Although every death is as individual as every life, knowing a few common experiences can help families endure the decline and prepare for this passing from life. Although it is hard to predict the exact time, certain changes in health and behavior can help give an idea. Jordan McLaughlin, a registered nurse, helped take care of her grandmother for the last five years of her life. “About a year before she passed,” said McLaughlin, “everything became harder, slower, took more time, she ate less, she drank less and she could help herself less.” 

Activities are often avoided as death nears. Where once a daily shower was a part of everyday life, her grandmother struggled to do this basic chore. She required some assistance to do it well and as she declined, had to be supported to avoid falling. Sometimes the twice weekly shower would take all the energy she had for the day. Refusing physical therapy and avoiding most activities and sometimes not even getting out of bed for the day became the norm.

“It was interesting watching the things that used to bring her joy change,” said McLaughlin. “She didn’t really feel like her chocolate milk, or she didn’t want to eat bacon anymore, even though she used to really love those things.” She didn’t even like Coke anymore, which was her go-to drink for decades. The physical system just slowly slows down and eventually it stops altogether. The goal is not to force food at this point, but rather honor what the older adult wants. Often swallowing can become difficult, so food is not desired. Discontinuing pills that must be swallowed and choosing absorb-in-the-mouth options for the most needed drugs may be an option.

As death approaches the core body temperature can reduce by one or more degrees, or a fever can develop. “She loved her heated blanket because her body didn’t keep her warm anymore,” said McLauglin. “She wanted her heated blanket turned on all the time.” Blood Pressure and heart rate may also gradually decrease, becoming quite low in the final days and hours of life. 

Look out for signs of pain in older adults. Arthritis and other injuries may begin to ache more. It can be painful to do simple things, like stand. “She was wiggly,” said McLaughlin. “Her hips and knees would hurt and become weaker and she might buckle and threaten to fall over.” Giving pain meds can be comforting and liquid meds that absorb in the mouth are available.

Not only does breathing slow but it also takes on a new pattern. Rather than breathing at a regular rate, rapid breathing can be followed by longer and longer periods of no breath. As the ability to swallow decreases, the breathing becomes noisier as it is forced through the building congestion. McLaughlin thinks this is a really hard stage because she really wants to help, but recognize it is out or her hands and part of the final dance. 

An older adult may become confused as they near death seeing and believing things that are not reality. They may become agitated by these fraught situations. Medications are available for this agitation. Eventually, the older adult becomes less conscious, responding only occasionally until they are no longer speaking. Hearing is one of the last senses to fade. “It was good for family to be there,” said McLaughlin. “I think it’s comforting to not be doing all the scary stuffy by yourself. It’s just a good time to be with your loved one and heaven just feels really close.”