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Sudden improvement before death?


Specializes in Geriatric Psych.

Have you had experiences with pts having a marked sudden improvement just before death? I have a friend whose mother went unresponsive (they were unable to wake her) for most of the day yesterday. She is in end stage Parkinson's and recently had a second CVA. That was the first time she has been unresponsive.

They were finally able to wake her last night for very brief periods where she would say one or two words, then go back to sleep.

My friend prepared herself for a death vigil. Before her mother became unresponsive and since her last stroke, she has been very weak, not able to speak loudly enough for anyone to hear her, and not "brightly" alert.

Today, her mother has awakened and is bright-eyed, alert, and talking better than she has in months. My friend is wondering if this could be the phenomenon of getting much better just before death. Since I am a nurse she asked me that question.

I told her I just don't know. I've been a nurse since 1998, and I've seen a few people improve a little just before death, but not that much. I would be interested in hearing your experiences on this.

Nurse Ratched, RN

Specializes in Geriatrics/Oncology/Psych/College Health.

Used to see it all the time in the nursing home. Was unfortunately often a very accurate predictor.

wonderbee, BSN, RN

Specializes in critical care; community health; psych.

I saw it happen with my own mom.

Seen it a million times....(okay, not a million, but you get what I'm saying)

Same thing happened with my Mom. She had been unresponsive for 2 days and then was completely alert for a few hours. It was nice because she got to cuddle with my daughter one last time.

jnette, ASN, EMT-I

Specializes in Hemodialysis, Home Health. Has 10 years experience.

Have not seen it, but have certainly heard of it.... many times by family members.

I've seen it too. Its a mixed blessing because while it gives the loved ones a last chance for a bit of quality time, it often gives them false hopes that the patient is going to completely pull out of it.

renerian, BSN, RN

Specializes in MS Home Health.

Calm before the storm/I have seen this many times

Definitely.....see it more often than not.

I've seen temps go back to wnl

i've seen sudden progress on non-healing wounds

i've seen hunger in anorexic patients

and i've seen alertness in lethargic/obtunded patients.

To this day, i find it a phenomena and never cease to be amazed.

KaroSnowQueen, RN

Specializes in Telemetry, Case Management. Has 30 years experience.

Very common. Seen it a zillion times, pt in bad shape, get in report, pt doing better, awake, eating, etc, and we know that the end is near.

Yeah, I seen it on my granfather. He was haveing strokes one after another.He got very mean so we had to put him in a nurseing home.He did not know who my granmother was untill she came in that day and he said thats my wife.My granmother thought he was gonna pull through. I tried to tell her he was not gonna get better.That he had a major stroke and died. So i know that is very true the calm before the storm. He was also very nice day talkin about a light he seen in his dreams the night before. That is one thing my granmother will always remembers he knew who i was before he died and not "The old bag thats changes me!"

txspadequeenRN, BSN, RN

Specializes in ICU, PICC Nurse, Nursing Supervisor. Has 20 years experience.

I work in hospice often ,it happens in about 97% of the patients I deal with.

That happeened to my mom. She suddenly gotten better, sat up, ate some of her favorite jello, took a sip of juice, and then she just drifed away and died.


VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

I can't count the number of times I've seen this phenomenon. The most recent was a couple of weeks ago, when a comatose patient I'd cared for several times suddenly woke up, looked at his wife and family gathered round, smiled and said a few words. They thought it was a miracle. I tried gently to discourage this thinking, but to no avail, and they were genuinely shocked when he slipped back into the coma and died an hour later.

Havin' A Party!, ASN, RN

Specializes in ICU, CM, Geriatrics, Management. Has 10 years experience.

txspadequeen921 said:
... happens in about 97% of the patients I deal with.

Knew it was common. But didn't think it was that high a proportion.

Thanks for quantifying your experience.

nursedawn67, LPN

Specializes in Geriatrics, LTC.

Been there....seen that! Over and over again.

nursnancy, LPN, RN

Specializes in Geriatric Psych.

txspadequeen921 said:
I work in hospice often ,it happens in about 97% of the patients I deal with.

Wow! 97%? I didn't realize it was that common.


Specializes in NICU- now learning OR!.

Absolutely. I have heard it many times and I have seen it personally.

On the personal side, it can be a wonderful way to say goodbye.

On the professional side....when they "perk up" like that - I was told to get the family in ASAP!


ADN Dec 2005