Signs of Dying in Elderly

Posted by Dr. El - January 11, 2012 - Anecdotes, Communication, End of life, Transitions in care - 15 Comments

I hadn’t been on the North wing of the nursing home in a while, and when I saw Juanita Johnson sleeping in a geri-recliner,  I turned to the nurse, aghast.  “I barely recognized her!  She’s lost so much weight!”  

“I know.  It’s terrible,” the nurse replied.  “We’re having her evaluated by hospice today.”

Ms. Johnson was accepted into the hospice program, and died two days later.  

I’ve seen many late referrals to hospice in my years as a nursing home psychologist.  It’s the rare older resident who wants every treatment possible late in life.  Most of the time, the resident is going along with the program, waiting for the doctor to say that it’s time to rethink how we’re handling things.  The resident is waiting for “the conversation,” but all too often the conversation doesn’t happen until it’s too late.  The resident’s last days and months are ones of unpleasant medical interventions rather than a time of comfort and emotional support.  This affects their family as well, with the emotional ripples of a “bad” death living on for years.

It’s not so easy to determine when someone is dying, but this week’s article by Paula Span in the New York Times, Interactive Tools to Assess the Likelihood of Death, discusses the use of interactive tools and how they can help us make better end-of-life medical decisions.  The tools are posted at



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