When someone is approaching death, especially an elderly person or someone with a terminal illness, their body and behavior go through a number of changes. Recognizing these changes can help you understand your loved one’s journey as their life comes to an end.
Many of these changes can cause some distress for family members and people looking on, but they’re not necessarily uncomfortable for the dying person. If you understand what they mean, you may be better able to cope with your loved one’s decline.
These signs typically begin to appear in the weeks before death. As death comes nearer, changes may be more apparent and new symptoms may arise. Active dying — the final stage of the dying process that lasts no more than a few days — comes with its own set of symptoms.
This information applies less in cases where death is quick or sudden. Some of these signs may be present just before a sudden death, but they are much more likely to occur and be noticeable in a death that comes after a decline.
Here are the signs and symptoms that indicate a person is close to death:
1. Loss of appetite
As the end nears, the dying person will begin to want less food and water. This is normal and it’s okay not to expect them to eat or drink more than they want. To alleviate some of the discomfort from dehydration, you can help them eat popsicles if they want them, or apply lip balm to their lips and lotion to their hands.
Sometimes, a dying person will stop eating and drinking altogether. This can be voluntary, as a way of bringing a terminal illness to its conclusion more quickly. Or it can be because they are rarely or never conscious, or because they simply have no appetite at all. Generally a person will eat when hungry, so a total loss of appetite in a dying person isn’t something to feel distressed about.
2. Less frequent urination and defecation
As a person eats and drinks less, their toilet habits will change as well. They may not need to move their bowels much, if at all. Urine may be dark-colored because of dehydration. If they have stopped eating and drinking entirely, and are not receiving IV fluids, they may not need to use the bathroom at all.
If the person is still drinking but is bedridden and unable to get up to use the bathroom, it’s a good idea to ask their care providers about installing a catheter, if this hasn’t been done already.
3. Frequent sleeping
In the months before death, a person will generally sleep more and more. Their body is weak and needs more rest than a healthy body does. It’s important to let a dying person sleep when they feel tired. When possible, encourage them to get out of bed and walk a bit, or turn them to a new position if they can’t do that, to try to prevent bedsores from developing.
4. Physical weakness
As the body weakens, another symptom will be an inability to do things like walk or sit up. As their decline progresses, a dying person may not even be able to turn in bed or hold objects. Again, you can help turn them to prevent bedsores, and caregivers may also be needed to help them eat and drink and hold other objects as needed.
5. Talking less
A dying person may not want to socialize much. Talking can be tiring, but that might be only one piece of the situation. Sometimes a dying person is acutely aware of the changes to their body, and they feel uncomfortable letting others see their decline. Other times, they are not lucid enough to carry on a conversation. Some simply lose interest in socializing and will prefer not to respond to questions.
Though it can be upsetting when a loved one seems not to want to talk, it’s best not to insist that they socialize when they don’t want to. Instead, respect their wishes and sit quietly if they prefer not to talk, and don’t bring in other visitors if they’ve requested privacy.
6. Blood pressure drops and heart rate changes
If you’re taking a dying person’s blood pressure regularly, you’re likely to see it drop in the days and weeks before death. You may also notice that their pulse becomes irregular and hard to measure.
7. Changes in appearance of skin
As the dying person’s blood pressure drops, less blood travels to their arms and legs. This leads to one change that is typically a sign that death is imminent within hours or days. The skin of the arms, legs, hands, and feet becomes mottled with purple, black, and/or blue patches.
The skin may also feel cool to the touch. If you are concerned that they may be cold because their skin is cool to the touch, you can offer a blanket or cover them up if they’re sleeping. The lips and nail beds may also look pale or bluish due to the reduced circulation.
8. Changes in breathing
A dying person’s breathing is typically not as easy and regular as it once was. They may experience some trouble breathing and gasp for air. There may be long pauses between breaths.
In their final hours and days, you might hear a rattle in their throat as they breathe. This is due to phlegm or fluid in their throat and is often very distressing to loved ones looking on, but it is not uncomfortable for the dying person. In fact, it can indicate that they are in such a deep and relaxed sleep that they’re not bothered by the fluids that would make us want to clear our throats.
As death is imminent, a breath pattern called Cheyne-Stokes breathing may begin. This is a series of short, rapid breaths followed by a long pause in breathing.
9. Confusion and hallucinations
A dying person may have periods when they are confused or incoherent. They may see things that aren’t there, or speak to people who aren’t in the room. Sometimes they might feel scared that someone is trying to hurt them, even when that isn’t happening. If they seem distressed, try to soothe them if possible, but be aware that these mental changes are normal.
Sometimes a dying person will pick at the bed covers or their clothing, or move their arms and legs restlessly. If you perceive that they’re uncomfortable and need to be changed or have blankets put on or taken off, you should step in to help. But these agitated movements might just be involuntary, with no external cause.
11. Surge of energy
Some dying people will experience a sudden increase in energy a few days before death, showing a new desire to eat after a reduced appetite, or to get out of bed after being bedridden. This typically doesn’t last long, and the previous state of weariness will return. This doesn’t always happen, so don’t necessarily be expecting it.
12. Loss of consciousness
It’s not uncommon for a dying person to entirely lose consciousness for hours or days before death. They won’t wake to eat, socialize, or use the bathroom. Despite their unconscious state, their eyes may be partially or fully open.
Even when your loved one is no longer waking up at all, you should still mind what you’re saying in their presence. Research shows that hearing is the last sense that remains before death, and it’s likely that a dying person can hear what’s said around them, even if they’re unconscious. You can still offer calming words, express your love, and talk about memories.
When death takes place
You might not know right away that your loved one has died, especially if their breathing has been quiet and they’ve been unconscious. If a heart monitor is attached, it will alert you that their heart has stopped. If not, you may notice that their breathing and heart have stopped. If you’re unsure, you should ask a health care provider for assistance.
It’s your right to spend some time with your loved one’s body after their death, if you wish. You can take some time to say goodbye before alerting medical staff or calling the funeral home. On the other hand, if this makes you feel uncomfortable or you otherwise prefer not to remain in the room with your loved one after their death, that’s also fine.
If you’ve been taking care of a dying loved one for some time, their death is likely to bring a wide range of emotions. It’s a good idea to talk about the grief and other feelings that follow a loved one’s death. Grief counseling and grief support groups are there for you as soon as you’re ready to connect with others who will understand. You can find comfort in Legacy’s online support groups.