Coping with dying

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					                                       The changes which occur
                                                 before death
                                        The dying process is unique to each
                                        person but in most cases, there are
                                        common characteristics or changes
                                        which help to indicate that a person
                                        is dying.
                                        Any one of these signs can be
                                        attributed to something other than
Loved ones may find it easier to        dying, so remember that the events
support each other if they know what    to be described here are happening
                                        to a person whose illness is already
may happen during this sad and
                                        so severe that life is threatened.
challenging time.
                                        The many changes which indicate that
                                        life is coming to an end fall into three   This leaflet was conceived and developed
                                                                                   by practicing palliative care nurses.
                                        main categories:
                                                                                   Irene Salmon RN, Catherine Griffiths PhD RN
                                                                                   and John Bridson BA (Hons) MSc RN
                                                                                                                                 Coping with dying
                                        1. Diminished need for food and drink

                                        2. Changes in breathing                                                                  Understanding the changes
                                                                                                                                  which occur before death
                                        3. Withdrawing from the world
                                              Diminished need for                       Changes in breathing                     Withdrawing from the world
                                                   food and drink                    People who suffer from breathlessness           ‘Withdrawal from the world’ is a gradual
                                                                                     are often concerned that they will die          process. The person will spend more
There comes a point in most people’s      Initially, as weakness develops, the
                                                                                     fighting for their breath. Yet towards          time sleeping and will often be drowsy
                                          effort of eating and drinking may
lives when death and dying are                                                       the end of life, as the body becomes            when awake.
                                          simply have become too much and at
contemplated. Perhaps we must face        this time help with feeding might be
                                                                                     less active, the demand for oxygen is
                                                                                                                                     This apparent lack of interest in one’s
our own death or that of someone                                                     actually reduced to a minimum.
                                          appreciated.                                                                               surroundings is part of a natural process
close to us, but we don’t know what       Your relative/friend will be supported
                                                                                     This may be comforting to those who             which may even be accompanied by
to expect.                                                                           have had breathing problems, as carers          feelings of tranquillity. It is certainly not
                                          to take food and fluids by mouth for
                                                                                     often remark that when a loved one is           a snub to loved ones.
                                          as long as possible.
In order to reduce the anxiety which                                                 dying their breathing is easier than it
                                                                                                                                     Eventually the person may lapse into
often comes from the unknown, this        When someone stops eating and              has been for a long time.
                                                                                                                                     unconsciousness and may remain in
leaflet describes some typical features   drinking it can be hard to accept,
                                                                                     Of course, breathing difficulties can be        this state for a surprisingly long time
                                          even when we know they are dying.
of the process of dying.                  It may be a physical sign that they are
                                                                                     made worse by feelings of anxiety. But          (in extreme cases many days) although
                                                                                     the knowledge that someone is close             for others it is shorter.
It anticipates questions you may want     not going to get better. Your
                                                                                     at hand is not only reassuring; it can be
                                          relative/friend may neither want or                                                        When death is very close (within minutes
to ask and hopefully it will encourage                                               a real help in preventing breathlessness
                                          need food and/or drink and decisions                                                       or hours) the breathing pattern may
you to seek further help and              about the use of artificial fluids (a
                                                                                     caused by anxiety.
                                                                                                                                     change again. Sometimes there are
information.                              drip) will be made in the best interests   Occasionally in the last hours of life          long pauses between breaths, or the
                                          of your relative/friends for this          there can be a noisy rattle to the              abdominal muscles (tummy) will take
                                          moment in time. This decision will be      breathing. This is due to a build up of         over the work – the abdomen rises and
                                          explained to you and reviewed              mucus in the chest, which the person            falls instead of the chest. If breathing
                                          regularly.                                 is no longer able to cough up.                  appears laboured, remember that this
                                                                                     Medication may be used to reduce this           is more distressing to you than it is to
                                          Try not to be discouraged if there is
                                                                                     and changes of position may also help.          the person dying.
                                          little response – this may be due to
                                          weakness, not lack of appreciation.        These measures may have limited                 The skin can become pale and moist
                                          Simply being together can be a great       success, but while this noisy breathing         and slightly cool prior to death. Most
                                          comfort to both of you.                    is upsetting to carers it doesn’t appear        people do not rouse from sleep, but
                                                                                     to distress the dying person.                   die peacefully, comfortably and quietly.
                                          Most importantly, being cared for in
                                          this way enables people to feel that       If the person is breathing through the          This is a difficult and painful time for
                                          their lives have been worthwhile and       mouth, the lips and mouth become dry.           you. You are leaving those you love or
                                          that they will be remembered.              Moistening the mouth with a damp                losing someone you love and care for.
                                                                                     sponge and applying lip salve will give         It is often hard to know what to say to
                                                                                     comfort.                                        each other at a time like this.
                                                                                                                                     Nurses, doctors and other staff are there
                                                                                                                                     to help you to work through your worries
                                                                                                                                     and concerns and to offer you care and

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