Are you ready… to prepare to say goodbye?

Are you ready? Every day during Dying Matters Awareness Week, we’re asking a pertinent question about preparing for end-of-life. Settling practical issues now can offer peace of mind and free up precious time to enjoy what really matters during last weeks and months.

The death of someone close is one of the most difficult experiences we are likely to encounter. We look at the physical and emotional changes that can occur as death approaches, so that you are better prepared to say goodbye.

When a loved one is dying it can be an anxious time for everyone involved. At Martlets we understand that each person’s journey towards death is unique; however, there are common themes and experiences that are often universal and knowing what to expect can be helpful.

Physical changes

The most important aspect of care when death is approaching, is to keep your loved one comfortable.

When someone is close to death, they may lose interest in what is going on around them, and become weak and tired, sleeping for long periods. Memory and concentration may be impaired and they may become confused.

It is common for the skin to become cool to the touch and, due to changes in blood circulation, the lips and nails may begin to show a bluish tinge,or appear bruised. There may be changes in bowel and bladder function, with urine passed less often and much darker in colour than usual.

The breathing may become shallow and quickened for a time, followed by a lengthy pause where it may appear that breathing has stopped altogether. After a minute or so this process starts again. Their breath may also seem to ‘rattle’, as the they no longer have the energy to cough up the saliva and mucus that naturally occur at the back of the throat. This is unlikely to distress the person who is dying and may be helped by medication, or changing their position.

As death approaches, it is likely they will no longer be interested in eating as their body no longer requires nourishment, and their mouth may become very dry. You can offer them sips of drinks and small ice chips if they can still swallow and moisten their mouth with wet sponge sticks (available from a healthcare professional); lip salve can also keep the lips comfortable.

You may also be aware that, as death draws closer, the they become more restless; repetitive movements of the hands are common. Talking calming and softly and gently stroking them can be soothing, rather than trying to stop the movements.

Emotional and spiritual changes

Hearing is often the last sense to be lost, so even if your loved one appears to be asleep and unable to communicate, continue to talk to them naturally as this can be a huge comfort to them. Talk gently – whisper in their ear if they are hard of hearing – and say everything you need to say. Let them know they are loved and will be remembered. You may want to get into bed with them and hold them close.

Some people wish to create a special atmosphere in the room that reflects the life and personality of the person who is dying – perhaps lighting candles, playing favourite music or reading poetry or prayers. If they have religious of spiritual needs they would wish to observe, ensure any personal rituals and practices are carried out. It is common for some people close to death to have visions and to appear to be conversing with loved ones who have already died. Accept what they say and offer comfort.

During a person’s final moments, their breathing will cease, their heart will stop beating and their skin will take on a lighter pallor. Their eyes will remain in a soft stare (if they are open), their jaw will relax and their mouth may fall open.

Some people die at very the moment you have stepped out of the room, after you have been sitting with you for some time, as if waiting for you to go. This can leave you with feelings of guilt and sadness, but allowing a loved one to ‘let go’ when they need to is one of the most precious gifts you may ever give them; let them know it is ok to let go without worry or regret, at a time of their choosing.

Even though you have been expecting this moment, it is still likely to come as a shock and will bring up a variety of emotions. You do not need to do anything immediately and you may want to spend some time sitting quietly with your loved one. It can be a comfort to see someone at peace, particularly if they have been through a long illness and a difficult time.

 

This information has been drawn from a collaborative leaflet published by Martlets and Sussex Community NHS Trust