Watching as a loved one nears death can be an incredibly challenging experience, and it's difficult to know what to expect. No matter the cause of death — cancer, heart disease, or other organs shutting down — the experience can be frightening and painful for both parties.
Understanding the signs of approaching death can help you deal with the situation and be better able to offer support, and that's really important for everyone involved. There are simple ways you can comfort your loved one through this process, from adjusting their position to offering a blanket.
Signs of Organs Shutting Down and Approaching Death
Although it's not easy for anyone to watch or experience, there are several physical and mental signs that are related to the body's functioning as a person nears death. Keep these in mind.
Loss of Appetite
As the end of life nears, the person will likely be less interested in food and drink. The metabolic needs of the body decrease as the body slowly shuts down and the person stops using much energy to get around. Near the end, your loved one may not be able to swallow, which may be another reason why solid foods may be rejected.
You can't force food on someone, but it's good to offer ice chips or sips of water or juice (if your loved one can swallow) to keep the mouth moist and make the person more comfortable.
Increased Need for Sleep
As the metabolism of the body slows down, the person will begin to sleep for most of the day. One reason for this is the fact that food intake may have gone down, which lowers available energy levels. You should allow the extra sleep, but remember that everything you say can probably be heard, even if the person appears to be sound asleep.
The brain is also affected as the other organs begin to shut down. This can feel alarming, but it's a normal part of the process. Your loved one may seem confused as to time and place and may not be able to recognize people whom they already know.
The person may be completely lucid one minute and then drift into a state of confusion. Remember to be reassuring and to identify yourself and others as they enter the room.
Loss of Bladder and Bowel Control
There may be a loss of bowel and bladder function as the nervous system shuts down. The caregiver — usually a nurse or hospice caretaker — may suggest a catheter to collect urine; you can also place absorbent pads on the bed in case of accidents. If your loved one is lucid, try to be reassuring and preserve their dignity where you can.
Noisy, Labored Breathing
You may notice a change in breathing rates, such as the person breathing very fast, followed by a period of slow breathing. One type of breathing pattern is called Cheyne-Stokes, which is a long deep breath and then a period of no breathing for up to one minute before breathing starts again.
Breathing may also be very loud, and this is an indication that there may be phlegm or mucus in the back of the throat.
Oxygen or a vaporizer may increase your loved one's comfort level, as can adjusting the person's head position.
Changes in Pain Perception
Your loved one may have more or less pain as death approaches. If there is more pain, you should alert the nurse or hospice caregiver so more pain medication can be given.
Does organ failure hurt? This is a natural thing to wonder, but the experience is different for everyone. Abdominal and chest pain can be some of the symptoms of organ failure, but they may not be experienced by everyone to the same degree.
Coolness in Hands and Feet
Eventually, the blood starts to centralize, meaning that the blood stops circulating to the hands and feet, and stays in the central part of the body to better support the failing vital organs. If the cold hands or feet bother your loved one, a blanket may make them a bit more comfortable.
Decrease in Urine Production
What happens when your kidneys shut down is that less urine will be created, making it change color or become darker. Another contributing factor to the decrease in urine production is the decrease in fluid intake that occurs as death nears.
As the kidneys fail, the extra toxins and waste in the blood may cause a coma; in many cases, this type of coma is considered a calm path to death.
What Organ Is the Last to Shut Down When You Die?
In most cases, dying is a gradual process and the organs begin to fail and eventually shut down. Physiological death happens when the vital organs no longer function. These are a few of the affected organs/systems:
- The digestive system is the first to be affected. When the dying process begins, there is a loss of appetite and thirst.
- The brain will also lose function and shut down. This is due to a lack of oxygen attributed to labored breathing and the eventual cessation of breathing.
- The kidneys aren't able to process fluids as before and will also shut down during the dying process.
- The heart and lungs are generally the last organs to shut down when you die. The heartbeat and breathing patterns become irregular as they progressively slow down and fade away.
Hearing may be the last sense to go during the dying process. Don't assume your loved one can't hear you. Try to speak to your loved one, even if they are unconscious.
Preparing for the Signs of Death
Not every person will exhibit each one of these signs, but most will show several. These symptoms are what happens when the organs shut down, but it's a difficult process to predict on an individual level. Since we don't know exactly when death will occur, people often hold vigils by the bedside so that they will be present as the person passes on.
Although many people do not want to talk about death, it is a part of life. Understanding and being prepared for the uncomfortable and sometimes scary signs of approaching death will give you the chance to help your loved one and be at peace with the situation yourself.