Coping with dying

The following coping with dying leaflet explains the changes you can expect in the end stages of life.

Coping with dying

The dying process is unique to each person. However, in many cases there are common characteristics or changes that help us to know that a person is dying. This leaflet describes some of the changes that happen to people as they start to die, it anticipates some of the questions you may want to ask about what is happening and why, and it will encourage you to ask for further help or information if there is anything at all that is worrying you.

The advice in this leaflet falls into four main categories:

1. Reduced need for food and drink 2. Withdrawing from the world
2. Withdrawing from the world
3. Changes in breathing
4. Changes which occur before death

Reduced need for food and drink

When someone starts to die their body no longer has the same need for food and drink. This is because metabolism slows down and the body can’t digest food very well or take goodness from it. People may stop drinking and although their mouth may look dry, it’s not necessarily a sign they are dehydrated. Applying lip salve and artificial saliva spray will give comfort.

Withdrawing from the world

For most, the process of withdrawing from the world is a gradual one. People spend more and more time asleep and when they are awake they are often drowsy and show less interest in what is going on around them. This natural process can be accompanied by feelings of calmness and tranquillity.

It can be hard to accept these changes, even when you know that the person is dying, as it’s a physical sign that they are not going
to get better. Nevertheless, you can still show that you care about your loved one

by spending time with them, talking to them and giving comfort through your presence. Maintaining a calm environment can help your loved one remain peaceful.

Changes in breathing

Towards the end of life, as the body becomes less active, the demand for oxygen lessens. People who suffer from breathlessness are often concerned that they may die fighting for breath but, in many cases, breathing eases as they start to die.

Very occasionally breathing problems can be made worse by feelings of anxiety. However, the knowledge that someone is close at hand can be reassuring and help to prevent this form of breathlessness. Often sitting quietly and holding your loved one’s hand can make a real difference.

Occasionally in the last hours of life there can be a noisy rattle to the breathing. This
is due to a buildup of mucus in the chest because the person no longer has the energy to cough. Medication may be used to reduce this and changes of position may also help.

The noisy breathing can be upsetting to carers but, in our experience, it doesn’t appear to distress the dying person.

Changes which occur before death

When death is very close (within minutes or hours) the breathing pattern may change again. Sometimes there are long pauses between breaths or the abdominal muscles (stomach) will take over the work – the abdomen rises and falls instead of the chest. If breathing appears laboured, please remember that this is likely to be more distressing to you than it is to the person dying.

Some people may become more agitated as death approaches. To help prevent this Dorothy House staff will talk to you about it and, having ensured that pain and other symptoms are controlled, will ensure that appropriate sedation is available for use, should it be required.

The skin can become pale and moist, and sometimes slightly cool prior to death.

Most people do not rouse from sleep, but die peacefully, comfortably and quietly, and are reassured by the presence of family and friends.

The dying process

  1. People with lighter skin tones may go blue or mottled. Mottling may be difficult to see on darker skin tones, it might look darker than normal or purple.
  2. They may become very cold or hot as the body stops regulating temperature.
  3. The facial expression and muscles may relax. Sometimes bodily fluids such as urine or faeces will release.
  4. Breathing will stop and heart will stop beating
  5. Person cannot be woken – eyes may remain partially open, and their mouth may fall open slightly as the jaw relaxes.
  6. If possible, you could lay the person on their back in a flat position, arms by their side. Over a few hours, the body will stiffen.

How we can help – coping with dying

This is likely to be a difficult and painful time for you as you lose someone you love or have cared for. It can be hard to know what to say, how to help or what to do.

Your healthcare professionals are there to help you work through your worries and concerns and to offer you care and support.

We hope you will come and talk to us if there is anything on your mind.

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