Chapter 6: As death nears
Final physical changes
At the end, her breathing changed dramatically, so I called her doctor.
There are some physical changes when a person is just minutes or hours from death, particularly in skin colour and breathing, that can indicate that the body is in the process of shutting down. These reflect the normal dying process and cannot be prevented by medical treatments.
Sometimes these changes can be concerning to those at the bedside, as most people are not used to seeing them. In this final phase, the person will not likely be conscious and will not be aware. These normal changes are happening to the physical body and do not cause suffering.
Click below to read more about these changes in the order
they tend to appear.
The circulation of the body gradually shuts down, which causes the hands and feet to feel cool, and a patchy purplish colour called “mottling” often appears on the skin of the extremities. The skin of the face may develop a bluish or purplish colour, related to decreasing levels of oxygen in the blood. The heart tends to beat more quickly, but not as strongly. This makes the pulse rapid and hard to feel at times. All of these changes are normal, and not distressing to the patient near end of life. Turning down the lighting in the room can make the colour changes less obvious.
As people are closer to dying, they will take in less food or drink and produce less stool, so bowel movements will be decreased. Managing constipation is not usually considered necessary in the final few days of life. Although incontinence of stool is not particularly common due to the decreased stool production, if necessary, this can be managed with adult absorbent or incontinence products, waterproof pads, and cleansing of the rectal area by care providers.
Urine production also decreases as the person takes in less fluid. In the last one or two days of life, they may have no urine output at all. Loss of control of urine is sometimes best managed with a catheter that is inserted into the urinary bladder and connected to a drainage bag. The presence of a catheter can help to prevent skin breakdown that might occur from wetness.
Changes in breathing are generally the most significant physical signs that death might occur within minutes or hours. These breathing changes do not mean that the person is uncomfortable. If you are wondering whether the person who is dying is comfortable with their breathing, look at their facial expression and overall calmness rather than their breathing rate or their oxygen levels.
Some of the changes may include:
- The rate – how fast the breathing is
- How shallow, normal, or deep the breaths are
- How regular (the pattern) the breathing is
- The kinds of muscles used in breathing
- The mucous or secretions that can build up due to inability to cough or the development of an infection
There may be a buildup of secretions in the lungs, which can be noisy (rattling or gurgling) and sometimes upsetting for people at the bedside. This is sometimes referred to as the “death rattle” and is likely not distressing to the unconscious dying person. However, medications can be given to help dry the secretions if there is a possibility of discomfort. Treating the secretions may also make it easier for people to comfortably visit.
There may be very slight motions of breathing happening irregularly for a few minutes after the final breath. These are reflex actions and are not signs of distress.