What Is The Downward Spiral And How Is It Predicted?

The ‘downward spiral’ refers to the time period leading up to someone’s expected death.  Experienced nurses and physicians can see this and when asked, will say, “I’d be surprised if she were still alive in 6-12 months”.


The following are seen in the ‘spiral’; the more of them you have, the more likely a person is in the ‘spiral’.


  1. Increasing dependence on others. One of the best predictors of approaching EOL [end-of-life] is needing increasing help with ADL’s [Activities of Daily Living]:  dressing, bathing, toileting, food preparation, walking.
  2. A new incurable and terminal disease [such as metastatic cancer] develops.
  3. They eat less; and steadily lose weight; and sleep more in the day.
  4. Saying frequently they “won’t be here this time next year”; that they are “tired and ready to go”; wanting to see deceased relatives!
  5. Suddenly making funeral arrangements; buy a gravesite, complete a will, make a list of who gets what after they die.
  6. An increase in doctor visits and hospitalizations.
  7. Losing interest in activities/readings/TV/family.


It’s important to make sure they don’t have an easily treatable problem or that they aren’t primarily depressed (where taking an anti-depressant might reverse their decline).  If not, and they have many of the above behaviors, then help them focus on living ‘comfortably’.

And, as the wise ‘Maxine’ says: “try to stay away from doctors”!