Pulse rate, also known as heart rate, measures how many times the heart beats each minute. It indicates the heart’s function and can be felt by gently pressing on arteries close to the skin, such as those in the wrist or neck. This article explains how pulse rate naturally changes as someone approaches the end of life.
Initial Shifts in Pulse Rate
As a person’s overall health declines due to illness or aging, subtle changes in their pulse rate may appear. These initial shifts often involve a modest increase or decrease from their usual resting pulse. A normal resting pulse for adults typically falls between 60 to 100 beats per minute, though this can vary depending on age and general health. These early changes reflect the body’s broader decline in organ function and overall health, not immediate indicators of death.
These variations occur as the body’s systems become less efficient. For instance, a weakened heart muscle might not pump blood as effectively, leading to changes in how the pulse is felt. Conditions like dehydration or infection can also stress the body, potentially causing the heart rate to increase as it works harder to maintain function. These changes are part of a gradual process, differing from the more acute shifts seen in the immediate final stages of life.
Pulse Patterns Nearing End of Life
In the final hours or days of life, the pulse rate undergoes more significant changes, reflecting the body’s systems shutting down. The pulse often becomes increasingly weak and “thready,” meaning it is difficult to feel and has a faint, fine quality. It may also become irregular, alternating between periods of very rapid (tachycardia) and very slow (bradycardia), before becoming undetectable.
Some studies indicate heart rate can increase by 25-50 beats per minute when death is imminent, though this can vary. Blood pressure typically drops significantly in the last few days, and the heart rate may fluctuate as the body prepares to cease function. Ultimately, as death occurs, the heartbeat slows and then ceases entirely, leading to the absence of a palpable pulse.
Physiological Explanations for Changes
The alterations in pulse rate nearing the end of life are rooted in profound physiological changes. A primary factor is the declining function of the heart, which becomes less efficient at pumping blood throughout the circulatory system. As the heart weakens, blood pressure drops, and the supply of oxygenated blood to organs decreases. This reduced circulation affects all organ systems, including the brain, kidneys, and liver, leading to their progressive failure.
Metabolic changes also contribute, as the body’s energy reserves are depleted and its ability to process oxygen diminishes. The body’s attempt to compensate for these systemic failures can initially lead to an increased heart rate, as it tries to maintain circulation and oxygen delivery. However, as compensatory mechanisms fail, the heart becomes overwhelmed, resulting in the irregular, weak, and slowing pulse observed in the final stages.
Observing Pulse and Other Signs
For family members and caregivers, observing the pulse can offer some indication of the dying process, often by gently feeling the wrist or neck. However, continuous monitoring is generally not necessary or beneficial, as the focus shifts to comfort rather than medical intervention.
Other observable signs often accompany pulse changes, providing a more comprehensive picture. These can include shifts in breathing patterns, such as shallow breaths, periods of no breathing, or noisy, rattling sounds. Skin may become cool to the touch and appear pale, mottled, or bluish due to decreased circulation. Changes in consciousness, increased sleepiness, and reduced appetite are also common. Understanding these signs as a natural part of the dying process can help caregivers provide compassionate support, prioritizing comfort and presence.