It’s never easy to think about your or your loved one’s death, but the reality is that everyone reaches this stage at some point in their life. While we all go through a different journey, there are some common end of life signs that may indicate when we are nearing death.
As much as you might not want to think of the dying process, knowing what to expect as death approaches can help you prepare ahead and make necessary arrangements. It also allows you to maximize the time you have left and spend more time with your family, friends, and loved ones.
With that, here’s a guide containing more information on what to expect at the end of life. Whether you intend to prepare yourself for this inevitability or plan to arrange hospice care for your loved ones, you can continue reading below to understand the signs and stages of death and dying.
End of Life Signs
Decreasing Appetite and Thirst
As a person’s body starts to shut down, it stops seeking the nourishment and energy that it normally gets from food. As such, you’ll notice a dramatic decrease in appetite, with patients refusing food and water. While this is understandably upsetting, it’s important not to push someone to eat or drink when they are dying, as doing so can increase the risk of stomach concerns or choking.
Changing Toilet Habits
In line with their decreasing appetite, dying people may also have reduced bowel movements or have difficulty urinating and passing waste. It’s also common to experience incontinence over time—usually due to a terminal illness or surgery. When this happens, healthcare professionals may opt to place a urinary catheter to help.
Dying patients may sleep more than usual due to slowing metabolism, resulting in less energy and increased fatigue. At times, certain medications may also cause more drowsiness. But whatever the case, you should allow the person to sleep to keep them comfortable. In addition, caregivers may help reposition them from time to time to avoid muscle stiffness.
Weight loss is another common physical change near the end of life. This may be caused by illness, excessive treatments, or the general loss of appetite from your weakening or slowing body. Your skin may also get thinner and frailer since it gradually becomes more difficult to regenerate skin cells.
Changes in Breathing
Breathing difficulties may become more prominent as you approach death. One moment, you might be breathing normally—then the next, you alternate between periods of rapid breathing followed by periods of no breathing (apnea). Breathlessness and shortness of breath are also common symptoms at the end of life.
Additionally, as dying patients get closer to their last day, they may experience what’s known as the death rattle. Over time, mucus and fluids get trapped in your airways and lungs, causing a rattling sound when you breathe. While this can sound alarming, patients don’t usually feel pain or might not even be aware of the congestion.
Pain is one of the most common symptoms experienced by dying persons at the end of life due to disease progression or worsening of chronic conditions. According to a Health and Retirement Study, arthritis was the top predictor of pain. Based on the results, more elderly patients with arthritis reported pain at the end of life than those without arthritis.
Fortunately, doctors can prescribe appropriate pain medication to help patients stay as comfortable as possible.
People may gradually talk less as they get weaker and become less conscious of their surroundings. However, you can still hold their hand and talk to them even if they no longer respond to you. Hearing is widely believed to be the last sense that fades in the dying process, so you can continue to offer words of comfort to your loved ones in their final moments.
Nausea and Vomiting
Worsening illnesses or persistent medications and treatments can cause nausea and potentially even vomiting. The case can vary from one person to another, so it’s important to consult with a doctor or nurse, who can adjust their medication or suggest a potential remedy. Aside from this, you can also explore options like trying different food, eating smaller portions, going out for some fresh air, and limiting odors in the room to prevent such symptoms.
Drop in Body Temperature
As a person approaches the end of life, the part of the brain that regulates body temperature gradually stops functioning. For some, this may result in erratic temperature changes where they fluctuate between feeling hot and cold.
Once a dying person reaches their final days, their body temperature may drop by a degree or more. At this point, their circulation focuses on internal organs, causing reduced blood pressure and blood flow to the hands, feet, and lips. When this happens, you may notice their skin feeling cold to the touch and looking pale or mottled, even though the person may not necessarily feel cold.
Delirium and Restlessness
Delirium may sometimes occur near the end of life due to disease progression, medications, infections, dehydration, or constipation. In such cases, a person may suddenly feel confused, disoriented, agitated, and restless, making it difficult to stay relaxed. Sometimes, they may also experience hallucinations and see or hear things that aren’t there.
If you notice your loved one exhibiting this behavior, you can inform their doctor or nurse. This way, they can prescribe appropriate medicines or help create a safe and relaxing environment for patients. The latter can be done by dimming the lights, putting calming scents, and the like.
As you near death, it’s common to experience sensory changes like illusions and hallucinations. A dying person might see, hear, or feel things that don’t exist or mistake an object for a person or sound for another thing. Some may also experience a type of near-death awareness and start talking about seeing God or other religious figures—or perhaps even loved ones who have passed away before them.
Timeline for End of Life Signs
Now that you’re more familiar with the common end of life signs, it’s equally important to know when to expect them. Of course, everyone has different experiences, but there are generally some signs you can look out for to indicate the final moments in a person’s life.
To better understand the dying process, here’s a timeline leading up to the end of life. Knowing this can help you properly plan for end of life care, whether for yourself or a loved one.
Weeks Before End of Life
Weeks before the end of life, a person may start exhibiting changes related to their eating habits, sleeping patterns, and sociability. Specifically, they sleep for longer periods, refuse solid foods, and become more withdrawn and uninterested in communicating with others. At this stage, patients may spend more time alone or with their thoughts.
During this time, you can keep your loved one company and help them be as comfortable as possible. Don’t force them to eat if they don’t want to since their stomach might not be able to take it. Speak to them calmly even if they withdraw from activities or don’t respond since they can still hear you. Overall, it’s important to let your loved one set their pace as they undergo many behavioral changes.
Additionally, physical changes may also emerge at this time, including the following:
- Chronic fatigue
- Drop in body temperature
- Lower blood pressure
- Irregular pulse
- Changes in skin color
- Changes in breathing
- General pain
Days Before End of Life
Days before the end of life, you’ll notice more physiological changes. Their pulmonary system starts failing, causing changes in their breathing patterns. It’s usually at this point when you hear the death rattle, and your loved one starts coughing more frequently due to respiration problems. While these may sound alarming, they’re generally painless for the person.
Some people may experience a sudden burst of energy one day before death. As painful as it looks, this is not a sign that they are getting better but getting closer to death. The energy burst usually only lasts a short time before all other symptoms worsen. Apart from erratic breathing, here are other signs you might observe in their last few days of life:
- Drop in blood pressure
- Difficulty swallowing
- Blotchy and purplish hands and feet
- Erratic sleeping patterns
- Less urination and bowel movements
Hours Before End of Life
There’s no tougher time than seeing someone you love in their final hours of life. Once they reach this stage, their body starts to shut down and fail. This may lead to falling body temperatures, sudden outbursts, and unresponsiveness when you try talking to them. Additionally, their breathing becomes more erratic, and their pulse starts weakening.
Some might lose consciousness near the end of life, though they may still be aware of their surroundings. At this point, they may also experience more hallucinations, glassy or teary eyes, cold hands, and shallow breathing with occasional gasps.
Signs at the Time of Death
By now, you’re more familiar with the signs to expect in a person’s final days or hours. But will you know when they’ve truly passed away? Generally, here are the common indicators that death has occurred:
- No pulse or heartbeat
- Not breathing for a prolonged period
- Eyelids are half-open with enlarged pupils
- Person cannot be woken up
No matter when or where death occurs, take comfort in knowing that you don’t need to rush things. For example, if it happens at home and in the middle of the night without a hospice nurse, you can notify your loved one’s doctor in the morning. Alternatively, if it happens in a healthcare facility, the nurses will give you time to be with the body before they proceed with the necessary procedures.
Contact Cardinal Hospice to Learn more about End of Life Signs
Discovering that someone you love only has limited time left in the world can be one of the most painful things to go through. When this happens and you start noticing the common end of life signs, it may be time to start considering hospice care.
Regardless of your needs, Cardinal Hospice aims to help you navigate these challenging times by providing hospice and palliative care for people nearing their death. Our goal is to help our patients receive the highest-quality end of life care to ensure that they are comfortable until their final moments. Contact us today to learn more about how we can assist you or your loved ones.