Coping With Dying

Information for patients and those important to the patient

We want the person at the end of their life and those important to them to receive the best quality care, tailored to their wishes and preferences.

If the patient has designated a Lasting Power of Attorney or written an Advance Decision to Refuse Treatment or an Advance Care Plan, please inform the team looking after your next of kin.

This page describes some of the physical and emotional changes that happen when someone is in their expected last days and hours of life.

It covers some of the questions you may want to ask about what is happening and why. It also encourages you to ask for further help or information if there is anything at all that is worrying you.

The dying process is unique to each individual. Yet in most cases, there are common characteristics or changes that occur when a person is dying.

These fall into four main categories:

• Reduced need for food and drink
• Withdrawing from the world
• Changes in breathing
• Changes which occur before death

1. Reduced need for food and drink

When someone is in their expected last days and hours of life, their body no longer has the same need for food and drink as before. The body’s metabolism slows down, and the body cannot digest the food so well or take up the goodness from it. People stop drinking, and although their mouth may look dry, it is not a sign that they are dehydrated. Moistening the mouth and applying a gel will give comfort. You can participate in this if you wish to. It is understandable for someone to want to see their loved one eating well. It is often hard to understand the person no longer wishes to eat or is unable to do so. Family/carers may wish to offer small amounts of favourite tastes or sips of drinks. However, it is important not to burden people if they do not want or are unable to eat and drink.

It can be hard to accept these changes, even when you know the person is dying. It is a physical sign that they are not going to get better. Even so, you can show that you care about your loved one by spending time with them and giving comfort through your presence.

2. Withdrawing from the world

For most, the process of ‘withdrawal from the world’ is a gradual one. People spend more time asleep. When they are awake, they might seem sleepy or show less interest in what is going on around them. Feelings of calmness and tranquillity can accompany this natural process. At this stage, it is possible that a dying person may still be able to hear, so talking to your loved one is important; your voice is a familiar sound.

3. Changes in breathing

As someone nears the end of their life, the body becomes less active, and the need for oxygen is much less. People who suffer from shortness of breath are often concerned that they may die fighting for breath. However, there is medication available which helps to ease this.

Feelings of anxiety can make breathing problems worse. The knowledge that someone is close at hand is not only reassuring; it can be a real help in preventing shortness of breath caused by anxiety. Sitting quietly and holding your loved one’s hand can make a difference.

In the last hours of life, you may hear a noisy rattle at the back of the throat/mouth. This happens because they cannot clear spit or mucus from their mouth or chest by swallowing or coughing, creating a buildup. This often indicates that the person is sleepy and quite relaxed. Medication may reduce it, and changes of position can also help. The noisy breathing can be an upsetting sound, but it does not appear to distress the dying person.

4. Changes which occur before death

The body follows the natural process of slowing down, such as loss of energy, the need for more sleep and rest, and reduced appetite.

When death is close (within minutes or hours), the breathing pattern may change again. There may be long pauses between breaths, or the abdominal muscles (tummy) will take over the work. As a result, the abdomen (tummy) rises and falls instead of the chest. If breathing appears hard, remember that this is more distressing to you than it is to the person dying.

The skin can become pale, moist, and slightly cold before death.

Some people may become more restless or unsettled as death approaches. If this happens, the health care professionals will talk to you about it. They will aim to manage the pain and other symptoms with medication to help calm the person.

Often, people do not rouse from sleep, but die peacefully.

How we can help

This is likely to be a hard and painful time for you, as you lose someone you love or have cared for. It can be hard to know what to say, how to help or what to do.

Nurses, doctors and other staff are there to help you work through your worries and concerns and to offer you care and support.

We hope that you will come and talk to the staff on the ward, if there is anything on your mind.

There is a Spiritual Care team available if you would like to speak with a member. Please ask the nurse and they can request a chaplain or another spiritual care provider to visit.