When a person enters the final stages of the dying process, two different dynamics are at work which are closely interrelated and interdependent.
On the physical side the body begins the final process of shutting down, which ends when all the physical systems stop functioning. Usually is this an orderly and undramatic series of physical changes which are the body's normal and natural way of preparing itself to stop. The best thing you can do in most cases is make sure the person is as comfortable and as pain free as possible.
'Watching a peaceful death of a human being reminds us of a falling star; one of a million lights in a vast sky that flares up for a brief moment only to disappear into the endless night forever.' - Elisabeth Kübler-Ross
The person’s hands, feet, arms and legs may become increasingly cool to the touch and the color of their skin may change. This is a normal indication that the circulation of blood is decreasing. Keep the person warm with a blanket.
The person may spend an increasing amount of time sleeping and appear uncommunicative, unresponsive and at times difficult to arouse. This normal change is due in part to changes in the metabolizing of the body. Sit with them and hold their hand speaking softly and naturally. Hearing is the last of the senses to be lost so don’t assume they can’t hear you.
The person may seem confused about the time, place and identity of people. This is also in part due to the metabolism changes. When you speak be clear and identify who you are.
The person may lose interest in food and drink. This is because the body is trying to conserve energy. Don't try to force the person to eat or drink as it can often only make them more uncomfortable. Small chips of ice or frozen drink may be refreshing in the mouth and small sips of drink from a syringe if the person is able to swallow. Glycerine swabs can help keep the lips and mouth moist and comfortable. A cool facecloth on the forehead can also be a comfort.
The person may begin to make gurgling sounds which can become very loud. This normal change is due to the decrease of fluid intake and an inability to cough up normal secretions. Gently wipe the mouth with a moist cloth and turn their head to the side to allow gravity to drain the secretions.
As the muscles begin to relax the person may lose control of urine and/or bowel. Bed covers and/or pads can be used.
The person may make restless and repetitive motions like pulling at sheets or clothing. This is often due in part to the decrease in oxygen circulation to the brain and metabolism changes. Don’t try and stop them. Try and create a calming environment for example speak in a quiet natural way, read to them, play soothing music, use aromatherapy.
Breathing Pattern Change
The person’s regular breathing pattern may change. A common new pater is called Cheyney-Stokes breathing which is shallow breaths with periods of no breathing of 5-30 seconds and sometimes up to a full minute.