Signs of dying: how to recognize impending death?

Each dying process is individual and varies in duration and severity. Nevertheless, there are some signs that life is coming to an end and death is imminent.

When dying, the functions of the organs cease, which eventually leads to death. This process of dying, i.e. the decline of bodily functions, does not happen from one minute to the next, but can take several hours and days, so there is no fixed point in time.

In many cases there are external signs and physical changes, so-called signs of death, which can indicate an imminent death. The various stages of dying that the body goes through in the last hours before death often include falling blood pressure, restlessness, increased sleepiness, and a decrease in hunger and thirst, among others. A further, clearly perceptible sign is the so-called changed breathing, the so-called rattling breathing – due to restrictions of the respiratory tract because of mucus, which the deceased can no longer cough up, there is a rattling or stertorous breathing, whereby the breath usually also goes shallowly and irregularly.

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The stages of death

The medicine divides the dying process of humans, who are not taken directly from the life, but die from an illness or other physical damage, into the three following phases.

Rehabilitation phase

In this phase, the disease progresses and the sick person becomes partially dependent on care, but he or she can still live self-determined and largely independently. Sometimes the dying person also recovers from some acute symptoms of illness. In the rehabilitation phase, the expected lifespan is a few months; in rare cases, the phase extends for years.

Terminal phase

Terminal phase refers to the phase when the disease is already advanced and the patient has a poor prognosis for recovery. The person becomes increasingly weaker and physically declines. He is extremely weakened, dependent on the care and support of others. The immune system visibly declines and some people are temporarily disoriented. Already, many become less interested in eating and their surroundings. If many or even all of the following symptoms are observed in the ill person, the probability is very high that he is in the terminal phase and will die in the next six months.

  • Limited mobility, bedriddenness, and extreme weakness
  • Restlessness, confusion and disorientation
  • dependent on significantly more care and support
  • Anxiety
  • Shortness of breath
  • Nausea and constipation
  • Lack of concentration
  • Loss of appetite
  • Decreasing interest in the surroundings
  • Incontinence

Dying process – Frequently asked questions

There is no one-size-fits-all answer to this question – each phase of dying can take a different amount of time. The natural dying process begins a few weeks before death, during which the person becomes weaker and more tired. A few days before the end, the dying person loses interest in his surroundings and food intake. The final phase, the last days and hours are characterized by slow organ failure.

Rattled breathing, also called death rattling, refers to the noisy breathing that begins in dying people hours or even days before death. The dying person is no longer able to swallow saliva and cough up mucus, resulting in rattling and rustling breathing.

Once the final phase of the dying process has begun, it can no longer be stopped. However, most people come to terms with the impending death in this last phase of their lives and are relatively relaxed about the end.

The first death spots – the reddish-blue discoloration of the skin – appear 20 to 30 minutes after cardiac arrest. Rigor mortis, on the other hand, does not set in until several hours after death. After one to two hours, the facial muscles freeze, and after six to twelve hours the entire body is rigid. After 24 to 48 hours, rigor mortis resolves itself again.

Final phase

The final phase or the actual dying process begins a few days or only a few hours before death – the physical dying process begins.

The physical dying process

A first sign of the beginning of the dying process may be that the person speaks very little and begins to sleep a lot. The body gradually reduces metabolism and feelings of hunger and thirst cease. This slow drying out of the body is a prerequisite for the release of further pain-relieving substances in the brain. The blood circulation worsens and the body temperature drops.

In the dying phase, breathing becomes shallower and irregular. In the advanced stage, a rattling of the lungs is added. The dying person can neither cough nor swallow, and mucus accumulates in the throat and bronchial tubes. While these sounds are often frightening to the family members present, it is not a great distress to the dying person.

The face of a dying person also changes. Often it can be observed how this becomes more pointed shortly before death. Due to the worsening blood circulation and the slackening muscles, the eyes and cheeks sink in and thus change the face. The skin around the mouth and nose becomes particularly pale during this stage of dying. This white "death triangle" is a typical sign of imminent death.

Decreasing blood flow in the body

Similarly, hands and feet become less well supplied with blood as the body focuses on the major organs inside the body – lungs, heart and brain. As a result, the extremities become cold and gradually turn blue. Dark spots may also form due to decreased blood flow.

Gradually, brain function declines and the dying person’s consciousness decreases. In the last phase of dying, the dying person often turns inward and perceives their environment only poorly or not at all. People may also become very restless, wiggle their feet or make erratic movements during the last hours before they die.

Download free checklist for the event of death

When a person first encounters death, it can quickly become overwhelming. We have summarized our experience and knowledge for you and provide you with a step-by-step guide with this checklist for the case of death.

In addition to the external signs of death, crucial processes also take place inside the body. Gradually, the internal organs also stop functioning. In addition to the digestive organs, the kidneys and liver also stop working, toxins can no longer be excreted and lead to a slow poisoning of the body. This may result in fatigue, impaired perception or nausea.

When dying, the heartbeat also decreases and becomes irregular. When the heart finally stops completely, the cells of the body are no longer supplied with oxygen and after a few minutes the brain cells die. The person is dead.

Facilitate the dying process

If a loved one is dying, it is important for many people to accompany the dying person on the last part of his or her journey and to be there for him or her. Whether the dying process takes place in a hospital, hospice, or at home, there are some things you can do for the dying person at this stage to help make the last hours of their life easier. However, you should always pay attention to the reactions and needs, as not every dying person reacts in the same way.

Do not leave the dying person alone. Many people find comfort and reassurance in being surrounded by people holding their hand, talking to them or stroking them shortly before they die – even when they are no longer conscious. Again, pay attention to how the dying person reacts to your touch – not everyone finds physical contact and tenderness pleasant. If the dying person is still able to speak, hold your ear close to their face to better understand them. This way, the dying person does not have to strain too much to speak in a loud voice.

When a person is dying, the extremities cool down. To make the dying person feel more comfortable, you can warm their feet and hands with a blanket. Comfortable positioning can also contribute to relaxation. Repositioning can now also be restricted or stopped altogether. Pay attention to whether the dying person expresses pain – this may be relieved by appropriate medication in consultation with a doctor.

Some people are afraid of the impending death. In these cases, it can help to talk reassuringly to the dying person. Quiet music in the background can also have a soothing effect.

Dying people usually no longer feel hungry and usually refuse to take in liquids and food. Therefore, do not force him to eat or drink. Food slows down the dying process at this stage. To prevent the mouth from drying out completely, you can still offer it a little liquid or at least moisten the lips a bit. Also mouth care can prevent dehydration and associated pain.

For some dying people, it is easier to say goodbye to life and let go when they are alone. Therefore, it happens again and again that they die in the moment when the present relatives or friends have left the room. Give the dying therefore in between again and again sufficient rest and make sure that no unrest develops by too many present ones.

If the dying person has wished for religious or pastoral care or other rituals, these should be made possible and carried out.

It is never too early to start planning for a funeral!

Already when the imminent death announces itself and the first signs point to the approaching end, wishes for the funeral can be specified in arrangement with the dying one.

Living will helps with decisions

If a living will is available in which the dying person has recorded his or her wishes, these should be taken into account in the dying process. Ideally, all details concerning medical assistance should be regulated in it. If the dying person still wishes to be hospitalized for medical care, does he or she want artificial nutrition or ventilation, or does he or she only want to receive medication for pain? If these wishes have already been recorded in a living will, this makes it easier for the surviving relatives to make the difficult decisions and ensures that the dying person goes his or her last way with dignity and according to his or her wishes.

Important when accompanying a dying person on their last journey of life: do not overwhelm yourself. After death, it’s usually very comforting to have been there for the dying person – but don’t overburden yourself emotionally. It is okay to withdraw even temporarily during the dying process or to get help after death to process what you have experienced.

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