• A transition occurs within each person, which takes them from the mental processing of death to the comprehension and belief in their own mortality.
• The body experiences a progressive process that leads to separation from the physical body.
• Death comes in its own time; in its own way.

One to Three Months

Withdrawal
As a person acknowledges that they are at the end of their life, withdrawal from the world and friends may occur. Isolation may be preferred and fewer visitors may be accepted. A person may begin to spend more time asleep during the day. “This appears to be just sleep but know that important work is going on inside at a level of which “outsiders” aren’t aware.” (Barbara Karnes, The Dying Experience, 1986)

Loss of Appetite
Hunger is no longer a physical experience. Small amounts of fluid and soft foods are preferred. Cravings may come and go but eating regular meals is no longer desired. “It is okay not to eat. A different kind of energy is needed now. A spiritual energy, not a physical one, will sustain from now on.”(Barbara Karnes, The Dying Experience, 1986)

One to Two Weeks

Mental Changes
There is usually an increase in sleep, progressive weakness and intake is minimal, limited to fluids. Arousal may be difficult and during wake time there may be confusion about people, place and time. There may be periods of restlessness or agitation.

Physical Changes
As the body begins to lose its ability to maintain itself, the blood pressure may decrease and the heart rate increases. Body temperature may fluctuate; fever may be present at times. Skin color changes; a pale yellowish pallor may accompany a bluish color in the extremities. The heart is no longer able to circulate the blood effectively.
Respiratory effort and rate fluctuate and congestion can occur as the swallowing reflex and strength weakens.

One to Two Days

There may be an increase in agitation and restlessness as circulation becomes more impaired. Breathing may become more labored and the rate accelerated to accommodate the deteriorating cardiovascular status. The person is no longer responsive to his environment.

The separation becomes complete when breathing stops.

If hospice staff is not present at the time of death, please call the office and staff will come to assist with end of life care.