Mottling of the skin isa common symptom that occurs near the end of life.Red and purples spots appear on the toes, feet, and fingers and spread slowly up the arms and legs. Lips may turn purple as well.
Mottling is caused by poor circulation; the patient’s heart can no longer pump blood effectively. This causes deprivation in the outer extremities, but eventually affects other body parts as well. It normally starts a few days prior to death but can appear up to four weeks earlier.
Treating mottled skin
Because itoccursso close tothe end of life, there is no way to treat mottlingof the skin.Impaired cardiac output cannot be reversedonce the underlying illness hasentereditsfinalstage.By the time mottling appears, most patients have stopped eatingand drinking. Their breathing has become irregular, and they are mostly uncommunicative.The weakening of theheart is another sign the body is failing. Now that it cannotprovideadequate blood flow, the only treatment is to make the patient comfortable as possible.Lack of blood flow means their limbs will be cold, so the best thing to do iswrap them in blankets to keep them warm.
For the most part, patientswithmottledskinare bed bound, but a fewwill remainmobile.However, even if a patient can stand, they should not be allowed towalk unescorted.Because of their poor circulation andlow blood pressure,there is a danger they may faint and fall.
Thoughmottledskin is painless,it may be connected to more serious symptoms.If the heart is having trouble pumping blood,patients are likely to feel short of breath.At the same time, muscles may begin to break down from lack of nutrients, whichcan bepainful.Fortunately, bothsymptoms can be treated.The hospice team will monitorthe patient, but alert them if you notice any changes or discomfort.
Spiritual & emotional interventions
Mottling of the skin indicates the patient does not have much longerto live. Families should alert relatives and friends so they can come pay their final respects. Parentsmaywant to sit down withyoung childrenandprepare them for the reality of death.Adultsand older childrencanturn tothe hospicechaplain if they need help processing their grief.
Most patients decline rapidly after mottling appears, so they should saytheir finalgoodbyes as soon as possible.They can also ask the chaplain for spiritual support or help arranging last rites.
Mottling of the skin near death
Mottling of the skin signals death is imminent.The hospice team will be on hand to ease the transition and keep the patient comfortable. Meanwhile, families need to prepare themselves for their loved one’s demise.Tell them how you feel and make sure they have an opportunity toexpress their final thoughts before they go.
Jose Escobaris the Hospice Executive for Parentis Health. He works with patients and families across Southern California,providingsupport and education,in order toalleviate the pain and suffering of chronic and terminal illness.
Lewis Jacksonwrites about technology and healthcare. His workprovidespractical insight into modern medicine and healthy living.
