What signs are there that the end is near?

Loveher asked...

My mom is in hospice right now because she has an artery closing up. She has congestive heart failure and two aneurysms that are inoperable. She is 89 years-old. Are there symptoms of the closing to look for? Every time she has a stomach ache or a pain, my first thought is of the two aneurysms. What will be signs that the end is near? Thank You.

Expert Answer

Audrey Wuerl, RN, BSN, PHN, is education coordinator for Hospice of San Joaquin in California. She is also a geriatric trainer for the End-of-Life Nursing Education Consortium (ELNEC), which promotes education in geriatric nursing and end-of-life care.

Frequently, families ask what to expect when the end is near for their loved one. You mention that your mother has congestive heart disease, a condition that is defined as the inability of the heart to supply adequate pressure and volume to important organs of the body, the most important being the heart itself. While this disease begins in either the right or left side of the heart, eventually both sides will become affected.

Usually, there is a lot of fluid retention that can cause swelling of the lower extremeties, or in the lungs. There can be difficulty breathing, much fatigue, as well as numerous other signs and symptoms. Since, your mother has other conditions such as the aneurysms, I will address the things we see as people near death that can be applied to the dying process in general.

Physical signs that death is near include changes in the mental status like increased periods of sleeping, decreased consciousness, and physical withdrawal. The urine can become more concentrated, the skin may feel cool, breathing becomes more difficult, and the person becomes incontinent of urine and/or bowels.

Breathing changes can occur; regular breathing may become irregular with periods of shallow breaths and also periods of 5 to 30 seconds of no breathing, up to 1 minute, which is known as Cheyne-Stokes breathing. You may hear wet, noisy breathing which can be alliviated by repositioning and by special medications that help decrease the secretions. Usually apnea, which is defined as no breathing, occurs for short periods and becomes longer as death approaches.

If your mother is not having pain at this time, she may not experience pain as death draws near. If she is having pain, her medications to help relieve it should be continued. Overall, managing her symptoms, and pain if present, should be the goal now.

Trying to enjoy this time with your mother, concentrating on what she can still do, is most important now. The hospice team will assist you in caring for her and keeping her comfortable. That is what we mean by comfort care. Our entire philosophy centers around a peaceful life closure with dignity and respect.