As someone nears the end of life, expect significant physical and mental changes as their body slows down, including increased sleep, reduced eating/drinking, skin coolness/discoloration (mottling), changes in breathing (irregular, noisy, pauses), and potential confusion or hallucinations; they may also become less communicative but can often still hear, requiring gentle presence, soft talking, and comfort care, even as consciousness fades towards the final hours or days.
For some people, the dying process may last weeks. For others, it may last a few days or hours. A dying person's experience may be influenced by their illness or medications, but certain signs and symptoms are common.
What are the three stages of death within the final 24 hours? Increased restlessness, decreased appetite and fluid intake, changes in breathing, and confusion or agitation. Unresponsiveness, slowed or erratic breathing, cool extremities, and changes in skin coloration.
The dying person's face, hands, arms, feet and legs often become very cool to touch. Their skin might also become pale and look blotchy or mottled. This happens because there is less blood circulation to these body parts.
Some people can become restless in the last few days of life. They will usually become calm again before they die. They may appear confused and not recognise familiar faces, and even see or hear people or things that are not actually there - for instance, they may see pets or people who have died.
Sudden death, terminal illness, organ failure, and frailty are the four most common types of illness trajectories found in end-of-life care.
Can a person tell when they are dying? Sometimes, a person who is very ill tells other people that they think they might be dying. Some people do say this when they are close to death. For other people, it might be that they feel unwell at the time but then feel better again for a while.
Hospice Isn't About Giving Up
It's not a place to speed up the process of dying. A doctor suggesting hospice does not mean they're giving up on providing care and medical treatment. It's end-of-life care, but this doesn't mean giving up hope. It means shifting focus from curative treatments to comfort and support.
As organs and bodily functions shut down, minimal amounts of nutrition or hydration/liquids might be needed, if at all. We recommend using the body's gradual decline as an indicator for when to stop giving food and water to hospice patients.
You can simply sit with the person and perhaps hold their hand. Hearing is said to be the last sense to go, so you may want to talk to the person or even have a conversation among the people in the room so that the person knows they are not alone. You could read aloud, sing or hum or play some of their favourite music.
In the final days and hours, a person may “wait” for someone to arrive—or let go when everyone is out of the room. Hospice nurse Barbara Karnes, RN, explains the limited control we have over the timing of when we die.
What other signs might there be that death is near? One is 'terminal agitation' or restlessness. This often appears as a need to get out of bed, agitated behaviour or commonly plucking of the sheets or 'knitting' of the hands. They might reach out as if towards something or somebody.
Research suggests that even as your body transitions into unconsciousness, it's possible that you'll still be able to feel comforting touches from your loved ones and hear them speaking. Touch and hearing are the last senses to go when we die.
Speak soothing words
“I love you, always.” “I'm here for you, no matter what.” “You're not alone; we're in this together.” “I'm just a phone call away.”
The 80/20 rule is part of the Medicare hospice rule that ensures most hospice services are delivered where patients feel most comfortable — at home. Under this guideline, at least 80% of all hospice care must be provided in a patient's home setting, such as a private residence, assisted living, or nursing facility.
One of the hardest things to witness in hospice is seeing someone you love slowly change. At this time, you can see how fragile life can be. There is a moment when a person's strength diminishes, and they start to lose their independence.
Unexplained Injuries Are a Major Warning Sign
Bruises, fractures, burns, or cuts without clear explanations are serious nursing home red flags. Physical abuse, neglect, inadequate supervision, physical restraints, and even sexual abuse often lead to these injuries.
Change in breathing.
Changes may include Cheyne-Stokes breathing or shallow breaths with periods of no breathing for a few seconds to a minute, as well as rapid, shallow panting. These patterns are common and indicate a decrease in circulation as the body shuts down.
This period runs from 3 to 72 hours after death. The early post-mortem phase is most frequently estimated using the classical triad of post-mortem changes – rigor mortis, livor mortis, and algor mortis.
Foot rubs, stroking an arm or shoulder, kisses, smiles and gazing into someone's eyes all communicate compassion, love and gratitude for a shared lifetime. Your presence and your touch rank among the most eloquent, regret-free ways there are to say goodbye.
People nearing death may report encounters with people who are already deceased or describe having been places or seen things not visible to others. These experiences, often referred to as visions or hallucinations, are not typically a drug reaction or mental illness.
Some proponents of the trifunctional hypothesis distinguish two types of threefold deaths in Indo-European myth and ritual. In the first type of threefold death, one person dies simultaneously in three ways. He dies by hanging (or strangulation or falling from a tree), wounding, and by drowning (or poison or burning).
“We found that both impaired olfactory identification and sensitivity functions are associated with frailty, which is interesting because it shows that it's not just your aging brain at work here, but it may also be something peripheral, like something at the level of your nose that is able to predict our impending ...
The eight signs identified were nonreactive pupils, a decreased response to verbal stimuli, a decreased response to visual stimuli, an inability to close eyelids, drooping of the nasolabial fold, hyperextension of the neck, grunting of vocal cords, and upper gastrointestinal bleeding.