The final stage of dying, known medically as active dying, is the last phase of the dying process. This stage usually begins about 2-4 weeks before death, though some sources estimate 1-3 months. It’s characterized by irreversible decline and the shutting down of major body systems. Understanding what to expect during active dying can help families and caregivers provide comfort care to their loved one in their final days of life.
What is active dying?
Active dying is the final phase of the dying process. It involves the shutting down of vital body systems as the body begins to die.
During active dying:
– The body’s systems start to fail and can no longer sustain life
– The dying person becomes increasingly weak, drowsy, and detached from their surroundings
– Appetite diminishes and vital functions like blood circulation and breathing start to slow down
The active dying phase is the body’s natural preparation for death. While difficult to witness, these changes are normal and often peaceful if the person is receiving effective end-of-life care.
How long does the active dying phase last?
The active dying phase typically lasts about 2-4 weeks but can range from a few days to several months. On average, the active dying phase tends to last:
– 2-3 weeks: This is most common. The person becomes increasingly weak and drowsy over 2-3 weeks as the body shuts down.
– 1 week or less: Sometimes active dying progresses rapidly over just several days. This may occur with sepsis or other acute health events.
– 1-3 months: In some cases, especially with cancer, the gradual decline of active dying may take 1-3 months before death occurs.
The wide timeframe reflects the individual nature of dying. The exact duration depends on the person’s health condition, disease progression, and other factors. Those who are actively dying due to a long illness may linger in the final phase for weeks or months.
Signs that indicate a person has entered active dying
Certain signs help identify when someone is transitioning into the active dying phase. These include:
– Minimal to no intake of food or fluids
– Difficulty swallowing medications or taking anything orally
– Limited ability to move around or shift positions without assistance
– Extreme fatigue and increased periods of sleep
– Confusion about time, place, or identity of people
– Spending more time sleeping and less time interacting or speaking
As death nears, the dying person will begin to withdraw more into unconsciousness. Their circulation becomes impaired, causing peripheral parts of the body to cool and turn bluish in color. Breathing patterns also change, often becoming irregular with periods of apnea (stopped breathing).
What happens in the body during active dying?
The body undergoes many changes as it prepares to die. Here is an overview of what happens in the major body systems:
Cardiovascular system
– Blood pressure drops
– Pulse becomes irregular and may slow or speed up
– Breathing can fluctuate between very fast and very slow
– Skin loses color and becomes mottled and cool to the touch
– Lips or nails may turn blue or purple
– Legs swell as circulation slows
Respiratory system
– Breathing patterns change, with periods of rapid shallow breaths followed by no breathing (apnea)
– Secretions build up in the back of the throat causing a gurgling or rattling sound when breathing
– Oxygen levels fall, but the dying person does not appear short of breath or in respiratory distress
Nervous system
– The person becomes drowsy, drifted, and detached from their surroundings
– There may be confusion about time, place, or identity of people
– Eyes are open less often and for shorter periods
– There are longer pauses between breaths
Digestive system
– Appetite is poor to nonexistent
– Swallowing becomes difficult then impossible as muscles weaken
– Urine output decreases and may become dark colored
– Bowel movements become less frequent and softer
As death nears, the body temperature lowers, breathing pauses become longer, and the heart rate weakens.quiet, withdrawal from surroundings
How death finally occurs
In the final hours before death, breathing becomes extremely shallow until it eventually stops entirely. The heart rate slows into intermittent beats followed by no pulse. Eyes open less frequently until they remain closed permanently. The exact moment of death occurs when both breathing and heartbeat cease altogether.
Death is medically defined as the permanent lack of cerebral function (brain activity) along with loss of circulatory and respiratory function. These physiological events signify that the person’s life has ended.
Providing comfort in the final stage
Active dying can be an emotionally intense time for both the dying person and loved ones providing care and comfort. Some strategies that may help include:
– Keep speaking in a soothing tone and saying comforting words
– Use gentle touch like holding hands or giving massages
– Play soft, peaceful music if desired by the dying person
– Limit noise and distractions to create a restful setting
– Keep lips moistened with a moistened swab
– Use blankets to maintain normal body temperature
– Position the person comfortably avoiding pressure sores
– Use medications as prescribed to manage pain, anxiety, nausea or other symptoms
The focus is on keeping the dying person as comfortable as possible until death comes gently and peacefully. This helps ensure their last days are spent with dignity surrounded by loved ones.
Emotional and spiritual end-of-life needs
In addition to physical comfort, supporting the dying person’s emotional and spiritual needs is crucial. Steps families can take include:
– Offer reassurance that you will be present and they will not be alone
– Share memories, stories, laughter, and anything meaningful to the person
– Allow time for goodbyes and closure in relationships
– Respect spiritual or religious rituals the person wishes to observe
– Help the person feel they lived a meaningful life and will be remembered
Meeting these needs provides solace and eases emotional anguish. This helps the dying achieve a sense of life completion and acceptance as they prepare to die.
Signs death has occurred
The following are signs that indicate death has definitively occurred:
– No breathing for at least a couple minutes
– No detectable pulse
– No heart sounds upon listening to the chest with a stethoscope
– Skin color becomes very pale, waxy, or grey
– Eyes fixed in one direction, half open
– Loss of muscle tone causing facial droop
– Body becomes cooler to the touch
Once these criteria are met, a physician can officially pronounce death along with the time. After death is pronounced, nothing further needs to be done except transferring the deceased to a mortuary or funeral home. There is no urgency required at that point.
Understanding the duration
Active dying signals the final 2-4 weeks of life, but the actual duration depends on the individual. For those with terminal diagnoses, families can help by:
– Discussing wishes for end-of-life care
– Ensuring comfort-focused treatment during active dying
– Getting affairs in order once decline begins
– Spending time together sharing, reminiscing, and saying goodbyes
– Following cultural and spiritual rituals that bring meaning
While losing a loved one is painful, understanding what to expect during active dying helps families provide the best care until a peaceful death arrives. The final weeks of life become a time of closure and final goodbyes. Staying Proactive ensures you’ll be fully present as your loved one’s life comes to its natural close.
Conclusion
The final stage of dying, known as active dying, is a distinct phase that precedes death. It involves the shutting down of vital bodily functions as the body prepares to die. This active dying phase typically lasts around 2-4 weeks on average, though it can range from just a few days up to several months in some cases.
Knowing what signs indicate active dying is underway helps families and caregivers prepare. They can then focus on keeping their loved one as comfortable as possible until death arrives. Providing physical comforts, emotional reassurance, and spiritual support creates the best conditions for a peaceful ending. Understanding the process guides families in fully embracing the time left to share love, complete closure, and say meaningful goodbyes. Though difficult, the precious final days with a loved one can provide comfort and meaning that sustains people through the grieving ahead.