When a person is nearing the end of their life, it is common for them to go through a transition period before passing away. This transition time is often referred to as “active dying” and can last from a few days up to several weeks. During this time, the body begins shutting down as the person prepares to die. There are common signs and symptoms that indicate when a dying person is transitioning. Understanding what happens during this transition period can help loved ones know what to expect and provide the best care and comfort to the dying person.
What is active dying?
Active dying is the final phase of the dying process as the body begins shutting down. This transition period is marked by significant changes in the body that indicate the person is preparing to die soon. These changes are irreversible and signal that death is imminent, likely within hours or days. During active dying, the body’s systems start failing, leading to symptoms like difficulty swallowing, decreased urine output, breathing changes, mottling skin, and a reduced level of consciousness. Knowing the signs of active dying allows loved ones and healthcare providers to understand what is happening and provide appropriate end-of-life care.
How long does the active dying phase last?
The active dying phase can last anywhere from a few days up to three weeks. However, for most people, the final transition tends to last less than one week. Here is an overview of the typical timeframe:
- 1-2 weeks prior: The person may become more tired and withdrawn. Appetite often decreases.
- 1 week prior: More notable changes occur as the body declines. The person sleeps more, sometimes difficult to rouse.
- 3-4 days prior: The person is sleeping most of the time. Minimal interest in food or drinks.
- Last 1-2 days: The person is unlikely to wake up or communicate. Breathing patterns and heart rate change.
The timeline varies tremendously for each individual. A hospice nurse can often predict when death is close based on the person’s specific symptoms and decline.
What are the signs that death is nearing?
There are some common physical and psychological signs that indicate a person is transitioning and death is drawing near. These include:
Decreased appetite and reduced eating/drinking
As the body begins shutting down, the dying person loses interest in food and drink. Difficulty swallowing often develops as well. Providing comfort measures like ice chips or swabbing the mouth is important.
Increased time sleeping and difficulty waking
As organs start failing, the dying person becomes increasingly fatigued and sleepy. They may become difficult to rouse or unable to wake up. Spending more time asleep enables the body to conserve energy.
Changes in urinary and bowel function
Urine output decreases significantly as kidney function declines. Urine may also become darker. Constipation is common, and loss of bowel control can occur as the muscles relax. Gentle peri-care helps keep the person comfortable.
Confusion and restlessness
As the body declines, the person may become disoriented about time and place. Restlessness, agitation, and confusion are common. Reassurance and orienting the person can help ease anxiety.
Changes in breathing patterns
Breathing often becomes irregular as the body weakens. Long periods of no breathing may occur, followed by rapid shallow breaths. Congestion and gurgling or rattling sounds may develop.
Mottling skin and reduced circulation
As blood flow decreases, the skin becomes mottled and patchy, with purple and blue discoloration. Hands and feet may feel cool to the touch. Keeping the person warm provides comfort.
Withdrawal from worldly concerns
As death nears, the person focuses inward and withdraws from what is happening in the outside world. Interactions decrease while sleeping increases. Saying goodbyes and final words provides closure.
What are the final stages just before death?
In the last hours before dying, the body goes through a final series of changes. Understanding these final stages can help loved ones know death is imminent:
- Vision changes – Eyesight becomes blurry or fixed. The dying person may report seeing loved ones not visible to others.
- Breathing changes – Breathing slows further and becomes very irregular, with periods of no breathing for up to 45 seconds. Congestion increases.
- Loss of bladder/bowel control – Loss of control occurs as the muscles relax. Gently keeping the person clean preserves dignity.
- Skin changes – Hands, arms, feet and legs become cool and mottled. The underside of the body becomes purplish and blotchy.
- Decreased consciousness – The person rarely wakes, and then only briefly. Unresponsive to voices or touch.
These final changes indicate death will occur in minutes to hours. Providing comfort, reassurance, and respect allows for a peaceful passing.
What are common symptoms during the active dying phase?
There are some symptoms that are commonly experienced by people during the active dying process. Being aware of these expected symptoms can help loved ones provide the best care.
Pain
Pain medication should continue to be offered regularly, even if the dying person is unresponsive. Moaning or grimacing may signal discomfort. Medications can be administered rectally if the person cannot swallow.
Anxiety
Some dying people experience fear or anxiety about death. Reassurance, calming music, spiritual support, or anti-anxiety medications can sometimes help relieve distress.
Delirium
Confusion, disorientation, and agitation are common. Reminding the person where they are and recalling fond memories can be comforting. Some medications may need to be discontinued if causing delirium.
Secretions
Congestion and an inability to clear secretions result in gurgling sounds and rattling breathing. Repositioning the person and suction can help. Medications may be used to decrease secretions.
Emotional distress
Saying goodbyes, expressing love, offering reassurance, and fulfilling last wishes can provide emotional closure. Listening without judgment and spiritual support are helpful.
Anticipating and managing these symptoms compassionately allows for a more comfortable dying process. Hospice or palliative care teams can recommend ways to alleviate distress.
What are some tips for end-of-life care during the transition period?
Providing quality care for a dying loved one brings comfort during the difficult transition period. Here are some tips for providing care:
- Keep the person’s lips and mouth moist with lubricant, glycerin swabs or sips of water.
- Speak calmly, identify yourself by name, and remind them of the time and place.
- Avoid having too many people in the room at once, as this can cause overstimulation.
- Raise the head of the bed or prop up with pillows to make breathing easier.
- Use cool washcloths to soothe and refresh the face, hands and body.
- Hum, sing or play soft music to create a reassuring environment.
- Hold the hands gently and reassure the person you are there for them.
- Inform family and friends that death is likely imminent so they can say goodbyes.
Being present and providing comfort care honors the dying person while creating meaningful moments for saying goodbye.
What physical changes occur right at the time of death?
There are some distinct changes that happen in the minutes and seconds leading up to the very end of life. These final physical changes include:
- Breathing becomes irregular with longer pauses between breaths.
- The skin of the arms, legs and underside of the body become purplish and mottled.
- Eye movement stops and eyes remain half-open or fixed in one direction.
- The jaw relaxes with the mouth remaining open.
- Loss of control over urine and stool occurs as muscles fully relax.
- Congestion leads to loud gurgling or rattling sounds with breathing.
- Hands and feet become cool as circulation decreases.
These symptoms mean the final moments have arrived. Staying calm and reassuring the dying person provides comfort. Death itself is very peaceful, with no struggle or distress evident.
What happens to the body immediately after death?
In the moments right after death, the body undergoes several expected changes. Understanding what happens provides closure for loved ones witnessing death:
- All breathing and heartbeat stops.
- Pupils become fixed and dilated.
- The body releases any remaining urine or stool.
- Jaw becomes slack and mouth remains open.
- Eyes begin to sink into the orbits and may stay open.
- Lips and fingertips may become bluish and cool to the touch.
- Skin becomes pale and waxy-looking as blood settles.
There is no appearance of struggle or discomfort. The person looks serene and peaceful in death. These post-death changes are simply the body’s final release.
What are some tips for nursing home staff during a resident’s transition?
When a nursing home resident is actively dying, staff can provide quality end-of-life care by following these tips:
- Communicate closely with the family about the resident’s decline. Update them regularly and notify when death occurs.
- Discontinue routine vital signs, medications, and interventions that may cause discomfort.
- Position the resident comfortably. Raise the head, support limbs, and turn gently every 2 hours.
- Limit visitors to immediate family. Avoid overstimulating the dying resident.
- Speak reassuringly, even if the resident seems unresponsive. Hold a hand gently.
- Use gentle care when cleaning and bathing. Prioritize comfort and dignity.
- Observe closely for signs of pain or distress. Administer medications as needed.
- Notify a chaplain if spiritual support is desired. Arrange for requested rituals.
With sensitivity and compassion, staff can ensure a peaceful transition surrounded by loving care.
What are some tips for family members during a loved one’s transition?
The active dying process is difficult for family members witnessing the decline. Some tips that may help include:
- Spend time at the bedside. Your presence is powerful even if your loved one seems unresponsive.
- Talk in a normal tone. Hearing is thought to remain until death. Share memories, say “I love you,” offer forgiveness.
- Hold the hand gently. Stroke the hair, forehead or arm lightly.
- Read aloud or play favorite music. Familiar sounds are comforting.
- Use moist swabs to moisten the lips and mouth. Eye drops refresh dry eyes.
- Provide favorite blankets or clothing. Familiar textures give security.
- Give permission for your loved one to “let go.” Reassure them you will be okay.
- Try to get rest during nap times. Ask friends and family to take turns at the bedside.
Supporting your loved one with comforting care creates meaningful moments during the transition.
What types of support are available during the transition period?
It is important for family members to also care for themselves during their loved one’s decline. Support and resources available can include:
- Hospice care – Hospice nurses and staff provide medical care and emotional support in the home during the end of life.
- Social workers – Assist with practical needs like funeral arrangements and provide counseling.
- Spiritual counselors – Chaplains address spiritual concerns and fulfill last rites or rituals.
- Home health aides – Help with personal care tasks like bathing and dressing under nurse supervision.
- Bereavement counselors – Specialized support for the grief process after the death occurs.
- Online/community support groups – Connect with others experiencing loss for mutual understanding.
Seeking help enables family members to focus their energy on caring for the one they love.
| Stage of Dying | Timeframe | Changes/Symptoms |
|---|---|---|
| Decline period | Weeks to months prior | Increased weakness, fatigue, weight loss |
| Pre-active dying | 2-3 weeks prior | Sleeping more, minimal interest in food/drink |
| Active dying | Typically < 1 week | Difficulty waking, breathing changes, mottling skin |
| Imminent death | Hours to minutes | Vision changes, loss of reflexes, terminal secretions |
This table outlines the typical stages and timeframe of the dying process. Being prepared for the changes ahead provides reassurance.
Conclusion
The transition period, or active dying phase, is a sacred time as a dying person prepares to pass from this world. Understanding the normal processes, expected symptoms, and ways to provide comfort allows loved ones to fully support the person during this transition. While emotionally difficult, accompanying a loved one during the final journey can bring closure and meaning. With education and compassion, families can ensure their loved one receives excellent end-of-life care.