Indicators that suggest death is approaching
Abernethy, 2005Ellershaw, 2003
Recognising when death is approaching is an important clinical skill; it allows patients and their families and carers to prepare, and the healthcare team to plan and provide optimal care for the last days of life.
Healthcare professionals need to recognise and acknowledge when a patient is deteriorating and likely to die within days, and communicate this clearly to the patient and their family and carers (if they wish to know this information—see Communicating with and supporting patients with palliative care needs).
A period of deterioration (deteriorating phase) usually occurs in the weeks leading up to the last days of life, but the duration can vary widely; Common illness trajectories for people approaching death shows common illness trajectories for people approaching death. Indicators that suggest an impending transition to the last days of life include:
- accelerating progress of disease (eg further enlargement of a solid tumour, progressive weight loss, increasing oedema, worsening symptoms, blood transfusions having little effect)
- progressive loss of strength and energy leading to the patient spending the majority of time in bed; even getting to the bathroom becomes exhausting
- increasing periods of sleep
- the patient becoming less interested in food and drink; oral intake consists mainly of fluids.
The last days of life (terminal phase) is when the patient is actively dying and continues to deteriorate despite optimal careAustralian Commission on Safety and Quality in Health Care (ACSQHC), 2015. The patient:
- is totally bed-bound and requires extensive nursing care by professionals and/or family (ie an Australia-modified Karnofsky Performance Status [AKPS] scale score of 20 or less1)
- is poorly responsive or unconscious with limited response to verbal or physical stimuli (eg no longer responding to voices)
- is unable to swallow
- may have reduced or no urine output
- may undergo changes in their breathing pattern
- may show signs of peripheral shutdown (eg pale or mottled skin, cold hands and feet) in the last hours of life.