsive to stimuli.
• The eyes may be fixed in directions. The pupils are dilated and fixed to light. The eyelids may be open or closed.
• A loss of control of urine and/or bowels may occur.
• The person becomes progressively mottled and cold and stiff (known as rigor mortis)
• The skin may become pale; there may be signs of blood buildup in the part of the body at lowest elevation (known as Livor mortis).