What are end of life signs?

September 21, 2023 Palliative care

What are end of life signs?

End of life signs final hours

The body initiates its inherent process of gradually slowing down all of its functions. The duration of this process varies from one individual to another, spanning hours to possibly days.

As the person approaches the end of life, they may experience weakness and increased periods of sleep. As death draws nearer, observable physical alterations may include changes in breathing, end of life rash (pruritus), loss of control over bladder and bowel functions, end of life rash (pruritus)and eventual unconsciousness.

It can be emotionally challenging to witness these physical changes in someone. Nevertheless, it’s essential to recognize that these changes are a natural part of the dying process and do not necessarily indicate discomfort or distress for the person.

Medical professionals, including doctors and nurses caring for the individual, will vigilantly monitor these changes. Their primary goal is to ensure the person’s comfort during their final moments.

If you are providing care for a person at home during their final stages, you should seek support from specialized nurses, district nurses, and the GP. They can address your concerns and make the process of home nursing more manageable for you.

Nurse giving a patient her medication sitting in a chair

End of life signs for cancer patients

When someone is approaching the end of life, they may exhibit various signs and experiences:

  • Sleepiness and difficulty waking: Dying individuals often sleep a lot and may not respond when you try to wake them. They can still hear, so it’s crucial to keep talking to them and offering comfort. Sitting close and holding their hand can provide reassurance.
  • Difficulty swallowing and reduced appetite: As the end nears, the person may lose their desire to eat or drink. Forcing them to eat or drink is uncomfortable, but you can moisten their lips and mouth, offer small ice pieces, and apply lip balm to prevent dryness.
  • Loss of bladder and bowel control: Due to muscle relaxation, the person may experience incontinence. Healthcare providers will take measures to keep the person clean and comfortable. Protective sheets or pads can be provided for home care.
  • Restless movements: Some individuals may worry about pain, but it can usually be controlled effectively by healthcare professionals. Restlessness may signal discomfort, so it’s essential to communicate this to the medical staff.
  • Changes in breathing: Breathing patterns may change, including Cheyne-Stokes breathing (intermittent stops). Elevating the head with pillows and offering reassurance can help. Morphine might be given to ease breathing.
  • Noisy breathing: Gurgling sounds may occur due to mucus and saliva build-up. Turning the person’s head to the side and informing the medical team can be beneficial.
  • Cold extremities: The person’s hands and feet may become cool to touch due to reduced blood circulation. Keep them warm with blankets and thick socks but avoid overheating the room.
  • Confusion and disorientation: The dying person may say things that seem irrational or behave out of character. Understand that these actions are not intentional and result from chemical changes in their body.
  • Complete loss of consciousness: Toward the end of life, the person will become unconscious, with irregular and noisy breathing. They won’t be awakened, and breathing will ultimately cease.
  • Emotional and spiritual changes: Emotional responses vary based on individual factors, such as age, support, beliefs, and life experiences. People may exhibit a range of emotions and behaviours as they approach death, which is a natural part of the process.
  • Unfinished business: Some individuals may express a desire to address unresolved matters before passing, such as personal relationships, visits, gifts, or legal and financial matters. This can help bring closure and peace in their final moments.

a man sitting on a bench by water

End of life signs for dementia

Identifying the final stages of dementia before death can be challenging, but certain indicators may provide insight. These signs and symptoms include:

  • Difficulty in speaking, often limited to single words or phrases, or a complete inability to speak.
  • Increased withdrawal or social isolation.
  • Reduced appetite and swallowing difficulties.
  • Loss of bowel and bladder control.
  • Inability to stand or walk, difficulty sitting up, and becoming confined to a bed.
  • Prolonged periods of sleep and resistance to being awakened.

When these end of life vital signs are accompanied by frailty, recurring infections, and/or pressure ulcers, it’s likely that the individual is approaching the end of life. If they have another life-limiting condition, such as cancer, the progression of that condition is likely to follow a more predictable course. Provision of palliative care for individuals in the end stages of dementia is crucial to ensure their comfort and quality of life during this challenging phase.

End of life signs for Parkinson’s

Consider the likelihood of end-stage Parkinson’s disease if a person experiences the following:

  • Severe and worsening motor symptoms, such as increased ‘off’ periods, dyskinesia, mobility issues, and falls.
  • Severe and worsening non-motor symptoms, including declining cognitive function, depression, anxiety, hallucinations, or delusions.
  • Decreasing response to Parkinson’s medication or the need for a more complex medication regimen.
  • Declining physical abilities, increased dependence on support, spending over 50% of the day in bed or a chair.
  • Frequent unplanned or crisis hospital admissions.
  • A low body mass index (BMI) or significant weight loss, e.g., over 10% weight loss in the past 6 months.
  • Dysphagia leading to recurrent aspiration pneumonia, sepsis, breathlessness, or respiratory failure.
  • Speech problems causing progressive communication difficulties or worsening dysphagia.
  • Presence of significant co-existing medical conditions.

various medicines

How can we help?

At Cavendish Homecare we are experts in providing palliative homecare for individuals with terminal illnesses who want to remain in their own homes. We work to support the patients and their families with sensitive and comforting palliative care.

Our Services Include:

Please call our Homecare Team on 0203 008 5210 or email us info@cavendishhomecare.com to see how we can assist you.

About the Author…

Mairead Liston

Registered Nurse and Founder of Cavendish Homecare

Mairead Liston, a dedicated figure in healthcare, began her journey as a nurse and midwife, laying the foundation for a remarkable career. Driven by passion and expertise, Mairead established a successful nursing agency, serving as a crucial staffing resource for major hospitals in London and the UK.

In 2010, Mairead founded Cavendish Homecare with a mission to provide exceptional care in the comfort of people’s homes. Mairead’s areas of expertise encompass palliative and end of life care, post-operative care, and cancer care, ensuring the delivery of the highest quality of care to her clients.

Her transformative impact is exemplified through prestigious awards, including the ‘Lifetime Achievement’ award and the Chief Nursing Officer in Adult Social Care Silver award, recognising her dedicated service to social care.

By becoming a member of the Guild of Freemen of the City of London, Mairead not only emphasises her active support for both current and future nurses but also plays a vital role in contributing to the ongoing evolution of the nursing profession.

Lady smiling for the camera