SIGNS OF APPROACHING DEATH

By William Lamers, M.D.
Medical Consultant, Hospice Foundation of America

Note: This is a general picture. It will vary greatly according to the cause of death, the person's general health, medications and any other significant factors. 

• The most obvious sign is a generalized decrease in activity: less movement, less communication, less interest in the surroundings, and diminished interest in food and water. 
• Body temperature lowers by a degree or more. 
• Blood pressure begins to fall, gradually. 
• Circulation to the extremities is diminished so that the hands and feet begin to feel cool compared to the rest of the body. 
• Breathing changes from a normal rate and rhythm into a new pattern of several rapid exchanges of air followed by a period of no respiration. (This is known as Cheyne-Stokes respiration, named after the person who first described it.)
• Skin color changes from normal to a duller, darker, grayish hue. 
• The fingernail beds become bluish rather than the normal pink. 
• Verbalization (speaking) decreases. 
• The person ceases to respond to questioning and no longer spontaneously speaks. 
• Coma ensues and may last from minutes to hours before death occurs. 

A person in a coma may still hear what is said even when he or she no longer seems to respond to verbal or even painful stimuli. Those who are nearby should always act as if the person is aware of what is going on and is able to hear and understand. 

The person's state of consciousness may also change as changes occur in the central nervous system. The dying person may go in and out of lower level of consciousness and experience sensory changes. The following definitions can be helpful: