When the end of life is approaching, physical and mental changes become evident, including increased sleep, reduced eating/drinking, breathing pattern changes (irregularity, pauses), cooler extremities (hands/feet), mottled skin, confusion (delirium/hallucinations), restlessness, incontinence, and less verbal communication, signaling the body is shutting down, with focus shifting from sustenance to comfort, requiring open communication with palliative care teams for support.
Active dying is the final stage of the dying process that lasts roughly three days. By definition, actively dying patients are very close to death, and exhibit many signs and symptoms of near-death. Actively dying patients are often unresponsive and their blood pressure often drops significantly.
In the last few days of life, they might sleep for longer periods and seem less aware of what's going on around them. They may still have some awareness of what is happening in the room. They may be able to hear what's being said or feel someone holding their hand.
Physical signs of dying
Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing. Towards the end, dying people will often only breathe periodically, with an intake of breath followed by no breath for several seconds.
In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before they die.
Actively Dying: 24 - 48 Hours before Death
Near the end of life, breathing (respiration) may become irregular. Your loved one may have periods of rapid breathing or stop breathing for a short time. Coughing, noisy breaths, and shallow breathing are common in the final hours or days of life.
As people get closer to dying, they may sleep more, become drowsy or be difficult to wake. They may fall asleep while talking. A person may slowly lose consciousness in the days or hours before death. When visiting someone with advanced cancer, be aware that visiting may be tiring and difficult for the dying person.
Seven Minutes of Life
During this short window, electrical surges ripple across the cortex, creating what some scientists describe as a last burst of consciousness . Some neurologists believe this window could be responsible for the life-flashing-before-your-eyes phenomenon reported in near-death experiences.
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.
Some studies have shown that your brain releases a surge of chemicals as death approaches that may heighten your senses into a state of awareness or even hyperreality.
Because of decreased fluid intake, the person's urine output will naturally decrease. As a result, the urine may become concentrated and “tea” colored. The person may also lose control of urine and bowel function as the muscles in that area begin to relax.
Restlessness. 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.
In the last days and hours, fluid build-up in the lungs and slower (and skipped) breaths lead to what we call the “death rattle.” This is one of the most tell-tale signs someone is actively dying. They are not suffering, although the sounds of the death rattle often cause loved ones to worry.
A recent study, however, reveals that hearing is the last sense that remains for dying patients. With this in mind, Heart to Heart Hospice can help guide you to provide meaningful moments during their final days even when they can't respond.
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.
In the last 48 hours of life, common symptoms include significant changes in breathing (faster, slower, pauses, noisy), increased sleep/unresponsiveness, confusion or delirium, cold/mottled skin (especially extremities), decreased appetite/thirst, loss of bladder/bowel control, and restlessness, often with a "death rattle" from fluid buildup, as the body slows down and organs begin to shut down, emphasizing comfort care.
Saying someone is your "seven minutes" means they are a significant, beautiful memory that you would want to experience one last time before you die, or a person whose memory is so important they would dominate your final moments.
Rather, patients speak of relationships with the people they love and who love them; what life means to them and how they might be remembered; the reality of death; their hope that they won't be a burden to others; their worry about how those they are leaving behind will manage without them; and a fear of the process ...
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.
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.
Objective To determine if functional decline differs among 4 types of illness trajectories: sudden death, cancer death, death from organ failure, and frailty.
The end-of-life process varies greatly, lasting from hours to weeks or even months, depending on the individual and illness, with the "active dying" phase often taking days or hours as the body slows down, though some symptoms can appear months earlier in the pre-active stage. It's a gradual, natural winding down, not a fixed timeline, with some experiencing peaceful transitions while others may have periods of restlessness or confusion.
What to do for someone who is dying
Fatigue (feeling very tired) is one of the most common symptoms in the last days of life. A person's fatigue may become worse every day during this time. Drowsiness, weakness, and sleep problems may occur.