Recognising dying 

Recognising dying is the first step in terminal care management. The terminal phase may be hours or days. It is important to plan for symptoms and changing circumstances. Anticipatory prescribing can prevent crises and unplanned admission to hospital supporting home death.

The needs of families during the dying process and after death should be clarified and discussed.

Key points

  • Recognising dying is the first step in terminal care management. If three or more of the following symptoms are present is likely the patient is entering the terminal phase.
    • ​Experiencing rapid day to day deterioration that is not reversible
    • Requiring more frequent interventions
    • Becoming semi-conscious, with lapses into unconsciousness
    • Refusing or unable to take food, fluids or oral medicines
    • Irreversible weight loss
    • An acute event has occurred, requiring revision of treatment goals
    • Profound weakness
    • Changes in breathing patterns
  • ​The duration of the terminal phase is hard to predict. It can range from short hours to many days. The family should be advised of this.
    • ​Cachexia, end-stage organ failure, or infection may be associated with a more rapid deterioration
    • Patients may survive for some days, even without fluids.
  • In patients with severe dementia and similar end-stage chronic conditions affecting the conscious state, it may be quite difficult to clearly identify the onset of the terminal phase.
  • The clinical priorities at this stage are:
    • Talk to patient and / or family
    • Address symptoms
    • Ensure needed medications are available
    • Advise other health professionals
    • Consider whether the patient is in residential aged care or at home, or if they have expressed a preference for admission to hospital or palliative care unit for end of life, and plan accordingly

Last updated 24 August 2021