Question about when elderly are declining

R

Rose65

Well-known Member
Location
United Kingdom
I wondered if carers of the elderly develop a sixth sense almost, about when their patients are showing signs of impending natural death in advanced old age. It may seem a strange question, but there must be subtle signs, such as reduced appetite, less interest in what's going on, inability or reluctant to move.
 
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I am no expert and even though I worked in nursing homes as a CNA, what I learned based on my in-laws and my own parents was this. All four of them started talking about it being their last year. As if they knew. All four were right. In the nursing home though my residents in my group could not communicate to me.
 
Hospice nurses mention those signs, loss of appetite and listlessness. Some also say they've seen patients staring at some point in the room as though they see something there, and some of them point to "it" now and then, or wave at it, and some even say a few words to it. They say some patients tell them their mother or some other deceased relative came to visit them.

But some dying patients have what hospice calls terminal restlessness, where they yell and toss around in their bed and are very upset, and it comes and goes in waves and can last for hours or even a day or more. I suppose they don't know how long, really, because they normally sedate patients with terminal restlessness.
 
Rose65 said:
I wondered if carers of the elderly develop a sixth sense almost, about when their patients are showing signs of impending natural death in advanced old age. It may seem a strange question, but there must be subtle signs, such as reduced appetite, less interest in what's going on, inability or reluctant to move.
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@Stoppelmann are there tell tale signs you are aware of, especially if the patient is the one asking?
 
I used to care for young men with AIDS. Once when I went to visit a lovely young man, he was so happy to see me as he didn't have many visitors. He suddenly said, "I feel like taking a long walk, will you come with me"? I helped him out of his bed, and we proceeded to slowly walk down the corridor to the amazement of the nurses, because he never got out of bed. After a short walk he wanted to go back. He was exhausted. He died a couple of days later.
I was told that sometimes they are getting ready for their final trip into the unknown. A dear friend of mine was in the final stages of cancer and she wanted to put all her make-up on to make herself look good for her final journey. I think many people show signs; we just have to be aware of them.
 
Murrmurr said:
Hospice nurses mention those signs, loss of appetite and listlessness. Some also say they've seen patients staring at some point in the room as though they see something there, and some of them point to "it" now and then, or wave at it, and some even say a few words to it. They say some patients tell them their mother or some other deceased relative came to visit them.
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My MIL was staring at the wall like that. Even raised her arms way up in the air (and she could not even feed herself or scratch her face before that). By that time she was communicating with someone else not us.

My father said he saw my mother and the next day as he went into the transition period he was staring intensely at the wall. When the nurse tried to move him he got agitated keeping his face toward the wall. I felt like my mother was there in the room with us.
 
During her last days in "home hospice" my wife progressively slept more and ate and communicated less as the morphine dosages increased.

During her diminishing periods of lucid communication she primarily recalled childhood memories...not much about her memories as an adult.
 
Imogene said:
I was in my late 20’s when I had a job in the AR end of a firm that owned nine nursing homes.

It got to where I could tell when someone was on the decline and even how much time they might have left, just by not only the change in ancillaries that had been ordered, but often the dosage of certain drugs.
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Exactly.
 
Have experienced only two deaths close up and personal.
The first one was my father in law. He started begging for forgiveness the day before he died.
The second one was my mother. She had lung failure and the struggling to breathe for one day wore her out one day just laying in the hospital bed, her kidneys began to fail (dark urine) and she died the next day. The odd thing was she "died" in every way, she stopped breathing and non-responsive, except her heart. I had the stethoscope on her chest, waiting to pronounce her...and it seemed to take FOREVER.

She went from a ward up in a hospital to hospice on another floor in one day, and died that night.
They wanted know if we wanted her to go to ICU to be put on a ventilator.
Geez, 72 years old, lungs a wreck. She'd lived on oxygen for ten years. Why bother.
 
MarkD said:
@Stoppelmann are there tell tale signs you are aware of, especially if the patient is the one asking?
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Nurses are trained to recognize signs that indicate a person is nearing the end of life, allowing them to provide compassionate care and prepare the family for what to expect. Common signs include:

Physical Signs​

  1. Decreased Responsiveness: The person may become less alert, drowsy, or unresponsive, with prolonged periods of sleep.
  2. Changes in Breathing Patterns: Breaths may become irregular, with long pauses (Cheyne-Stokes breathing) or noisy (death rattle) due to the buildup of secretions.
  3. Cool Extremities: Hands, feet, and legs may feel cold or appear mottled and bluish due to reduced circulation.
  4. Weakening Pulse: The pulse may become faint, irregular, or difficult to detect as the heart weakens.
  5. Decreased Blood Pressure: Blood pressure typically drops significantly.
  6. Changes in Skin Color: Skin may appear pale, waxy, or blotchy, especially in extremities.
  7. Reduced Urine Output: As kidney function declines, there may be little to no urine output, and it may appear dark or concentrated.
  8. Loss of Appetite and Thirst: The person may stop eating or drinking altogether.
  9. Relaxation of Facial Muscles: The jaw may drop, and the face may appear slack.
  10. Fixed Gaze: The person may stare at one point or seem unable to focus.

Emotional and Psychological Signs​

  1. Restlessness or Agitation: The person may appear unsettled, picking at sheets or seeming distressed, often termed "terminal restlessness."
  2. Withdrawal: The person may disengage from conversations and social interactions, retreating inward.
  3. Visions or Hallucinations: Some may report seeing deceased loved ones or other comforting images.

Timing​

  • Weeks to Days Before Death: Appetite decreases, sleep increases, and social withdrawal may occur.
  • Days to Hours Before Death: Breathing changes, extremities become cool and mottled, and consciousness often diminishes.
  • Moments Before Death: Breathing slows, becomes irregular, and eventually stops; there is no pulse or heartbeat.
Nurses use these signs to guide conversations with family members, helping them understand the natural process and encouraging them to be present, provide comfort, and say their goodbyes.
 
Stoppelmann said:
Nurses are trained to recognize signs that indicate a person is nearing the end of life, allowing them to provide compassionate care and prepare the family for what to expect. Common signs include:

Physical Signs​

  1. Decreased Responsiveness: The person may become less alert, drowsy, or unresponsive, with prolonged periods of sleep.
  2. Changes in Breathing Patterns: Breaths may become irregular, with long pauses (Cheyne-Stokes breathing) or noisy (death rattle) due to the buildup of secretions.
  3. Cool Extremities: Hands, feet, and legs may feel cold or appear mottled and bluish due to reduced circulation.
  4. Weakening Pulse: The pulse may become faint, irregular, or difficult to detect as the heart weakens.
  5. Decreased Blood Pressure: Blood pressure typically drops significantly.
  6. Changes in Skin Color: Skin may appear pale, waxy, or blotchy, especially in extremities.
  7. Reduced Urine Output: As kidney function declines, there may be little to no urine output, and it may appear dark or concentrated.
  8. Loss of Appetite and Thirst: The person may stop eating or drinking altogether.
  9. Relaxation of Facial Muscles: The jaw may drop, and the face may appear slack.
  10. Fixed Gaze: The person may stare at one point or seem unable to focus.

Emotional and Psychological Signs​

  1. Restlessness or Agitation: The person may appear unsettled, picking at sheets or seeming distressed, often termed "terminal restlessness."
  2. Withdrawal: The person may disengage from conversations and social interactions, retreating inward.
  3. Visions or Hallucinations: Some may report seeing deceased loved ones or other comforting images.

Timing​

  • Weeks to Days Before Death: Appetite decreases, sleep increases, and social withdrawal may occur.
  • Days to Hours Before Death: Breathing changes, extremities become cool and mottled, and consciousness often diminishes.
  • Moments Before Death: Breathing slows, becomes irregular, and eventually stops; there is no pulse or heartbeat.
Nurses use these signs to guide conversations with family members, helping them understand the natural process and encouraging them to be present, provide comfort, and say their goodbyes.
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Thanks!
 
There must be times, like the examples in the previous posts, when caregivers know. The body starts shutting down. Eyes sometime get faraway, unfocused looks. But my mother was in the last stages of Alzheimer's for quite awhile, and seemed fine one week, then passed on the next week with very little perceptible change.

Also, I've heard of times when a person in the last stages of life holds on, waiting for a certain family member to come, then when that person arrives, they seem better at first, but pass on very soon afterward.

And, sometimes they need permission. My cousin's husband went thru chemo, but it didn't bring about the desired results, and he was in great pain. His wife took it as long as she could, but finally, she told him, "We've done all we could do. I'm sorry it didn't help us. It's okay if you want to just let go." Within minutes after she said that, he took his last breath. I asked her if she regretted saying that to him, and she said no; it seemed to bring him peace.
 
Talking about declining and maybe making an early diagnosis of Dementia..I've literally just been watching a documentary on tv on how to diagnose, and also the various types of dementia...and the fact that now Dementia causes twice as many deaths as cancers..

....so it's become almost a pandemic in it's widespread affect in the western world..

They have discovered that most people don't seek medical intervention until they've noticed that their lapse of memory is becoming problematic... like causing something dangerous to happen , leaving a pan to burn on the stove for example..... so it could actually be several years before they seek help, by which time little help is available.

They have discovered tho' that long before lapses in memory alert us that something is wrong , our hearing can often tell us there;s a problem,

Hearing is more attached to the brain that it is in fact to the eardrum...so in most recent AZ or dementia cases they have found that these same people had complained of hearing loss, even slight like not being able to differentiate chat in a crowded room, or having to turn the TV up much louder than would be considered normal ... as far back as 15 years before they started losing their memories..

The doctors in this documentary study, urge people to not put loss of hearing down to old age, but to ask for a dementia test from their primary doctor if they start losing their hearing in any way..
They have a very good hearing test that can tell if the brain is hearing the sounds that it's being given...

if it's discovered this far ahead long before the memory loss then they can take steps to prevent the demntia getting a good grip...

as an extra, studies have found that those with hearing loss already.. who wear aids.. hearing aid wearers, have a 50 % less risk of cognitive impairment, than those who do not wear their hearing aids.....and should really be shouted from the rooftops (unintended pun ) it's massively importent for people who are hearing aid wearers to know this.

That's an Incredible statistic... IMO

https://www.psych.ox.ac.uk/news/testing-for-hearing-loss-could-reduce-dementia-risk-later-in-life
 
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hollydolly said:
Studies have found that those with hearing loss already.. who wear aids.. hearing aid wearers, have a 50 % less risk of cognitive impairment, than those who do not wear their hearing aids.....and should really be shouted from the rooftops (unintended pun ) it's massively importent for people who are hearing aid wearers to know this.
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As a writer who is constantly active in my imagination, I have only used my hearing aids selectively. Since reading the report I may reconsider. Thanks for that.
 
Murrmurr said:
Hospice nurses mention those signs, loss of appetite and listlessness. Some also say they've seen patients staring at some point in the room as though they see something there, and some of them point to "it" now and then, or wave at it, and some even say a few words to it. They say some patients tell them their mother or some other deceased relative came to visit them.

But some dying patients have what hospice calls terminal restlessness, where they yell and toss around in their bed and are very upset, and it comes and goes in waves and can last for hours or even a day or more. I suppose they don't know how long, really, because they normally sedate patients with terminal restlessness.
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It's quite scary really, the mystery of what's next.
 
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