Download When someone is dying…

LCP/ICP Carer Leaflet
Palliative Care Team
St George’s Hospital
Tel: 020 8725 3311
When someone
is dying…
Understanding the changes which occur as
a person approaches death
This leaflet describes some of the changes which are
likely to occur as a person draws close to death.
Understanding these changes can help lessen your anxiety
during this stressful time. We hope that it helps to
prepare you for the last few days and moments of your
loved one’s life.
Physical changes
As death draws nearer, people often feel more tired and
have less energy. They become bed bound and spend
greater amounts of time sleeping. They may become semiconscious or even unconscious. Nurses will help your
relative/friend change their position regularly, to stay
comfortable. A special mattress can help vulnerable areas
such as the bottom or heels from becoming sore.
Eating and drinking
People often lose interest in eating or drinking during
their final days. The body doesn’t need food in the same
way it used to and the sensation of being hungry / thirsty
may disappear. This change in appetite can be difficult
for family and friends especially if you have been used to
tempting your relative with favourite foods. When s/he
stops eating, his/her lips and mouth may become dry. You
can moisturise the lips with lip balm or Vaseline and
gently clean the mouth to keep it moist with mouth
sponges. The nursing staff will watch carefully to keep
your relative/friend’s mouth moist. Once your relative
stops eating, he or she may stop having bowel movements,
and pass less urine.
Communication
Tiredness can make it difficult to concentrate and join in
conversations. It becomes more difficult to stay
interested in things that were previously important. It is
often a good idea to say anything you want to tell your
relative before they become too tired and weak, although
it can be difficult to predict when this will be.
Breathing
If someone’s breathing becomes difficult or noisy, there
are medicines that can help. It is often more distressing
for family and friends than it is for the person
themselves.
Consciousness
As your relative spends more time sleeping, you may find
it more and more difficult to wake them up. Gradually,
they are likely to slip into unconsciousness, although they
may have brief moments when they are awake. While you
may not be able to hold a conversation with them, it can
still be comforting to talk to them. They may well be able
to hear what is said to them, even if they don’t respond.
Some people become very restless and agitated, which
can be very distressing for the family to watch. This is
usually caused by chemical changes in the body.
Medication can be given to help this.
Medication
Not everyone gets pain. If your relative/friend is in pain,
it is important to give painkillers regularly to keep the
pain controlled. Anti sickness drugs can be given to
control any nausea or vomiting. Some medication is
available as a liquid but if swallowing becomes a problem,
it can be given through a syringe driver. This is a small
pump that gives a continuous dose of a drug though a tiny
needle inserted under the skin. The nurses and doctors
looking after your friend or relative will be monitoring
their medication carefully to make sure they are as
comfortable and as free of pain as possible.
Emotional changes
As the body begins to withdraw from the world, some
people become disorientated. They may speak to people
who are not really there, perhaps people from their past
who have already died. Other people may become irritable
or angry. This can be difficult to cope with when you are
trying to make their last few days as comfortable as
possible.
The last few moments
It's difficult to know exactly when someone will die.
Many people worry what will happen at the time of death.
Your relative’s breathing may become irregular, with very
shallow breathing. Or they may appear to stop breathing
for a time, then take another breath. It does not usually
cause distress to the person but can make it difficult to
tell if it is the last breath. When you touch your relative,
their skin may feel cold and moist. These changes are
normal and are part of the body’s shutting down process.
The person’s body may relax completely at the time of
death. Some people may lose control of their bladder and
bowels as the body relaxes.
We hope this leaflet has answered some of your
questions about what is likely to happen during the last
few days of your loved one’s life. If you would like to find
out more, then please don’t hesitate to ask one of the
medical or nursing team looking after your friend or
relative.
Approved by the Patient Information Group March 2011
Review date: March 2014