Death and dying is a part of getting older, and especially a part of living and working in aged care.

For older people who move into residential aged care, this is often their last home before they pass away.

And for staff, they see old and frail people die on a regular basis.

What can be confronting for families is seeing the person they love dearly dying in front of them. Most don’t know what to expect of what the signs are.

The most common symptoms observed closer to death is a change in breathing pattern – the breathing itself can often become irregular, and quite shallow through the chest. Confusion and sleepiness may occur in the last days and hours.

The breathing itself can become “noisy” because of secretions in the throat or relaxing of the throat muscles. This is believed to not cause pain or discomfort to the dying person, but it makes it unpleasant to witness someone you love in this position. This breathing can continue for hours and often means that death will occur in hours or days.

There are ways to decrease the noise, for example, repositioning the person, limiting fluid intake, or using drugs to dry secretion.

It should be noted that those treatments help those around the dying person more than the dying, because at a time when the dying person is unaware of the noises they are making.

The dying person’s consciousness may decrease. Often their limbs may become cool and perhaps bluish or mottled.

Unless the person has a contagious or infectious disease, family members should be assured that touching, caressing, and holding the body of a dying person, even for a while after the death, are acceptable.

Physical contact can be soothing for the dying, and many family members should be encouraged to hold their hands if they are comfortable.

However, it is entirely up to the family if they – or others, such as young children – want to be with or see the person as they die, as the last moments of a person’s life can have a lasting effect on family members, friends, and caregivers.

Ideally, the person who is in care will have an advance care directive in place that instructs their loved ones and their care staff on what they would like when the end is near.

This may be the choice of whether they wish to be in hospital or to be at home, or whether a ventilator is used.

Many people wish to be organ donors – is everything put in place to ensure that happens?

It’s sad to see a loved one die, especially if it is after a long struggle. But if you have some idea of what to expect, it can be less confronting to witness. The key is to be ready.

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