On Death and Dying: The Dying Process

Health Professional

When people are diagnosed with Alzheimer's disease, they not only have to face living with the illness itself, they often begin to consider their death.  Both they and their family  may wonder how they will die and start to ask health care workers for more information about end of life issues.

People with Alzheimer's can die at any time of related and unrelated illnesses. On average though, the survival time from diagnosis to death, is about  eight years. Dying however, remains a personal journey, regardless of the disease. People's mental and physical deterioration will depend on many factors and will progress at different speeds.

As Alzheimer's disease progresses, cognition, memory and behavior are affected so profoundly that people with late stage Alzheimer's often do not  recognize or acknowledge they are beginning that final journey towards death. The withdrawal and separation from the world experienced by people who are dying from diseases with fewer neurological symptoms have often happened earlier in someone with Alzheimer's.

What Happens in the Months Before Death?

As death approaches people with Alzheimer's will, in general:

  • Sleep a lot more
  • Take little/no interest in their surroundings
  • Be disinterested in eating or drinking -  resulting in weight loss.
  • The dying person may actively  neglect  diet by refusing to open their mouth, or push the hand of the caregiver away.

What Happens in the Last One/Two Weeks Prior to Death?

As the person moves nearer to death they:

  • Sleep most of the time.
  • Are often more disorientated.
  • May experience hallucinations and delusions.
  • May become more agitated (picking of the sheets on their bed and clothing is quite common).
  • Interacting with others decreases and  eventually stops.

Physical Changes as the body systems fail:

  • Body temperature lowers by a degree or more.
  • Their pulse becomes irregular and can slow down or speed up and blood pressure drops.
  • As the changes to their circulatory system fails skin color changes. Their skin becomes pale. They may get blue lips as oxygen levels decrease.
  • They may perspire more.
  • Breathing becomes more labored and rapid.
  • As the lungs  become congested, breathing can sound louder and you can hear a rattling or 'bubbly' sound as they breathe in and out.

The Final Days/Hours Before Death

It is strange, but often in the last hours people who are very near death appear to rally. I've seen it often. They may speak again and move about in bed more, but this apparent increase in energy soon stops. Breathing becomes more irregular and often slower. A type of breathing called "Cheyne-Stokes" occurs, in which  rapid breaths are followed by long pauses of no breathing at all. Their chest and airway becomes congested with secretions causing loud, rattled breathing. Hands and feet may become purplish and mottled. This mottling may slowly work it's way up the arms and legs and  appear on pressure areas such as the back and buttocks. Lips  become blue or purple. The person usually becomes unresponsive and whilst eyes may be open or semi-open they do not see their surroundings.

The Moment of Death

In the final moment breathing will cease altogether and the heart stops beating. Death has occurred.

Can I help Ease The Dying Process?

You can help your loved one by:

  • Carrying out their wishes, as much as this is practicable.
  • Making them as comfortable as possible.
  • Seeking medical intervention and advice.
  • Allowing drug treatments for pain control, and the reduction of  anxiety.
  • Gentle touching.
  • Hearing is, apparently, the last sense to go. Soothing conversation and music, supportive words all help ease the transition  from life to death.

Caregiver Tips on the Dying Process

Sara has written a sharepost on the recent death of her Grandmother called Sometimes, They Are Waiting for Something  that is thought provoking.

Carol Bradley Bursack a book review called Sparking Conversation and Thought about the Dying Process

Here are two more informative shareposts ;

On Death and Dying; Causes of Death in Alzheimer's Disease

On Death and Dying: Burial and Memorial Planning