What Is the “Death Rattle”?

“Death rattle” is the term used to describe the gurgling sound that many people make when they are actively dying. Although it can be distressing to family members and others at the bedside, it is simply the sound of air passing through saliva or mucus that has built up in the back of the person’s throat. Since swallowing or coughing is often difficult for those who are dying, these secretions collect in the airway and are difficult to clear. 

This sound may be likened to the noise you hear when the last of liquid in a glass is sucked up through a straw.

Death rattle occurs in about half of people who are close to death, usually within the last 24 to 72 hours of life. Research confirms it is not a sign of respiratory distress for the person who is dying. Most often, this sound happens naturally when the patient is unconscious and unresponsive while breathing with an open mouth. However, it may be present at other times. 

Death Rattle’s Effect on Families

Witnessing a death rattle can be unnerving for families. In a recent study, researchers looked at the impact of the experience on loved ones and found that a majority of relatives found the symptom to be upsetting. Their concerns included subjective issues  (e.g., it sounds “horrific” or “inhuman” ) and objective concerns about the suffering of the dying person, whom several participants said seemed like they were “suffocating.” Many family members also felt the death rattle lasted an inordinate amount of time. As one participant said “… everybody is saying that when you hear this rattle, death is near…Two days then is a long time …”

It should be noted that not all families who were interviewed for this study found the death rattle burdensome, and the sample size was small (only 19 of 95  families agreed to be interviewed.) However, the death of a loved one is already traumatic. Healthcare providers should seek solutions to ease the suffering of family members to the greatest extent possible during this difficult time. 

In that regard, education is a key component of helping family members cope. For example, bedside nurses and hospice staff can reassure the family that the patient is not suffering despite the disturbing sound. However, if the family is in severe distress, providers can try medications that may reduce saliva production and relieve the death rattle a bit. Anticholinergic drugs such as atropine and scopolamine are often used for this purpose, although their efficacy varies significantly. There is also concern among some clinicians that their use may induce unpleasant side effects for the dying patient, such as dry mouth, urinary retention and confusion. However, it has not been determined that patients in the final stages of dying actually experience these effects. 

Fostering better understanding for families

While healthcare providers grapple with the challenge of helping loved ones cope with the death of their loved one, some end-of-life clinicians have taken to social media to try to educate the public about what it’s like to watch a loved one die. HOSPICE NURSE JULIE, for example, offers a video on her YouTube channel that demonstrates the death rattle and attempts to clarify what the sound means. We invite you to watch the video if you would like to learn more. 

Sources

“Death Rattle”. National Cancer Institute. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/death-rattle 

“Death rattle is not associated with patient respiratory distress: is pharmacologic treatment indicated?” Journal of Palliative Medicine. https://pubmed.ncbi.nlm.nih.gov/24047451/ 

“Understanding relatives’ experience of death rattle”. BMC Psychology. https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-020-00431-3 

“Atropine”. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470551/ 

“Scopolamine Transdermal Patch”. Medline Plus. https://medlineplus.gov/druginfo/meds/a682509.html 

“Assuaging listener distress from patient death rattle”. Annals of Palliative Medicine. https://apm.amegroups.org/article/view/21469/22764