On Death and Dying: The Dying Process
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 ;
Christine Kennard wrote about Alzheimer’s for HealthCentral. She has many years of experience in private and public sector nursing care homes for people with dementia. She has worked in a variety of hospital, public and private health settings and specialized in community nursing. Christine is qualified in group analytic psychotherapy, is registered in general and mental health nursing and has a Masters degree.