Is this patient in the last hours or days of life?

Recognising when a patient is in the last hours of life may be straightforward if they have followed the sudden death trajectory above (but see ‘Pitfalls’ below). Clinical signs that may point towards imminent dying in the other end of life trajectories include^10,13:

• Increased agitation
• Cheyne-Stokes breathing
• Refractory / progressive bradycardia
• Reduced consciousness
• Deeply mottled skin/cyanosis
• Progressive rapid weight loss
• Noisy pharyngeal or respiratory secretions
• Functional changes such as dramatic reductions in mobility or social interactivity.

Combining these signs with information from the patient, caregivers and other members of the multidisciplinary team, monitoring in the hours after arrival, and response to any treatment may help clarify if the person is nearing death, deteriorating, stable or improving¹³.

Learning Bite

Diagnosing dying is difficult. A range of clinical indicators combined with multidisciplinary assessment can clarify the situation in cases of uncertainty.