This information is sourced from Dr Kathryn Mannix
Eating and drinking
In the last days of life the person’s appetite and thirst is likely to be much reduced. Families and carers may be concerned about the effects of reduced food intake or dehydration but this is a natural and expected part of the dying process. The body is slowing down, and if someone eats or drinks more than they really need it can cause them discomfort. More care is needed with swallowing and soft food is a little safer.
Please see: Eating and drinking towards the end of life: Information for carers for more information and practical tips
Breathing
As a person’s body shuts down, it is normal that their breathing becomes shallower often with long pauses between breaths. Sometimes this alternates with rapid breathing. Both are normal and not a sign of distress or suffocation.
Sometimes the person’s breathing may become irregular and noisy. This is likely to be because they are not able to swallow their saliva, which can cause a rattling sound. Whilst the sound may be unsettling it does not usually cause distress. If there is distress then small doses of medicines to dry the secretions, or to deepen sleep may help.
Tiredness, sleep and consciousness
As time goes by the person will spend more time sleeping, often very deeply. Some people become completely unconscious for a period of time - this could be short, or as long as several days.
Changes in complexion and temperature
The person’s skin may feel cold and change colour. Their hands, feet, ears and nose may feel cold to the touch due to reduced circulation in the final hours. Occasionally, a person’s hands or other parts of the body may swell and their skin may also become mottled or uneven in colour as their circulation slows down.
Confusion and Agitation
In the last few days some people become more restless and agitated. They may hallucinate, and see or hear people or things that are not actually there which can be distressing to watch.
Simple things like favourite music, familiar voices, lavender oil on the pillow may help but there is also medication that may help a person to settle. There are some oral options that may help (to avoid injections), even in a very sleepy patient. The Palliative Care Team can advise.Loss of bodily functions
The person may lose control of their bladder or bowels. This happens because the muscles in these areas relax and don’t work as well as they did. They may also have fewer bowel movements as they eat less, and their urine may get darker as they drink less. There are many practical ways that nurses can advise on how to manage this to help retain dignity.
The Hospice in the Weald guide on the Last Days and Hours has more detail.
Dr Kathryn Mannix is a hugely experienced palliative care doctor and author, and she speaks in this video below about the process of ordinary dying and what patients and families can expect.