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Saturday, May 30, 2009

Impact of Death Rattle Sounds on Hospice Workers (Research, Video 3:27)


Anyone who works closely with dying patients may have heard death rattle sounds. Hospice workers, including volunteers, who have heard these sounds in the presence of patients’ relatives and friends may feel the need to explain to them what the patient is experiencing and reassure them.

According to Wikipedia, a “death rattle is a gurgling or rattle-like noise produced shortly before or after death by the accumulation of excessive respiratory secretions in the throat. Those who are dying may lose their ability to swallow, resulting in such an accumulation. While it is medically established that the death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex. It is sometimes misinterpreted as the sound of the person choking to death. In terminal care, drugs may be used to reduce secretions and minimize this effect.”

A study reported in Palliative Medicine was done to see how the death rattle sounds impacted hospice staff and volunteers. Most expressed negative feelings about hearing the sounds. Many felt the need to intervene to end the sounds using a therapeutic option. The study concluded that “doctors and nurses need to consider why, when and how they intervene and the consequences of that intervention.”
You can read more about this study here and more recent 2015 research here.

This video features signs of a person's approaching death:



Visit here for more research and other information about the death rattle experience, including a recording of actual death rattle sounds.

It would be interesting to read firsthand information from hospice workers, healthcare staff members, and other caregivers regarding their personal experiences with a patient during a death rattle experience.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

38 comments:

  1. Hi--I am a hospice nurse with 15 years experience. Usually I medicate dying patients who have the death rattle with atropine or scopolomine simply because the sound upsets the family so much. Many families ask fearfully "Is that the death rattle?" and I just explain what causes it and how we will treat it. Knowledge can take away fear.

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  2. Thanks for that information, Karen.

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  3. AnonymousJune 20, 2009

    Hello......not sure you will have an answer BUT, my mother in law is having a difficult time dying. In a hospice setting for 6 weeks.
    Some coherence but only briefly. She is on 17.8 fentanyl by microdrip and
    Ativan .25.....which makes her just zonked out......at times on the Ativan we hear what sounds like the death rattle. We are wondering if the Fentanyl is making it more difficult to work through the pain and then to die on her own. She wants to die, has resolved anything and everything, ready for this at 83. She expresses the desire to die.
    Can you suggest any other helpful ways to approach this for her. Thank you.

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  4. I wish I could help you, but, as you suspected, I am not qualified to comment on this medical matter. I can only suggest that you seek further assistance from others who can. You are fortunate that your mother has "resolved anything and everything" before her death. I hope you find the answers you seek.

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  5. i usually suggest turning patients side to side prior to any medicine and explain to the family what is going on internally with regard to the uvula relaxing air going thru etc

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  6. Hilde, thanks so much for sharing that. Through the years, this post continues to get many hits. Apparently, a I lot of people are interested in death rattle sounds.

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  7. AnonymousMay 02, 2012

    We are experiencing these sounds from my mother-in-law right now and are trying to get her into the hospice care center. Although we understand what causes theses sounds, we are more concerned that she may be feeling pain or discomfort totally unrelated to them. We know the staff at the care center can do a much better job at keeping her totally comfortable than we can at home.

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  8. Thank you for sharing your experience. I wish you all the best on your mother-in-law's journey.

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  9. AnonymousJuly 31, 2012

    My mom went into the hospital for back pain June 18th. After an MRI and 2 CT Scans & 2 biopsys, she was diagnosed with stage 4 cancer. My mom went into Hospice Care July 4th and passed away July 15th. Her breathing the last 2 days were short breaths with long pauses in between. The Hospice Nurses told us that was normal. At midnight on July 15th her breathing changed and by 3:00 a.m. she had a slight rattle. By 5:00 a.m. it was bad.
    My mom died at 5:50 a.m. The most painful, heartbreaking experience I have ever gone through in less than a month...

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    1. I know just what you mean. My mom was rushed to ER on Nov. 15th and was found to have cancer all thru her. She died on Dec. 11th. The day before she died, she had a very noisy death rattle, was trying to cough and sit up. It was very distressing to think she was struggling to breathe. We did get a nurse to roll her on her side and give some meds which helped some, and another nurse's aide suctioned a bunch of mucus out of mouth/throat. That helped. Truly, it was a heartbreaking and traumatic experience for us all.

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  10. Thank you for sharing your experience. I extend my sympathy to you and your family. You did indeed go through a lot in less than a month. I hope you are seeking and getting any support you need as you make this transition in your own life.

    These suggestions may help:

    1) Flow with the grieving process. Each person’s bereavement is unique. Maintain good health, accept assistance from others, and get counseling support if needed.

    2) Remember that you are responsible for your own happiness. Hobbies, travel, social functions, volunteer service, and other enjoyable and fulfilling activities add quality to your life.

    3) Establish new holiday traditions and family rituals if you think you should. You can include ways to commemorate your mother. Keep her stories alive for generations to come.

    4) Remember that life is for living. Your mother would want you to move forward productively on your journey. Doing so is another tribute to her.

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  11. My mother died in her care home about 8 weeks ago. We were very aware on her last day that she was close to death because she had lapsed into a sort of coma, her breathing was very shallow and there were long pauses in between breaths. In her last few minutes she had a death rattle twice. I have never been with anyone as they died before and it made me jump. It was quite disturbing. It sounded to me as though she was about to be sick. My brother is a priest and is more used to seeing death, so was not as alarmed. It helped me to know afterwards she wasn't suffering when she made this noise.

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  12. I extend my sympathy to you and your family. You were fortunate to have your brother with you to provide that support. Thanks for sharing your experience.

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  13. Thank you Frances. You probably realise I am not a hospice worker. I live in the UK and I should explain that I found your site when I was looking on the internet because the sound of Mum's death rattle has stayed with me. There are you-tube recordings of a death rattle sound, but I am not sure I want to hear it again deliberately. We knew Mum was dying about a week before she passed away, and my brother, husband and I were able to spend some time with her every day. For much of that time she was able to interact with us, and we were also able to bring some of her elderly friends to her care home to spend some time with her too. It was only on her last day that she lapsed into a sort of coma and we had no reaction from her at all. I had 'googled' signs of dying so I would know what to expect, so I was aware she might have a death rattle but it still startled me at the time. Something that also sort of upset me, that no one has been able to explain is that in her last couple of minutes of life two tears squeezed out of one of her eyes. I know I am probably reading more into that than I should, but it was still sad to see them at the time.

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  14. It sounds like your mother had a beautiful death journey with positive interactions and supportive closure. Sometimes without realizing it, we interpret patients' responses based on our own feelings. While you may have been disturbed hearing the death rattle sound, you say your mother "wasn't suffering when she made this noise."

    Keep in mind that even when your mother stopped communicating, she still may have heard and appreciated what was going on and being said around her. Your mother experienced what most people dream of when they think of their own deaths. After reading your description of your mother's death journey experience, I think her two tears represented her joy and gratitude in being blessed with such comforting closure provided by loving family and friends.

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    1. How can we be certain that the patient isn't suffering during that death rattle sound? My mom went through that just last week (and died a day later). She was coughing and trying to sit up and her oxygen levels were going way down. The nurses rolled her on her side and suctioned out of bunch of thick mucus. It helped her, but I still fear that she was suffering and couldn't breathe.

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  15. Thank you so much, Frances. Your words are very comforting. it is never easy to lose your mum but you have made me feel better. With best wishes, Catherine ('anonymous')

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  16. My mother is upstairs at my house and has been here for a year. The past month has been insane, the hospice nurses that come expected her to die within the last month. I have just started hearing noises when she breathes, 2 short breaths for what would be a normal breath..the noise is like a gurgling sound. Is this the death rattle. I'm really trying to find information on when the final hours are going to be. She cannot use her arms for the past two weeks. She has the mottling on her forearms and hands, not really on her feet. Also she is hot to the touch not cold. She has always run cold before in her life. Anyone give any hint of what the hours are.

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  17. Continue to work with the hospice nurses. No one can predict with certainty the exact hour your mother will die. You can listen to a recording of a person's death rattle at this post I did recently:

    http://hospiceandnursinghomes.blogspot.com/2013/09/death-rattle-sounds-myths-and-facts.html

    In the meantime, try to relax and allow death to come in its own time. I wish you strength and peace.

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  18. Linda NoonisAugust 28, 2014

    Administering any aid to relieve excess phlegm and/or make breathing easier for the patient who is passing seems to me simply to be an extension of palliative care. If there is some improvement in the patient's breathing and the family feels less anxious, this would be a secondary benefit, but an important one nonetheless.

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  19. AnonymousMay 29, 2015

    How long usually once the person gets the death rattle is it that they die? My grandad is 91 and 3 weeks ago was diagnosed with severe lung and liver cancer, he has deteriorated quickly, 3 weeks ago he was walking, driving and now he is lying in bed. He hasnt eaten in days, he has drank plenty, this morning the rattle started, does anyone have an idea on time, so i can prepare myself and the family and so we can say our goodbyes. Thank you

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  20. I hope this information will be helpful to you in making your decision. I wish you and your family the best.

    The consumer version of the Merck Manual, one of the world’s most widely used medical information resources, states, “The death rattle does not cause discomfort for the dying person. This breathing can continue for hours and often means that death will occur in hours or days.”

    Wikipedia, the free encyclopedia, states further, "While death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex, such as brain injuries."

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  21. My father inlaw is 90 and had 3 strokes and now in a coma for 2 days has the rattle yesterday. How long will he hang on.

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  22. Carrie, there is no set time, but it is usually within hours or days. I wish you and your loved ones the best.

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  23. Hi, my husband has MS and is in a nursing home. He also has respiratory muscle weakness. He has been making a death rattle like sound for about a week or so now. He is alert and oriented and eating and mostly unchanged except that he has a lot of mucus all of a sudden. He is on atropine. Can someone have the death rattle for a while and be alert?

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  24. Liska, the death rattle (note the name) is usually associated with death within hours or days. Patients usually experience increased fatique and slowing down. However, some may have a period of mental alertness and increased energy when they can interact more with loved ones. Each person is unique, and medical staff working with your husband can probably explain his condition better. I wish you both the best.

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  25. My Mom passed 5 months ago ... She stopped eating on a Saturday ...she could no longer swallow so I would wet a washcloth for her ..By Monday she begin the "gurgling" and I called Hospice ..They were there within 30 min . I told then I had given her a washcloth and she explained to me that since she was no longer able to swallow her body didn't need fluids and at this point any fluids would just increase the "gurgling" ...From then on I used the sponge sticks and lip balm on her mouth until Friday when I tried to use it and she tightly closed her lips ... She died a very peaceful death the following Monday .. I was given morphine and ativan for pain along with Atropine if the gurgling started again ... I never had to use the Atropine and only had to use the Morphine and Ativan twice ... Hospice came everyday to check on my brother and I and of course our Mom.. They were angels for us and could never express all of our thanks to them ... She was not responsive the last few days ... But she knew we were with her .... I miss her terribly but feel so privileged that we were able to care for her in her own home granting her that wish .

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  26. My Mom passed 5 months ago ... She stopped eating on a Saturday ...she could no longer swallow so I would wet a washcloth for her ..By Monday she begin the "gurgling" and I called Hospice ..They were there within 30 min . I told then I had given her a washcloth and she explained to me that since she was no longer able to swallow her body didn't need fluids and at this point any fluids would just increase the "gurgling" ...From then in I used the sponge sticks and lip balm on her mouth until Friday when I tried to use it and she tightly closed her lips ... She died a very peaceful death the following Monday .. I was given morphine and ativan for her pain and anxiety/restlessness along with Atropine if the gurgling started again ... I never had to use it and only had to use the Morphine and Ativan twice ... Hospice came everyday to check on my brother and I and of course our Mom.. They were angels for us and could never express all of our thanks to them ... She was not responsive the last few days ... But she knew we were with her .... I miss her terribly but feel so privileged that we were able to care for her in her home and gave her that wish ...

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  27. Such a beautiful story. Your mother must have been happy with the care she received. Thank you for sharing. Your words will help others.

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    1. Thank you Francis ..taking care of her those last 2 weeks as she began her journey was the final gift we could give her ...She passed in the early morning hours the day after Mother's Day ... We were fortunate that we had our last Mothers Day with her to tell her how much we love her and what a wonderful mother she is ..❤

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  28. My mother passed away 3 days ago, she had cancer all through her body, the brain cancer affected her vision. Even though I unfortunately saw a program about terminally ill persons and hearing their death rattle, nothing prepared me for the sounds she made. It absolutely broke my heart. She was struggling and reaching into the air like she wanted to escape the place she was in. I cuddled and kissed my mother's forehead and kept telling her it was time to sleep mum, telling her what a great mother she was, kept telling her we loved her. I said many times its ok to sleep now mum, its time to rest. As I sat with my mother holding her hand, her breathing eventually calmed and very slowly her head turned in my direction and She stopped breathing. Its the most difficult experience I've had. I've lost other family members but wasn't present at their passing.
    It was my wife's suggestion that I give my mother permission to 'close her eyes' and rest. My wife felt my Mother was hanging on for her children because it was Christmas time. My Mother was unconscious the whole time I was with her, but I really do hope she heard me and felt her hand in mine. The palliative nurses were just amazing and kind... even comforting a grown man sobbing cause his most trusted friend died. I want to believe my mum could hear me

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  29. Thank you for sharing your experience. I extend my sympathy to you and your family and commend you on the sensitive manner in which you participated on your mother's journey. You reminded her of your love in many ways and comforted her. In her unconscious state, research indicates she appeared to be more traumatized than she actually was. You say you "hope she heard me and felt her hand in mine." She was aware on another level and, no doubt, very proud of you. If you believe that there is life beyond physical death, she still is.

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  30. I'm listening to my father's dying breaths. I've been so blessed to have him as a father and he's lived a wonderful life. He's 91 years old and very ready for heaven. Reading these journies of others has been comforting. Of course, a quiet sleep would be easier on me, but understanding the death process allows me to be here with my dad as he exits this world for one much better.

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    1. Mort, you are truly blessed to have been the daughter of this wonderful man. Now, you have the privilege of sharing his final journey. What a happy ending to this life! I wish you both the best.

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  31. I am listening to my mother's dying breaths now too, and also finding comfort in these stories. Thank you to everyone who has posted, and to Frances for your kind responses. My mother is 88 and has been ready to go, and we're ready for it too ... just sitting with her and waiting. Listening to her sounds is very difficult - twice already nurses have told us it's the end, but she rallies and her breathing gets better. Hoping it will be soon ... also imagining that we're suffering more than she is, because she looks peacefully asleep.

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  32. Sarah, thank you for sharing your special time and thoughts concerning your mother's end-of-life journey. Knowing that your mother and family are all "ready" enhances the experience even more. With so much loving attention surrounding her, it is not surprising that she is in no hurry to leave. Regarding your "suffering," keep in mind that the level of consciousness of people experiencing death rattle symptoms is usually so low that it is generally believed medically that they are not in any pain. She will leave when she is ready, and you and your family can bask in the satisfaction of knowing the comfort you provided leading to her happy ending.

    Happy endings,
    Frances Shani Parker

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  33. Frances, your responses have been so kind, gentle and reassuring. My mother had a "happy death" with hospice and loved ones by her side and was kept comfortable throughout. That experience prompted me to recommend hospice today for a dear friend who has fought cancer courageously for two years. She is finally ready to accept hospice. I only wish she had done so months ago. It would have made life so much easier for her. But I am grateful that she will be cared for by the best, in the time she has left. THANK YOU for all that you and other hospice angels do for the dying.

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    1. Orion Lake, thank you for taking the time to send me such a lovely word bouquet as I begin my day. Sharing the "happy death" experience your mother had will be very inspiring to many and hopefully encourage them to accept hospice care sooner. Sadly, too many apply late and miss out on benefits they could have enjoyed. It's all about being proactive about our quality of life, being at peace while treated with dignity on our journey. I wish you and your friend happy endings.

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