30.5.3  Recognising signs of death

When a patient is very close to death, watch for these signs:

• Decreased social interaction — the person sleeps more, they may act or speak with confusion when awake, and they may slip into a coma (become unconscious).
• Decreased food and fluid intake — the person no longer feels hunger or thirst.
• Decreased urine and bowel movements, or incontinence.
• Respiratory changes — irregular breathing or ‘death rattle’ (a rough gurgling noise that sometimes comes from the throat when a person is close to death, caused by breath passing through mucus).
• Circulatory changes — the hands and feet may feel cold and appear greyish or purple as the heart slows and can no longer pump blood to these extremities. You may notice a decreased heart rate and blood pressure.

When the patient dies, you can confirm death by checking that:

• breathing stops completely.
• heartbeat and pulse stop completely.
• the person is totally unresponsive to shaking or shouting.
• the eyes are fixed in one direction, with eyelids open or closed.
• the skin changes tone and becomes pale.