Dear Readers,

Myrna J writes Lifeline from Montego Bay where she lives with her older sister and 86-year-old mother. Myrna is concerned that her mother has 'gone off food' for months and now seems to rest a lot these days. She is not talking much with the family either. The doctor has seen her and said that she is stable and nothing much is wrong for she doesn't even need her high blood pressure medication any more. Myrna thinks her mother is 'travelling' (preparing to die) and asks Lifeline "what are the signs to look for which indicate approaching death?"

No one can predict the moment of death for anyone as this can be influenced by several factors. In the elderly there are some typical signs which would lead physicians and nurses to expect death in the near future, but in many instances the individual is able to hold on to life in an effort to see certain goals accomplished.

Symptoms

Nevertheless, there are symptoms which are associated with the body beginning to shut down its functions. Dying in the elderly is a process which occurs over a period of time which could be days, weeks or months. The signs of approaching death are specific to the natural dying process and most people who live long enough to demise from 'old age' will experience some or all of the symptoms.

When an individual's body begins to prepare for death it begins a process of shutting down, which ends when all the physical body systems stop functioning. This is a physical process associated with a progression of physical changes in the body and is not a medical emergency requiring invasive intervention. The other process occurring at the same time is the more complex one involving emotions, and spiritual release. This refers to the individual's mental preparedness to accept coming death. Despite declining bodily functions some individuals' will hold on pending the outcome of matters which are important to them. This could be holding on to see a daughter or granddaughter birth a healthy child, or to see a marriage occur, or some other important event. Until the mind and emotions give the body permission to "travel" and 'let go' there will exist some conflict and the person does not feel free to pass on.

Often the elderly hold on to life while waiting for their relatives to accept the inevitable, for we all have to die one day. When they reach a comfortable place mentally they accept tacit permission to 'let go' and move on.

Transitioning signs

The physical signs which are associated with transitioning are:

Loss of appetite. The person may begin to refuse meals and only accept small amounts of very bland food. Meat, which is difficult to digest, is often refused first. Energy needs decline. The person should not be fed forcefully, but should be offered sips of water as well as much lighter and more easily digested foods such as clear soup and nutritional supplements.

Tires easily and is easily fatigued and drowsy. Eventually rouses from sleep with some difficulty. The person should be allowed to sleep, but it should be remembered that often the person is conscious enough to hear what is said so there is a need to be careful what is said, near the bedside.

Increased physical weakness occurs and the person should be allowed to rest comfortably.

Mental confusion may occur as organs continue to fail, including the brain. The person may call out to people already passed and whom they seem to see as the body prepares for transition. They may even become restless. Remaining calm and supportive is important.

The person may claim to have spoken to persons already dead and may see persons not visible to others. This is as a result of the person preparing to transition and detach from this life in a non- frightening way. Their experience is real to them and should be affirmed. This occurs commonly at the time of transition.

Breathing may eventually become laboured and irregular with pauses in breathing. Sometimes gurgling exhalations are heard like a chest rattle. The dying person is thought to be unaware of the type of breathing which is occurring and family and caregivers should concentrate on keeping the person comfortable. Sometimes it helps to raise the head up higher on extra pillows or turn the person on to their side to allow secretions to drain out.

As death approaches, the person may become more withdrawn although some dying individuals will surprise everyone with alertness and an ability to communicate which lasts only for a short time. A physical presence should be maintained such as talking to the person and holding their hand. Treasure alertness as this is often a very short interlude.

As the time to pass approaches the individual will pass less urine and the blood pressure may fall. This is part of the dying process as the kidneys shut down. Loss of bladder and bowel control may occur near death. The person should be kept clean and dry and dignified.

Swelling of the feet and ankles might also occur as the kidneys fail.

The fingertips and toes become cool during the hours before death as blood is withdrawn from the periphery to maintain the function of the vital organs. The person should be kept warm and comfortable. Light skin may appear mottled as death approaches due to reduced blood circulation.

Impending death

These signs of impending death vary in sequence and are a part of the natural dying process. They are normal and represent the body preparing to STOP. Let us, therefore, give comfort and support to loved ones passing through this final gateway. Death is the final culmination of the body shutting down and relatives and loved ones should prepare for the event as it approaches. This is the time to give the transitioning loved one support and comfort. The time to effect change in any real way has usually passed already. Give elderly or very ill loved ones permission to go and remove the guilt which they may feel at needing to leave. This is difficult, but often a transitioning individual will try to hold on, even in the face of real suffering in an effort to ensure that everyone is alright. The assurance that "all is well" and that the need to transition is understood is a real gift to the transitioning individual. If the loved one can say "good-bye" it allows closure and makes the final letting go peaceful. Perhaps say "I love you and I thank you". Tears are a normal part of saying goodbye and there is no need to hide them.

Write to:
LIFELINE
PO BOX 1731
KGN 8
AJM