Signs That Someone May Be Dying

How to Tell When Death is Nearing

Many times caregivers for the dying want to know what signs they can look for that hint at approaching death. Although there is no absolute progression of stages that the dying go through, there are some signs that you can watch for to know that death is near. There are two main phases that the dying go through prior to actual death. The first stage is called the pre-active phase of dying and the second phase is called the active phase of dying. It is important to understand that not all patients will clearly exhibit these stages --this is just a guideline. The signs that the dying person exhibits will be heavily dependent on the nature of the illness or physical condition of the patient. The pre-active phase of dying may last weeks or months, while the active phase of dying is much shorter and lasts only a few days, or in some cases a couple of weeks.

Signs of Dying -- Preactive Phase

- Subject withdrawals from social activities and spends more time alone or at home.
- Subject speaks of "tying up loose ends" and may be concerned with finances - wills, trusts, insurance.
- May show a desire to speak to family and friends and make amends or catch up.
- Increased anxiety which can result in restlessness, the inability to get comfortable, confusion, agitation and nervousness.
- Loss of interest in daily activities.
- Increased inability to heal from bruises, infections or wounds.
- Loss of interest in eating or drinking.
- Increased periods of inactivity, lethargy or sleep.
- Subject may begin to speak about dying, state they are going to die or ask questions about death.
- May state that they see people who are already dead.
-Edema - the swelling of the body or extremities with fluid.
-Apnea - subject may experience periods where breathing stops for several seconds before starting again. This can happen while awake or sleeping.
-The dying may request to speak with a religious leader or show increased interest in praying or repentance.

Signs of Dying -- Active Phase

- Major changes in respiratory health buildup of fluid in the lungs, congestion, longer periods of apnea, and abnormal breathing patterns such as cycles of slow then fast breathing.
- Subject states that he or she is going to die soon.
- Difficulties swallowing liquids or the resistance of all food and drink.
- Marked changes in personality, acting wildly, severe agitation or hallucinations.
- Increased difficulty waking subject from sleeping, the inability to arouse them at all, or a coma-like state.
- Subject is unresponsive or cannot speak.
- Subject does not move for longs periods of time.
- The extremities -- hands, feet, arms and legs -- feel very cold to touch. Subject may say that they are numb or cannot felt at all.
- Mottling of the arms, legs, hands and feet giving a blue or purple splotchy appearance to the skin.
- Decrease in urination with urine darkening in color or changing colors.
- Urinary or bowel incontinence.
- A continued drop in blood pressure to 20 to 30 points below normal range or a systolic pressure below 70 with a diastolic below 50 points.
- Loss of hearing, feeling, smell, taste or sight at the final stage.

Often, the dying can sense people in the room or hear you speaking to them up to the very end. Talking to the dying can comfort even if you don't think they hear you. Your presence is felt and that can help the dying feel less afraid or alone. It is important to be supportive of the dying and loving. The Dalai Lama's book, "Advice on Dying: And Living a Better Life" states that the soul is aware of its surroundings and crying or grieving should be avoided while in the room with the dying. The goal is to provide the dying with a warm and relaxing atmosphere to die in peace and hearing their loved ones crying and depressed can cause sadness, fear or anxiety for the dying. Always have someone by the dying person's side, if possible. Friends and family members can take turns so no one person gets too tired.

Please remember that all people will not share these signs, as each person's death is as individual as they are. These signs of death are merely a guide to what may or often happens. If you suspect that death is nearing it is important to be vigilant. Death can occur very suddenly or at any time. If your loved one wants someone with them when they die, it is important to keep watch as things can progress rather quickly. Some go through few signs and die within minutes of a change being noticed. It is best not to delay or put off visiting.