LPNI Health Topic – May 2015


The Process of Dying, then Death


“Therefore, just as sin entered the world through one man, and death through sin, and in this way death came to all people, because all sinned...” Romans 5:12


We live in a death denying society; we don’t talk about it much even when we witness the occurrence of death often depending on our area of nursing. People are often so busy thinking about life unlived that even older people do not think about their own death. It was quite the opposite in tribal life.  The fact of life is that we all have to die; death is a part of life just as is birth. As we support the families of those who are dying what do we tell them? We get asked so often “How long do you think?” As nurses how do we respond?

The common signs people experience 1-2 weeks before death

Weakness and lethargy

Increased sleeping or restlessness

Progressive disorientation

Short attention span


Less interest in food and fluids




Signs that may be evident 2-3 days before death


Decreased level of awareness

Glassy eyes, unfocused pupils

Loss of interest in food and fluids

Abnormal breathing pattern

Faint blood pressure and pulse rate

Unexpected energy surges

Progressive cooling and mottling of extremities


No one can predict exactly when death will occur. The common symptoms are fatigue, pain, and shortness of breath. For some there is also confusion, anxiety, depression and nausea and/or vomiting. “Death rattle” precedes death in about 57% of cases. Loss of consciousness is about 50% in the last 6 hours before dying. From my experience even with the knowledge of these signs and symptoms, I never hazard a guess to predict a person’s death. There are very few studies that focus specifically on the family of the person who is dying. It is an area where great sensitivity and sound knowledge is needed. When we care for the dying we care for their families, too.



Coleman P.G. & O’Hanlon A. (2004). Aging and Development.


Linton A.D. & Lach H.W. (2007). Matteson and McConnell’s Gerontological Nursing: Concepts and Practice, 3rd ed.


MacKinlay E. (2006). Spiritual Growth and Care in the Fourth Age of Life.