A dying person becomes agitated due to physiological changes like organ shutdown, causing waste buildup and low oxygen to the brain, leading to confusion (delirium) and restlessness; metabolic shifts; dehydration; uncontrolled pain; medication side effects (like opioids); or emotional/spiritual distress, often manifesting as confusion, restlessness, fidgeting, or irritability, though it's usually a natural, treatable part of the dying process.
What are the three stages of death within the final 24 hours?
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.
Just say goodbye in a way that lets the person know that he or she will always be important to you. If you are leaving for a longer time and unlikely to see the person again, your goodbye may be more emotional. You might acknowledge openly that you don't know whether you'll be with each other again.
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.
Terminal agitation, or restlessness, is a condition marked by agitation, confusion, and emotional distress during the last few days or hours of life. These changes in mental and emotional state are typically uncharacteristic and sudden. Terminal agitation may subside on its own or with treatment.
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 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.
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.
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.
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.
Many people wonder if their departed loved ones visit them after death. Spiritual beliefs vary widely, but many cultures and religions hold that our connections with those who have passed continue in some form. Some believe that after death, loved ones can reach out through dreams, signs, or other subtle ways.
We do not know exactly what people feel or see as they die. Some people who have had near-death experiences say that they saw a light or saw people they knew who had died. Other people say they felt peaceful or felt a sensation of leaving their physical body.
The person who is ill will want to be with loved ones, and may also feel a sense of responsibility towards them, not wanting to fail them nor cause them grief. He/she may have unfinished business. For example, the person may or may not want to reconcile with estranged family members or friends.
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.
Terminal agitation is more intense than a mood swing or feelings of sadness or anger that often arise as a person nears death. Terminal restlessness is often characterized by: Agitation (fidgeting, pacing, twitching, tossing and turning) Anxiety, fear or panic.
Sharing memories of good times is another way some people find peace near death. This can be comforting for everyone. Some doctors think that dying people can still hear even if they are not conscious. Always talk to, not about, the person who is dying.
5 things to say to someone who is dying
“I love you.” – you can express love to offer them comfort. “Thank you for everything.” – you can acknowledge their impact on your life so they know how important they are to you. “I'm here with you.” – let them know they aren't alone and you will support them.
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:
it does show that most people die between 2 a.m. and 5 a.m.," she says. She explains that some professionals refer to this window as the "letting go hour." Other studies and experts have a slightly different take, citing the most common time as 6 a.m.—8 a.m., or even peaking at 11 a.m.
Speak soothing words
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.
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.
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.