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When Death Is Near


Registered User
Mar 23, 2008
coast of texas
Originally I had scanned a booklet that was given to me by hospice. The book is awesome in that it gives foresight. Aim Hospice has given permission but in order to make things easier and not add extra work to those wonderful souls workload I have found it on the internet. I am posting the link as I know that when I go to the alzheimers.org website here in the US I do not end up on your website in England. (I wonder if this may have been the problem for you Bruce)

The link I am posting is 3 paragraphs short of the booklet and that would be the forward. It is identical and just as easy to read. This is a wonderful website and has lots of easy reading to help out every one with a terminal illness whether it be cancer or later stages of dimentia.

Bless all




Hope this helps someone.


Registered User
Jan 31, 2004
near London
Moderator note: At risk of totally confusing everyone - I have now removed Nancy's original post by agreement with her as the post above provides a link to the same information.


Registered User
Aug 29, 2006
SW Scotland
Nancy, thank you for that link. I've looked at it, and now need to download and print it.

When I have the courage!:(


Tender Face

Account Closed
Mar 14, 2006
NW England
Thank you, Nancy

I logged in earlier this afternoon and saw this during its transition - I'm not sure myself where its place is on the different sections of the forum (understand why Bruce moved it for now) ....... but from me a very heartfelt thanks .... I cannot believe I am looking at a palliative care plan for mum when just a few weeks ago she was so relatively independent ... (of course in our case - it is more complex than 'dementia' alone).

Agree totally with Hazel - it's tough reading - in the sense we have to be in the right mood - but as with anything in life I believe 'forewarned is forearmed' and having some better ideas how to do my best for mum is - well - some small silver lining for someone feeling totally incompetent at the moment ...

Love and thanks, Karen, x


Registered User
Sep 16, 2005
Is it just me, or do other people feel after they have read the link that their loved one has been exhibiting pretty much all of those things for years now?? Just posting here in case, some people new to these behaviours might panic thinking the end is near when it is not always so. Dad has been showing all these symtoms for at least 3 yrs now. For those for whom this link is appropriate I hope you find some solace in its words I know I will be re-reading it when again I think it is time.
Coolness: The person´s hands and arms, feet and then legs may be increasingly cool to the touch, and at the same time the color of the skin may change. This a normal indication that the circulation of blood is decreasing to the body’s extremities and being reserved for the most vital organs.
Sleeping: The person may spend an increasing amount of time sleeping, and appear to be uncommunicative or unresponsive and at times be difficult to arouse.
Disorientation: The person may seem to be confused about the time, place, and identity of people surrounding him or her including close and familiar people.
Incontinence: The person may lose control of urine and/or bowel matter as the muscles in that area begin to relax.
Congestion: The person may have gurgling sounds coming from his or her chest as though marbles were rolling around inside these sounds may become very loud.
Restlessness: The person may make restless and repetitive motions such as pulling at bed linen or clothing.
Breathing Pattern Change: The person s regular breathing pattern may change with the onset of a different breathing pace. A particular pattern consists of breathing irregularly, i.e., shallow breaths with periods of no breathing of five to thirty seconds and up to a full minute.
Withdrawal: The person may seem unresponsive, withdrawn, or in a comatose-like state.
Vision-like Experiences: The person may speak or claim to have spoken to persons who have already died, or to see or have seen places not presently accessible or visible to you.
Restlessness: The person may perform repetitive and restless tasks.
Fluid and Food Decrease: When the person may want little or no fluid or food, this may indicate readiness for the final shut down.
If we didn't try to feed him we wouldn't know he was hungry...but when we do try, he does eat quite well..Check?
Decreased Socialization: The person may only want to be with a very few or even just one person.
Unusual Communication: The person may make a seemingly out of character or non sequitur statement, gesture, or request.
Giving Permission
Giving permission to your loved one to let go, without making him or her guilty for leaving or trying to keep him or her with you to meet your own needs, can be difficult.
Have told Dad to not fight it unless he wants to, that we will be okay..Check.


Registered User
Jun 3, 2005
Hi Nat

I had just the same thought. Kind of confirms the "living death" feeling so many of us here have expressed.

Hope you are well as can be.



Registered User
Jan 4, 2006
Hiya Nat,
Know what you mean.
The coolness and change of colour in mum dying was different to that seen before.....an iciness...and different texture to the skin...and the blueness...it wasnt just a faint hue.

Bruce...just wondered if it would be worth making the link a sticky....if not the ensuing posts.....i think it might be helpful for people if it is permanently around.

Just an idea.
Love Helen


Registered User
Mar 1, 2007
Melbourne, Australia
hey nat, my mum is similiar to your dad and has been for 6 months now...but I found this information very useful after my FIL was diagnosed with terminal lung cancer in april and died at home 11 days later surrounded by family.
my SIL was with him when he died and had knowledge of this kind of thing....to the benefit of our family.

I wish for mums sweet release everyday, oh how I hope this doesnt continue for years, but as mum is kind of young (72)and is losing weight despite adequate nutrition I expect that she will decline faster than normal
she is borderline early onset.
this disease is totally cruel, and for the families, their worst nightmare come true.
I hope we are not going "check" in 3 years time.


Registered User
Mar 23, 2008
coast of texas
I think what we as an AD caregiver need to realize is that hospice is palliative care. The signs that hospice mention in their book are all too common to Alzheimers. In order to put them in perspective there needs to be a more substantial problem also....an example would be cancer or in moms case her bladder being with constant infections and the bleed into it that we have been watching of late.

Hospice care is set up in the US tobe for patients that dr.s feel have maybe 6 months to live...but once again they know that each person is different. Our hospice has an AD patient who has been with them for 4 years. He will go way down then rally and thrive. Tho his thriving is not a life tobe envied.

I posted this originally with this in mind:

Mom has recently gone into hospice. The information on this link is very helpful if you feel that this may be the time. I don't recommend reading it unless you feel the end may be near. It can be quite easy or can be hard to read. Please don't read just the article that has been posted as there is much more info on this sight that is very useful to a caregiver. I hope it will help to bring peace to you as a caregiver.

Personally for me I do not think it is appropriate to a patient who has AD, unless they are in the very late stages. Stage 7. Mom has been stage 7 for 3 months now and she went from 4 to 7 over night it seems. Thanks to a few strokes. Did I think hospice was approprate for her....not until a few weeks ago when her catheter bag filled with blood instead of urine.
That comes and goes. Do I feel she will be with hospice long? For her sake I hope she at least sees the birth of her first grandbaby..I know she won't know what is going on, but I at least will have the comfort of a 4 generation pic (I know selfish of me.)

I do feel however that there are other articles on the website that can give comfort to the caregiver of a AD patient. If you stop to think about it there comes a time in their life when you have to take over and in reality you are giving palliative care from that point. Maybe in bad health but will still live a long life and you know it you still want them comfortable.

I think a few weeks (?) back there was a thread on dying of AD. It came to no conclusion but the point with this is that the patient has AD and eventually he/she may die. With a health problem you watch them die with AD they can still die a normal death but we say AD because they had AD. I Know this can be different cases also because some AD patients are young..but do you get my drift. This is all about a state of mind that has to be achieved to get the patient comfortable and if you are uncomfortable so is your AD patient.

(Sorry I feel very strong about this.....and I promise I was not on 2 soap boxes, just one:eek:)

I hope I have not offended anyone.

I hope those of you who read this ahead of time will be able to understand me and I hope it will make it easier on you at that time.




Registered User
Jan 4, 2008
east sussex

I read something similar regarding the stages of death and when the time came i did find it a comfort to know what to expect when my husband passed away.

Cynthia x x


Registered User
May 19, 2006

I read this at a time when I was getting ready for the death of my beloved aunt and grandfather. I was up all hours googling, reading, looking for information on various (respectable) websites, and the one for which you provided the link did a lot for me, also in the aftermath of death, trying to comfort my uncle, and then about a year later, another uncle after the death of his wife.

While I've not been able to look at the When Death Is Near section since, the parts on grief and bereavement have been very helpful.

All the best,


Registered User
Aug 9, 2007

I think many people will find this useful. The timescales I know can very as Mum went through the extremity cooling and discolouration, breathing pattern changes etc just a couple of hours before her death but the others were there for years beforehand. However my Dad, whose end came from cancer did show most of these in the last day of his life together.

Dementia is a long bereavement.

A book I found of much comfort this year, while Mum lingered on was "Final Gifts". It is written by a hospice nurse and described many of the situations mentioned and many of the unique things that can happen at this time. I would recommend it to anyone in those final days as it, despite its subject matter, a very comforting read.

THinking of you all at this time



Registered User
Aug 11, 2008
chalfont st giles
coping with uncertainty

iaalleda found many of the comments helpful but i find the waiting and uncertainty difficult.twice my children have been calle.d to the home expecting the end i feel in a limbo


Registered User
Mar 21, 2003
Glad this has been made a sticky.

When mum was close to death the lady from the hospice sent me a similar booklet, it was before we'd even discussed death. At the time I was in total denial and thought mum would recover as she had done before. Her loss of appetite was definitely the most worrying although she ate like a bird for the last six months anyway.

I put the booklet in a drawer for a week and then one day opened it and read every word - it was just a few days before. The denial got a good bashing and although it was incredibly painful, reading the booklet helped me come to terms with things a little better, the penny dropped so to speak as there were just too many similarities. Nothing nothing prepares you when death is near in my opinion, but a little more information at least helps you come to terms with the practical things that you never expect.

With children it is even more difficult, I confess to hiding my daughter from the last few days.

Giving Permission
Giving permission to your loved one to let go, without making him or her guilty for leaving or trying to keep him or her with you to meet your own needs, can be difficult.
In my opinion this is the most important part when death is near. I think mum was looking for me to let her go and yes almost permission. She needed to be alone for moments too and it was difficult to get the balance just right (this is perhaps different for someone with dementia, mum died from COPD).

I'd really like to add one thing. It would have made a world of difference if someone had handed me the booklet with so many painful facts, instead of sticking it in the post. If I could sat and read it with someone close by and not alone it would have made a world of difference to me. We are all different, but I could have done with someone to talk to at the time. So some may find it easier to print it off and find the right time to read it or if you a people person like me, the right person to read it with and talk to.

Kindest Regards
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cotswold melody

Registered User
Nov 26, 2008
Thank you thank you thank you. This thread was exactly what I needed, exactly when I needed it. I am a carer on a one to one with a lovely lady who is nearing the end of her life (after reading this nearer than i thought!) Her husband is having problems coming to terms with the imminent loss of his wife (understandibly) and is insistant that she should eat/drink more. Today he took things into his own hands and encouraged her to 'drink more' and as a consequence she was sick. Had she been on her own she would have choked to death...It was my lunch time, luckily her daughter was there and acted very fast to help the lady. Now 'armed' with a print out of this leaflet I feel, hopefully, that the husband may be able to let her go at last. He is the last person to give 'permission'..I am sure that is what she is waiting for. So so sad.


Registered User
Dec 8, 2009
I have just read the link at the top of this thread and it is very accurate. Having sat with many gentlemen and ladies through their dying process over 10 years of working at a nursing home for people with Dementia and Alzheimers' Disease, I have witnessed all these stages many times. Almost always the same pattern takes place, however the stages can vary in intensity, breathing can be louder or softer, discolouration can be darker and spread more over the dying person's body. In most cases the dying process is a peaceful one and an experience to be cherished and a privilege to be part of. When my dear Dad passed away in February this year after 15 years with Dementia, it was an honour to share his final moments on Earth. He seemed aware I was there and seemed to know when to let go although his consciousness seemed to have gone at that point. It's hard to explain but he knew when to go. Telling the dying person you love them and that it's alright to go is so important and does help the process for transition into the next World/Heaven. Nobody wants to think about their own passing, but it does help to know about the dying process and also it can help their loved ones cope when the time comes. Thank you for the link.


Registered User
Dec 8, 2009
To add to the post above mine about offering fluids to someone who is dying - this is not good practice as the person could aspirate. Offering fluids (preferably thickened) at the beginning of the dying process is acceptable by syringe if the swallowing reflex remains intact. Where there is no swallowing reflex it is best to use mouth swabs to keep the mouth moist and fresh. Giving fluids when the person really can't accept them is more of a danger than a help at this stage and can cause extreme discomfort which the dying person might not be able to communicate effectively.