Signs That Are Present When Someone Is Dying

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You’ve probably been there a few times, although given the emotional nature of the thing, it’s likely that you weren’t taking notes. Hospice workers, on the other hand, do take notes, so here are some things you might want to know, and if anything makes the next time even a little easier, that’ll be good:

Last stages

Here are the discussed signs of the “active dying” phase:

  • Increasing unconsciousness:
    • The person will be mostly unresponsive most of the time.
    • Eyes may be open or partially open but not making eye contact.
    • Mouth will likely remain open due to muscle relaxation.
  • Cessation of food and water intake
    • The person will likely not eat or drink for several days.
    • This is a natural process and does not cause suffering per se (e.g. thirst, hunger).
    • Dryness of mouth, however, can be treated with a little moistening, for comfort.
  • Changes in breathing
    • Breathing patterns will change and may be irregular.
    • This is a natural metabolic response, and is not a sign of distress.
    • Terminal secretions (“death rattle”) may occur:
      • A gurgling sound caused by saliva buildup due to loss of swallowing reflex.
      • Not painful or distressing for the person.
      • Can be managed by repositioning or using medication to dry secretions.
  • Skin color changes / mottling:
    • First appears on fingers and toes (purple or gray discoloration).
    • May spread to knees, nose, or other extremities.
  • Temperature fluctuations:
    • The body loses its ability to regulate temperature.
    • Person may feel hot but be cold (or vice versa).
    • Fevers are common—cooling measures and/or Tylenol can help.

A person in discomfort may appear restless, have a furrowed brow, or show physical agitation. If on the other hand they appear peaceful and unresponsive, they are almost certainly not in distress. At such times, it’s best to focus on just keeping them clean and comfortable.

For more on all of these, see:

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Want to learn more?

You might also like to read:

Managing Mortality: When Planning Is a Matter of Life and Death

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  • How to Think Like Leonardo da Vinci – by Michael J. Gelb

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    Authors often try to bring forward the best minds of the distant past, and apply them to today’s world. One could fill a library with business advice adaptations from Sun Tzu’s Art of War alone, same goes for Miyamoto Musashi’s Book of Five Rings, and let’s not get started on Niccolò Machiavelli. What makes this book different?

    Michael Gelb explores the principles codified and used by the infamous Renaissance Man to do exactly what he did: pretty much everything. Miyamoto Musashi had no interest in business, but Leonardo da Vinci really did care a lot about learning, creating, problem-solving, human connections, and much more. And best of all, he took notes. So many notes, for himself, of which we now enjoy the benefit.

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    See today’s book on Amazon!

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  • Saffron For The Brain (& More)

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    Saffron For The Brain (& More)

    In yesterday’s edition of 10almonds, one of the items in the “health news from around the world” section was:

    Clinical trial finds herbal medicine Sailuotong effective for brain health in older people

    But, what is it?

    ❝SaiLuoTong (SLT) is a modern compound Chinese herbal medicine preparation in capsule form containing standardized extracts of Panax ginseng, Ginkgo biloba, and Crocus sativus L❞

    Source: A randomized, double-blind, placebo-controlled, parallel-group 12-week pilot phase II trial of SaiLuoTong (SLT) for cognitive function in older adults with mild cognitive impairment

    We’ve written previously about ginseng and ginkgo biloba:

    So, what’s this about Crocus sativus L.?

    That is the plant better known as saffron. And, for all its wide availability (your local supermarket probably has at least a tiny amount in the spice section), there’s a reason we don’t see much of it:

    ❝Saffron blooms only once a year and should be collected within a very short duration. It is picked during 3–4 weeks in October-November. The method for the cultivation of saffron contributes greatly to its high price. According to some reports, this species is a sterile triploid and so does not produce fertile seeds. Germination can take 1–6 months at 18°C. It takes 3 years for plants to flower from seed.❞

    Source: Crocus sativus L.: A comprehensive review

    That’s fascinating, but what does it do for us?

    Well, in the words of El Midaoui et al. (2022):

    ❝In the frame of a double-blind-placebo-controlled study, 30 mg per day supplementation with saffron for 16 weeks resulted in improved cognitive function in patients suffering from mild to moderate Alzheimer’s disease.

    Moreover, the follow-up of this study in which the authors evaluated the effects of saffron (30 mg/day) for 22 weeks showed that saffron was as effective as donepezil in the treatment of mild-to-moderate Alzheimer’s disease❞

    Read the full review: Saffron (Crocus sativus L.): A Source of Nutrients for Health and for the Treatment of Neuropsychiatric and Age-Related Diseases

    Not just that, but it also has powerful antioxidant and anti-inflammatory properties beyond the brain (though the brain is where research has been most focused, due to its neuroprotective effects).

    See: Antioxidant Properties of Crocus Sativus L. and Its Constituents and Relevance to Neurodegenerative Diseases; Focus on Alzheimer’s and Parkinson’s Disease

    (this, too, is a full research review in its own right; we’re getting a lot of “bang for buck” on papers today)

    And more?

    Yes, and more. Lots more. To bullet-pointify even just the abstract from another research review:

    • Saffron has been suggested to be effective in the treatment of a wide range of disorders including coronary artery diseases, hypertension, stomach disorders, dysmenorrhea and learning and memory impairments.
    • In addition, different studies have indicated that saffron has anti-inflammatory, anti-atherosclerotic, antigenotoxic and cytotoxic activities. (This is all good; the cytotoxic activities are about killing cancer cells)
    • Antitussive effects of stigmas and petals of C. sativus and its components, safranal and crocin have also been demonstrated.
    • The anticonvulsant and anti-Alzheimer properties of saffron extract were shown in human and animal studies.
    • The efficacy of C. sativus in the treatment of mild to moderate depression was also reported in clinical trial.
    • Administration of C. sativus and its constituents increased glutamate and dopamine levels in the brain in a dose-dependent manner.
    • It also interacts with the opioid system to reduce withdrawal syndrome.
    • C. sativus and its components can be considered as promising agents in the treatment of nervous system disorders.

    For more details on any of those items, see:

    The effects of Crocus sativus (saffron) and its constituents on nervous system: a review

    Is it safe?

    The effective dose is 30mg/kg and the LD50 is more than 20g/kg, so yes, it’s very safe. Given the price of it, this also means that if you’re the size of this writer (a little over 70kg, or a little over 150lbs) to poison yourself effectively you’d need to consume about 1.4kg of saffron at a time, which would cost well over $6,000.

    Where can I get it?

    Your local supermarket probably has a tiny amount in the spice section, or you can get better prices buying it in “bulk” online. Here’s an example product on Amazon, for your convenience

    Enjoy!

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  • State of Slim – by Dr. James Hill & Dr. Holly Wyatt

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The premise of this book is “people in Colorado are on average the slimmest in the US”, and sets about establishing why, and then doing what Coloradans are doing. As per the subtitle (drop 20 pounds in 8 weeks), this is a weight loss book and does assume that you want to lose weight—specifically, to lose fat. So if that’s not your goal, you can skip this one already.

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    The answer is a clear “yes, but”—and the caveat is “yes, but also some associated lifestyle practices”.

    The diet component is basically a very low-carb diet to start with (with the day’s ration of carbs being a small amount of oats and whatever you can get from some non-starchy vegetables such as greens, tomatoes, etc), and then reintroducing more carbohydrate centric foods one by one, stopping after whole grains. If you are vegan or vegetarian, you can also skip this one already, because this advises eating six animal protein centric meals per day.

    The non-diet components are very general healthy-living advices mixed in with popular “diet culture” advices, such as practice mindful eating, don’t eat after 8pm, exercise more, use small plates, enjoy yourself, pre-portion your snacks, don’t drink your calories, get 8 hours sleep, weigh all your food, etc.

    Bottom line: this is a very mixed bag, even to the point of being a little chaotic. It gives sometimes contradictory advice, and/but this results in a very “something for everyone” cafeteria approach to dieting. The best recommendation we can give for this book is “it has very many ideas for you to try and see if they work for you”.

    Click here to check out State of Slim, and take your pick!

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  • Wise Old Fool

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    How old is this dish? Well, let’s put it this way, it used to be called ” ” and remnants of it have been found at neolithic burial sites in Egypt. Nowadays it’s called “فول مدمس”, which gets rendered a lot of different ways in the Latin alphabet, but “fūl mudammas” is one option. For short, it’s just called “fūl”, which is pronounced like the English word “fool”, and it’s about the beans.

    From chana masala with poori to frijoles refritos to beans on toast, lots of cultures have some version of this breakfast food, and all can be great (yes, even the beans on toast). But today we’re about this particular kind of morning protein, fiber, fats, and healthful spices.

    You will need

    • 2x 14 oz cans fava beans (other kinds of beans work as substitute; kidney beans are common substitution, but this writer prefers black beans personally if she doesn’t have fava in), drained
    • 4 garlic cloves, crushed
    • 1 tbsp extra virgin olive oil
    • 1 teaspoon cinnamon (or ½ cinnamon stick)
    • 1 tsp cumin seeds
    • 1 tsp chili flakes
    • 1 tsp paprika
    • 1 tsp black pepper
    • Juice of ½ lemon
    • For the relish: 1 medium tomato, finely chopped; 1 tbsp extra virgin olive oil; 2 tbsp parsley, finely chopped
    • To serve: 4 pitta breads, 2 eggs (omit if vegan), and a selection of pickled vegetables, drained

    Method

    (we suggest you read everything at least once before doing anything)

    1) Add the olive oil to a saucepan over a medium heat; add the garlic, cumin seeds, and cinnamon. Keep these moving for a minute or two before moving to the next step.

    2) Add the fava beans, as well as the other seasonings (chili flakes, paprika, black pepper), and mix thoroughly

    3) Add 1 cup boiling water, and keep everything on a simmer for about 20 minutes, stirring often. Add the lemon juice while it’s simmering; when the beans start to break down and the mixture starts to thicken, it’s ready.

    4) Mix the relish ingredients (finely chopped tomato, olive oil, parsley) thoroughly in a small bowl

    5) Toast the pitta breads, and if using, soft-boil the eggs.

    6) Serve! We suggest: fūl in a bowl, with one half of a soft-boiled egg per bowl, topped with the relish, and served with the pitta bread and pickled vegetables on the side.

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • Want the health benefits of strength training but not keen on the gym? Try ‘exercise snacking’

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The science is clear: resistance training is crucial to ageing well. Lifting weights (or doing bodyweight exercises like lunges, squats or push-ups) can help you live independently for longer, make your bones stronger, reduce your risk of diseases such as diabetes, and may even improve your sleep and mental health.

    But not everyone loves the gym. Perhaps you feel you’re not a “gym person” and never will be, or you’re too old to start. Being a gym-goer can be expensive and time-consuming, and some people report feeling unwelcome or awkward at the gym.

    The good news is you don’t need the gym, or lots of free time, to get the health benefits resistance training can offer.

    You can try “exercise snacking” instead.

    Pressmaster/Shutterstock

    What is exercise snacking?

    Exercise snacking involves doing multiple shorter bouts (as little as 20 seconds) of exercise throughout the day – often with minimal or no equipment. It’s OK to have several hours of rest between.

    You could do simple bodyweight exercises such as:

    • chair sit-to-stand (squats)
    • lunges
    • box step-ups
    • calf raises
    • push-ups.

    Exercise snacking like this can help improve muscle mass, strength and physical function.

    It’s OK to hold onto a nearby object for balance, if you need. And doing these exercises regularly will also improve your balance. That, in turn, reduces your risk of falls and fractures.

    OK I have done all those, now what?

    Great! You can also try using resistance bands or dumbbells to do the previously mentioned five exercises as well as some of the following exercises:

    When using resistance bands, make sure you hold them tightly and that they’re securely attached to an immovable object.

    Exercise snacking works well when you pair it with an activity you do often throughout the day. Perhaps you could:

    • do a few extra squats every time you get up from a bed or chair
    • do some lunges during a TV ad break
    • chuck in a few half squats while you’re waiting for your kettle to boil
    • do a couple of elevated push-ups (where you support your body with your hands on a chair or a bench while doing the push-up) before tucking into lunch
    • sneak in a couple of calf raises while you’re brushing your teeth.
    A man does weighted lunges in his lounge room.
    Exercise snacking involves doing multiple shorter bouts (as little as 20 seconds) of exercise throughout the day. Cavan-Images/Shutterstock

    What does the evidence say about exercise snacking?

    One study had older adults without a history of resistance training do exercise snacks at home twice per day for four weeks.

    Each session involved five simple bodyweight exercises (chair sit-to-stand, seated knee extension, standing knee bends, marching on the spot, and standing calf raises). The participants did each exercise continuously for one minute, with a one-minute break between exercises.

    These short and simple exercise sessions, which lasted just nine minutes, were enough to improve a person’s ability to stand up from a chair by 31% after four weeks (compared to a control group who didn’t exercise). Leg power and thigh muscle size improved, too.

    Research involving one of us (Jackson Fyfe) has also shown older adults found “exercise snacking” feasible and enjoyable when done at home either once, twice, or three times per day for four weeks.

    Exercise snacking may be a more sustainable approach to improve muscle health in those who don’t want to – or can’t – lift heavier weights in a gym.

    A little can yield a lot

    We know from other research that the more you exercise, the more likely it is you will keep exercising in future.

    Very brief resistance training, albeit with heavier weights, may be more enjoyable than traditional approaches where people aim to do many, many sets.

    We also know brief-and-frequent exercise sessions can break up periods of sedentary behaviour (which usually means sitting too much). Too much sitting increases your risk of chronic diseases such as diabetes, whereas exercise snacking can help keep your blood sugar levels steady.

    Of course, longer-term studies are needed. But the evidence we do have suggests exercise snacking really helps.

    An older Asian man lifts weights at home.
    Just a few short exercise sessions can do you a world of good. eggeegg/Shutterstock

    Why does any of this matter?

    As you age, you lose strength and mass in the muscles you use to walk, or stand up. Everyday tasks can become a struggle.

    All this contributes to disability, hospitalisation, chronic disease, and reliance on community and residential aged care support.

    By preserving your muscle mass and strength, you can:

    • reduce joint pain
    • get on with activities you enjoy
    • live independently in your own home
    • delay or even eliminate the need for expensive health care or residential aged care.

    What if I walk a lot – is that enough?

    Walking may maintain some level of lower body muscle mass, but it won’t preserve your upper body muscles.

    If you find it difficult to get out of a chair, or can only walk short distances without getting out of breath, resistance training is the best way to regain some of the independence and function you’ve lost.

    It’s even more important for women, as muscle mass and strength are typically lower in older women than men. And if you’ve been diagnosed with osteoporosis, which is more common in older women than men, resistance exercise snacking at home can improve your balance, strength, and bone mineral density. All of this reduces the risk of falls and fractures.

    You don’t need heavy weights or fancy equipment to benefit from resistance training.

    So, will you start exercise snacking today?

    Justin Keogh, Associate Dean of Research, Faculty of Health Sciences and Medicine, Bond University and Jackson Fyfe, Senior Lecturer, Strength and Conditioning Sciences, Deakin University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Artichoke vs Cabbage – Which is Healthier?

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    Our Verdict

    When comparing artichoke to cabbage, we picked the artichoke.

    Why?

    Looking at the macros first of all, artichoke has more than 2x the protein; it also has nearly 2x the carbs, but to more than counterbalance that, it has more than 2x the fiber. An easy win for artichoke in the macros category.

    In the category of vitamins, both are very respectable; artichoke has more of vitamins B1, B2, B3, B5, B9, E, and choline, while cabbage has more of vitamins A, C, and K. Superficially, that’s a 7:3 win for artichoke, but the margins of difference for artichoke’s vitamins are very small (meaning cabbage is hot on its heels for those vitamins), whereas cabbage’s A, C, and K are with big margins of difference (3–7x more), and arguably those vitamins are higher priority in the sense that B-vitamins of various kinds are found in most foods, whereas A, C, and K aren’t, and while E isn’t either, artichoke had a tiny margin of difference for that. All in all, we’re calling this category a tie, as an equally fair argument could be made for either vegetable here.

    When it comes to minerals, there’s a much clearer winner: artichoke has a lot more copper, iron, magnesium, manganese, phosphorus, potassium, and zinc, while cabbage has a tiny bit more selenium. The two vegetables are equal on calcium.

    Adding up two clear artichoke wins and a tie, makes for an overall clear win for artichoke. Of course, enjoy both though; diversity is almost always best of all!

    Want to learn more?

    You might like to read:

    What’s Your Plant Diversity Score?

    Take care!

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