Mottling of the skin is a 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.
Because it occurs so close to the end of life, there is no way to treat mottling of the skin. Impaired cardiac output cannot be reversed once the underlying illness has entered its final stage. By the time mottling appears, most patients have stopped eating and drinking. Their breathing has become irregular, and they are mostly uncommunicative. The weakening of the heart is another sign the body is failing. Now that it cannot provide adequate 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 is wrap them in blankets to keep them warm.
For the most part, patients with mottled skin are bed bound, but a few will remain mobile. However, even if a patient can stand, they should not be allowed to walk unescorted. Because of their poor circulation and low blood pressure, there is a danger they may faint and fall.
Though mottled skin 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, which can be painful. Fortunately, both symptoms can be treated. The hospice team will monitor the patient, but alert them if you notice any changes or discomfort.
Mottling of the skin indicates the patient does not have much longer to live. Families should alert relatives and friends so they can come pay their final respects. Parents may want to sit down with young children and prepare them for the reality of death. Adults and older children can turn to the hospice chaplain if they need help processing their grief.
Most patients decline rapidly after mottling appears, so they should say their final goodbyes as soon as possible. They can also ask the chaplain for spiritual support or help arranging last rites.
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 to express their final thoughts before they go.
Jose Escobar is the Hospice Executive for Parentis Health. He works with patients and families across Southern California, providing support and education, in order to alleviate the pain and suffering of chronic and terminal illness.
Lewis Jackson writes about technology and healthcare. His work provides practical insight into modern medicine and healthy living.