Hospice of Missoula''s philosophy is that the "fear of the unknown" is always greater than the "fear of the known". It is important to know that everyone approaches end of life in their own way. Like birth, symptoms and experiences can vary a lot from person to person. You may see many of these symptoms occur or perhaps just a few. The signs and symptoms that are listed are a general idea of what can happen.

One to three months Prior to Passing:
The patient may gradually spend more time sleeping during the day and at times be difficult to arouse. Plan time with the patient during occasions when he or she seems more alert. As the patient becomes more aware of the dying process, he/she may begin to withdraw from the world around them. Loss of interest in TV, reading and people may be evident. Sleeping is one way of withdrawing.
Your loved one may lose interest in food, have no appetite or be unable to eat. Offer liquids or small amounts of food to the patient. When a body is preparing to pass, it is natural for the patient to stop eating and drinking. It takes a great deal o fenergy to digest food and a dying body does not have that energy. It is alright for the patient to not eat or drink.

One to Two Weeks Prior to Passing:
You may notice increased confusion regarding time, place, and identity of familiar people. Gently orient the patient of the date and time and who is in the room. Sleeping may be almost constant. The patient may not open his/her eyes; but can, however, be awakened and can always hear what is said, even if there is no response.
You may notice restless behavior such as pulling at bed linen, picking at clothing, the air or agitated arm movements. These symptoms are a result of a decrease in the oxygen circulation to the brain and a change in body metabolism. Talk calmly and assuredly with the patient. Music may be a good source of comfort. With confusion and disorientation, you may notice that he/she seems to be talking to people, and possibly about places and events that are unknown to others in the room. It may appear that he/she is communicating with loved ones who have previously passed away and may now be focusing on the transition from this world to the next.

One to Two Hours Prior to Passing :
The one to two week signs previously mentioned may become more pronounced as passing approaches.

• Restlessness becomes more intense.
• Breathing patterns become slower, shallower, and more congested.
• Eyes may be open or semi-open, glassy, and not seeing.
• Hands and feet may become purplish and may appear blotchy.
• Non-responsiveness.
• There may be a loss of body fluids.

Additionally, The National Caregiver Association is a wonderful organization with a vast array of helpful information for those dealing with the challenges of caring for others. The link to their website is www.thefamilycaregiver.org.