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The dying process is a natural slowing down of physical and mental processes. No one can predict the exact time of death. Some patients seem to know when death will occur. Death prediction is affected by the disease, and patient's will to live. Signs and symptoms of the dying process only serve as a guidelines. Not all patients experience all symptoms, and the signs and symptoms do not necessarily occur in sequence. Signs and symptoms can occur days, even weeks before the death, or may be present only hours/minutes prior to death.

What are psychological and spiritual symptoms occur at end of life?

  1. Fear of the dying process;
  2. Fear of abandonment;
  3. Fear of the unknown;
  4. Nearing death awareness;
  5. Withdrawal from family, friends and/or caregivers;
  6. Increased focus on spiritual issues.
What physical symptoms occur at end of life?
  1. Confusion, disorientation, delirium;
  2. Weakness and fatigue;
  3. Increased drowsiness, sleeping and decreased responsiveness;
  4. Decreased oral intake - The family may be concerned that the patient will "starve to death." Our society is one where nutrition is equated with caring. But there are some pros and cons of dehydration that should be considered before making choices. Consult your doctor or nurse if there are concerns about food intake.
  5. Decreased or lack of swallow reflex;
  6. Surges of energy;
  7. Restlessness and/or agitation;
  8. Fever;
  9. Change in bowel movement including constipation or diarrhea.
What are the universal symptoms of imminent death?
  1. Decreased urine output;
  2. Cold and mottled extremities;
  3. Vital sign changes;
  4. Respiratory congestion including respiratory bubbling;
  5. Breathing pattern changes.
How to deal with a child at a terminal stage?

Children usually know they have a terminal illness even if they are not directly given this information. Children can usually detect subtle changes in the way staff and family members react to them, care for them and talk to them. Some children do not want to talk about the disease, but want to know that someone is available to listen if they choose to talk. But they should talk to the child at his/her level of understanding. A child may let the family members or caregivers know he/she is finished talking by walking away, moving away to play, changing the subject, changing body posture and/or other non-verbal cues that signify withdrawal. Often, presence is the most powerful intervention for both children and their families. Parents should be encouraged to care for the child and include other children in care. Encourage life review. Siblings should be assessed as they are often forgotten as parents focus on the dying child.

How to deal with a dying older adult?

Factors that positively influence the elder facing their own mortality.

  1. Philosophically accepting of what life has to offer;
  2. Numerous encounters with death and learning to cope with it;
  3. Personal loss of parents, friends, spouse or children;
  4. Perceiving death as developmentally appropriate;
  5. Support from religious beliefs and the concept of life after death.
Factors that negatively impact acceptance of death.
  1. Multiple losses in rapid succession, leaving the elder emotionally exhausted;
  2. Ceath of significant other, resulting in fewer support people;
  3. Social assumption (incorrect) that elders easily accept death.
For more information e-mail lifeend@msu.edu or call (517-432-5511) End Of Life Research Center at Michigan State University.