People get confused at the end of life due to a combination of the body slowing down, organ function changes, and the effects of illness and medications, leading to delirium, a sudden decline in brain function causing disorientation, memory issues, and hallucinations, often characterized by restlessness or withdrawal, but this is a natural part of the dying process, not usually painful. Common causes include chemical imbalances, dehydration, infection, low oxygen, severe pain, and medication side effects, impacting the brain's ability to process information.
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.
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.
What to do for someone who is dying
Pain, dyspnea, anorexia, constipation, fatigue, depression, and anxiety are among the most common symptoms a patient at the end of life can encounter. Healthcare team members must screen for these and any other symptoms the patient may experience.
The length of end-of-life confusion can vary greatly depending on the individual, their illness, and other health factors. For some patients, confusion may appear only in the final hours or days of life. For others, it may begin weeks before passing and gradually increase in frequency and intensity.
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.
The “three magic phrases”—you will not be alone, you will not feel pain, we will be okay—struck a chord with me not only as someone who has sat beside dying friends, but as someone who has wondered what I would want to hear if it were me.
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.
It is the goal that no one dies alone. But believe it or not, it is a choice and the hospice philosophy recognizes and celebrates that choice. Hospice staff and volunteers can attest to the dying choosing when they will die. People working with the dying are aware that some wait to be alone to die.
Morphine is an opiate, a strong drug used to treat serious pain. Sometimes, morphine is also given to ease the feeling of shortness of breath. Successfully reducing pain and addressing concerns about breathing can provide needed comfort to someone who is close to dying.
Speak soothing words
In the final hours of life, signs of the body shutting down become more apparent. These may include: Irregular or shallow breathing (Cheyne-Stokes respiration) Coolness in the hands, feet, or limbs.
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.
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.
Often seen in delirious or semiconscious patients, carphologia describes the actions of picking or grasping at imaginary objects, as well as the patient's own clothes or bed linens. This can be a grave symptom in cases of extreme exhaustion or approaching death.
When your loved one's heart and lungs begin to shut down, oxygen levels in their body decrease. The loss of oxygen to their brain can make them confused or disoriented. They might hallucinate or talk to people who aren't there. This can be hard to watch, but these occurrences are all natural parts of the dying process.
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.
Tell Them It's Okay to Let Go
First, assure them that while it's normal to want to hold on at the end of life, it's okay to let go. Don't force things, but do remind your loved one of how much you love them. Let them know you're not angry and don't hold any resentment that they're dying.
Many people reach up or raise their arms near the end of life—it's a common and beautiful part of the journey. Some say it's the soul beginning to lift, reaching toward something beyond.
Phrases like, “I'm always here if you need to talk” or “You're not alone in this” can provide the reassurance they need. The goal is to offer comfort and remind them that they have your unwavering support.
The following symptoms are often a sign that the person is about to die:
If you move the person, be very gentle and tell them what you are doing. A few layers of light, warm clothing and bedding can help to keep them at a comfortable temperature. As the person gets closer to death, their breathing pattern will probably change.
A dying person may also keep hanging on due to emotional reasons. Some of these reasons include: Guilt. Some hospice patients may feel guilty about leaving loved ones behind or missing their life milestones.