End-of-Life Signs & Symptoms
It’s About Life
by Betsy Murphy , FNP, CHPN
Only 10 percent of Americans will die suddenly. The remainder of us (90 percent) will decline slowly, growing weaker until we die. Because this process is so gradual, we often don’t recognize that a loved one is approaching the final weeks of life. This may be why most Americans, around 80 percent, die in institutions, despite the fact that most Americans polled (85 percent) voice that they want to die at home. Perhaps the reason could be that we simply do not see it coming.
Well-thought-out preparation, on the other hand, will allow us to choose where death will occur, participate more fully in our loved one’s care, make better decisions and achieve a measure of control over the coming months. We will feel peaceful despite living with uncertainty. In the future, after our loved one has died, we will reflect back on these final months, and be left with the deep comfort that comes from knowing that we did our best for someone we love at a very difficult time.
So what are the signs that an elderly person may be approaching the final months of life?
Confusion and Delirium
As the time of death approaches, your patient may exhibit increased restlessness and/or repetitive actions, such as pulling at bed linens or repeatedly reaching for something in the air that is not visible to anyone else but the patient. This is sometimes referred to as “terminal anxiety.” You may also observe increased confusion as your patient is closer to death.
Changes in Breathing Pattern
Breathing patterns change often for patients approaching death. It may be accompanied by an individual’s inability to clear airway secretions which can sound very distressing like a “rattle” due to patient’s inability to clear his or her own saliva. Studies have shown that this “rattle” like breathing although very discomforting to hear for caretakers, family and friends may not be distressing to the patient. Patients breathing may vary from being normal to short and long periods of apnea (no breathing for several seconds–even up to 1 and 1/2 minutes) to rapid and shallow breathing to 40 breaths/min when an adult usually takes about 12-16 breaths per minute. These are within normal changes of breathing patterns for someone approaching death.
Withdrawal & Decreased Socialization
Decreased socialization often occurs at this time, so patients may become more quiet and withdrawn. This may be seen weeks or sometimes few months before death. Your patient may be trying to detach himself from his surroundings and those around him in order to “let go.” This progression of behavior is not exclusive to Vaishnavas and seems to occur in many patients no matter what spiritual or religious affiliation they adhere to. Your patient may indicate a desire to be alone more often or ask to see only a few people. Reassure family and friends that being one of the people he requests to see is, quite often, an indication of who he needs support from at this particular time and not necessarily a sign of who he loves or appreciates the most. It may also be someone the patient needs to see in order to reach an emotional closure. (The Final Journey, pg 188)
Decreased Eating & Drinking
Nutrition and hydration is what keeps us alive, as we say “Keeping the body and soul together.” This same amount of intake is not needed by the “dying” — to the degree it is mandatory for the living. Offering healthy, desired prasadam (sanctified food) and accepting it is one of the six loving exchanges among Vaishnavas. This principle also brings a beautiful interaction between the patient and the caregiver until the patient’s body starts to not “need” it due to bodily systems slowing down and deteriorating and not being able to use the nutrition for its purpose which is to “grow and sustain.” Often nothing tastes good to the terminally ill patient and the cravings come and go. Eating and drinking, therefore, is naturally decreased by the patient at the end of life. This is often the most difficult time for the patient’s loved ones who feel their family member is “starving.”
Incontinence is the inability of the body to control the evacuative functions of urination or defecation. This occurs as the bladder and bowels relax toward the last stages of life.
With decreased eating and drinking body conserves the limited energy it has and blood circulation through kidneys decrease resulting in decreased and darker colored urine, at times with a strong odor.
On a daily basis, the body makes about 8 liters of gastric and intestinal juices most of which is re-absorbed by the body in the process of digestion and assimilation of food, some of it is still eliminated as the bowels empty– even in a person not on oral intake. Therefore, in spite of decreased eating and drinking in a terminally ill patient, the body continues to produce some stool almost until the last days. But this function also decreases as the individual’s body prepares for death so decreased amounts of urine and stool and at times no elimination at all closer to death are all normal variants.
What Do We Owe Our Fellow Vaishnavas?
The Final Journey — Complete Hospice Care For Departing Vaishnavas (By Sangita Devi Dasi, RN, Hospice Educator (To order your copy, visit our “Store”on this website.)
As devotees of Lord Krishna, we are well aware that this material body is temporary and that the soul, the real “self” is eternal. Yet, if diagnosed with a terminal illness, each of us stands at varying places on the spiritual path and each of us will initially react differently to the news that we will soon be passing away. Our hope is that all of the devotees in our Krishna consciousness movement will receive the kindness and love they deserve from their fellow congregational members, whether they are senior devotees or someone who has just joined a temple. Our hope and prayer is that each Vaishnava will be well cared for and spiritually supported by the loving devotees in their community.
It is suggested that each terminally ill devotee should be guided to a nearby hospice agency for the end-of-life, medical help that is required. In addition, we suggest that you organize a group of devotees (a “Vaishnavas CARE Team”) who are enthusiastic to participate in the devotee’s spiritual, emotional and practical care.
Please watch this video below entitled, “Palliative Care vs. Hospice Care: How Do They Differ?”