Whilethe dying experience is unique for each person,accordingto health care professionals there are some commonly seen signs death is near.
During the last stages of dying,you will observe signs of death approaching that are likely unfamiliar to you and upsetting.
While no one isever fully prepared for the imminent death of a loved one, even when it is expected, learning about the dying process— including the physical and emotional signs of death—mayhelp you better copeduring this difficult time.
This post will give you a helpful summary of the 10 signs of death:
- Loss of thirst and appetite
- Dry mouth and eyes
- Weakness, disorientation and sleepiness
- Pain
- Restlessness and agitation
- Breathing changes
- Emotional distress
- Skin changes
- Unresponsiveness
- Not breathing for long periods of time
We will also give you topcaregiving tips. Learnthings you can do to helpease all the signs of death your loved one may experience.
You should also read our practicalguideon how to take care of yourselfduring this difficult time, complete with a helpful infographic that you can easily save to your Pinterest page or share across social media.
We also discuss what you can expect when death finally occurs. Again, knowing what to expect may be helpful.
Let’s get started…
Signs of Death: The Final Weeks & Days
Here are the 7 signs of death that are commonly observed during a loved one’s last days of life.
Since every person’s dying experience is unique, you may not observe every sign, or some signs of death may be more acute than others.
1. Loss of Thirst and Appetite
Lack of any desire to eat or drink is a commonly seen sign death is near. Dying people often refuse food and fluids that are offered to them.
Lack of fluids may lead to his urine becoming dark in colour. At this stage, food or water will not help your loved one, and it will not keep him alive longer.
If your loved one asks for water, raise the head of the bed a little and give him little sips of water from a syringe or baby cup with a spout. If he coughs or is having trouble breathing while you are giving him water, stop immediately.
Don’tforce your loved one to eat or drink as doing so can make him physically uncomfortable or even choke.
You could show your love in other ways, such as giving a gentle massage.
2. Dry Mouth and Eyes
In addition to not taking in many fluids, your loved one is likely breathing through her mouth, both of which lead to the mouth becoming quite dry.
Her eyes will also become dry because of a reduction in blinking and because of hospital air conditioning.
Alleviate this sign death is near by givingher ice chips,swabbing the lips and insider of the mouthwith a sponge, and administering eye drops.
This should be done at least every few hours.
If your loved one bites down on the sponge, do not be alarmed. This is a normal reaction. Continue to apply the sponge to her mouth—she will soon let go.
Ask the palliative care staff if you should purchase mouth products and eye drops from the pharmacy, or whether products will be provided to you by the hospital.
If you need to purchase products, ask the palliative care staff for their recommendations. Get instructions on how the products should be administered and how often.
It is worth taking the time to care for your loved one’s mouth and eyes as it will help keep her comfortable.
3. Weakness, Disorientation and Sleepiness
Another common sign death is near is weakness and tiredness. Your loved one may withdraw and spend much more time sleeping.
Some dying people sleep more during the day and are more awake at night. Plan to spend time with your loved one during those periods when he seems most alert or awake.
At the end of life, dying people often loose interest in their surroundings and what is taking place. Be prepared for the fact that your loved one may refuse to answer your questions, or answer them slowly.
Your love one may also appear disorientated, which is another common sign death is near. He may seem confused about what is going on and who is speaking to him.
Do not be insulted if your loved one doesn’t seem to recognize you. This kind of confusion is normal and is not a sign that he feels differently about you.
Using a soft and gentle voice, make sure you identify who you are, and always explain any medical procedure that is about to be done for his comfort—for example: “It is time to take your medications so that you won’t be in pain.”
Avoid loud noises around your loved one, as he may be startled and distressed.
If your loved one is no longer able to speak, he most likely is still able to hear you, so you should continue talking to him and leave nothing unsaid.
It is also important for both you and your loved one to hug and touch him, even if he does not respond.
Since your loved one may now be spending all of his time in bed, you should discuss with the palliative care team how to keep him clean and comfortable.
They may suggest lying your loved one on his side. Use pillows to support his body and changehis position at regular intervals.
If your loved one has lost control of his bladder and bowel, palliative care staff may suggestusing a urine catheter, (a tube placed into the bladder),or protective undergarments in orderto keep his bed clean.
4. Pain
When it comes to the most common signs of death, most people fear pain the most.
Speak with the palliative care team about the mosteffective strategy for dealing with any pain your loved one may be experiencing.
Making sure that your loved one is not in pain is an important part of managing her end-of-life care.
If your loved one is no longer able to speak, you can look for body language associated with discomfort, such asfrowning, moaning, moving around, or pulling away when touched.
You should report your observations to the palliative care team right away as thedose, or the way the pain medications are given, may need to be adjusted.
The doses of the medications or the methods of administration may also need to change when your loved one’sphysical condition changes.
For example, when your loved one can no longer swallow, pain medications can be provided in patch form, through an IV, or through an injection.
Your loved one may be in pain because ofswollen legs and arms from extra fluid. You can help the swellingby keeping her legs and arms raised.
You should also give your loved one gentle, soothing massages.
This communicates love to your loved one, even when she is not conscious, and also helps alleviates her pain.
5. Restlessness and Agitation
At the end of life, a dying person can become very restless or agitated. This sign death is near is referred to as “delirium” by health care professionals.
Your loved onemight make restless or repetitive motions, such as pulling the sheets or clothing.
Delirium is due to internal body changes that are taking place. Sometimes it is due to medication.
Do not restrain your loved one.Instead, try tofigure out what helps keep him calm.What works for one person will not work for another.
Techniques that you could try includes holding your loved one’s hands, lightly massaging his forehead, reading to him, playing soothing music, or verbally reassuring him that it’s okay to let go.
Your loved one may also be less agitated if a familiar face is there.
Often when a person is agitated, he will need some type of medication—usually a mild sedative—to help control this sign of death.
6. Breathing Changes
A typical sign death is near is changes in your loved one’s breathing patterns. Her breathingmay speed up, sound shallow, or become irregular.
There may even be short periods of time when your loved one stops breathing for a few moments.As death approaches, the time between breaths may get longer.
Towards the very end of life, your loved one will be extremely drowsy and perhaps become unresponsive.
You may start to hear gurgling or snoring sounds with each breathe. It may sound like your loved one is choking.
These noises occur because your loved one is swallowing less, resulting in a build-up of saliva in the throat. These sounds could also happen when the muscles in the tongue and jaw begin to relax.
Sometimes a soft, short moaning sound with each breath may accompany this.
The noises made by your loved one as she approaches death can make you worried or upset.
Be reassured that gurgling and moaning noises are not because of pain, but because her throat muscles are relaxed.
Be also reassured that your loved one is not in any danger of dying from suffocation.
A nurse may reposition your loved one’s body, or give her medication to dry up the secretions and lessen the sound, orsuction y0ur loved one’s mouth. (Please note that deep suctioning is discouraged as it can distress your loved one.)
A nurse can also give your loved one oxygen if you find it comforting.
7. Emotional Distress
Unsurprisingly, a common sign death is near is emotional distress.
Your loved one—and you—will feel different emotions as he is approaches death. Typical emotions include:anxiety, fear, anger, sadness, guilt, loss, and wanting to be alone.
Remember that it is normal to feel one or even all of these emotions.
Just as each person has a unique genetic makeup and personal history, each person has a unique dying experience.
What emotions a person feelswill depend a lot on what type of person he is, how much support he has, the experiences he had in life, his religious and spiritual beliefs, and his age.
For example, someone who is dying at a young age is likely to feel very different to someone who has enjoyed a long life.
As another example, someone who is leaving behind young children will have different worries than someone whose children are fully-grown and able to take care of themselves.
There are things that you can do to help your loved one—and you—deal with difficult emotions.
You can share your feelings.
You can talk about your fond memories.
Let your loved one know if you have any regrets orthings that you are sorry for. Your loved one will also want to hear that he is forgiven for mistakes he has made.
You can also let your loved one know that he has your support if he wants to let go, and that you will be all right.People who are dying often want “permission” to die from those they love.
You should also tell your loved one the ways his life made a difference, and reassure him that he will always be remembered.
You and your loved one may find comfort in knowing that you can never be truly separated by death because our love lives on.
Sometimes, just sitting and holding your loved one’s hand can be more important than words. You do not need to hide your tears from your loved one as it is a natural part of saying “Goodbye.”
If your loved one is in hospice care, you could bring familiar things from home for comfort. For example: blankets, photos, and music.
If your loved one has a pet, you should speak to the palliative care team about bringing the vet in for a visit.
If your loved one is religious or spiritual, he may find a visit from a spiritual care provider comforting.
Saying goodbye is never easy, however, it is important for you and your loved one to do so.
If you need help dealing with difficult emotions, you should ask the palliative care team about hospital and community support resources that are available.
Signs of Death: The Final Hours
There are additional signs of death that you might see during your loved one’s final hours of life.
8. Skin Changes
A common sign death is near is a change in your loved one’s skin colouring.
Your loved one’s face may be pale, with the area around her mouth appearing bluish-grey. Herskin may become blue and blotchy.The underside of her body, as well as her fingertips, may darken.
This sign of death occurs becauseher blood circulation is slowing down. Less blood is being sent to her limbs because it is being reserved for her most vital organs.
Your loved one’s skin will also become increasingly cool to the touch. Keep her warm with a blanket, but never use an electrical blanket or heating pad because burns can occur.
Don’t worry if the nurse stops taking your loved one’s blood pressure and pulse. According to health care professionals, they are not reliable signs that death is imminent.
9. Unresponsiveness
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During the last few days or hours of your loved one’s life, his eyes may remain open and not blink. As death nears, he will no longer respond to your voice or touch.
Your loved one may still be able to hear you, so you should continue speaking to him.
Occasionally, someone who is unresponsive may have a surge in energy and become more alert for a short period of time. If this occurs, he may be talkative or become interested in food or visitors.
This surge in energy can be for a few minutes—or for a few hours—prior to him becoming very sleepy and unresponsive again.
10. Not Breathing for Long Periods of Time
As stated previously, moaning is a typical sign death is near. To reiterate,moaning doesn’t necessarily mean that the dying person is in pain. It can also mean that the neck and jaw muscles are relaxed.
As your loved one nears death, she may stop breathing for long periods of time. This is normal for a dying person and is not painful.
Practical Tips for Easing the Signs of Death
It is a frightening and confusing time when you have a loved one who needs end-of-life care.
We’ve got you covered with our comprehensive list of questions to ask the palliative care staff regarding your loved one’s care.
We also have practical tips for how to make your loved one’s last weeks and hours of life more comfortable. Simple things like how you position his body in bed, or how you give him water, will make a world of difference.
Questions to Ask the Palliative Care Staff
Once your loved one’s condition has been diagnosed as terminal, she will be placed under the care of a palliative care team at a hospice.
They will ensure that your loved one has the best possible quality of life right for the remainder of her time.
You should discuss the following issues with the team:
- Given the specific circ*mstances of your loved one’s illness,what can you expectto see in the last days and hours of life?
- If your loved one loses control over her bladder or bowel movements what should be done to ensure hercomfort and cleanliness(e.g. urine catheter or protective undergarments)?
- If your loved one is spending all her time in bed, how do youcorrectly position her body, and how often it should be repositioned?
- Do you need to purchasemouth and eye care productsfrom the pharmacy, or will they be provided to you by the hospice?If you need to purchase products, which products do they recommend?How should they be administered and how often?
- What medications will be administered at the hospice forpain relief?How should they be administered and how often?
- Whatsedativeswill be administered for restlessness and agitation?How should they be administered and how often?
We recommend that youtake this list of questions with youwhen you meet with the palliative care team.
You should also take a notebook towrite down important informationthey give you.
During this stressful time, you might find it difficult to recall information, so having this list of questions and your notes to refer to will be helpful.
Things You Can Do to Make Your Love One More Comfortable
No doubt you want to help provide care and comfort for your loved one during his last days and hours of life.
The following table outlines common issues that arise when a loved one is in the final phase of his life, along with things that you should do to ease the signs of death, and not do because they are harmful to him.
| DO's | DON'T's | |
| Eating & Drinking | Give your loved one ice chips or swabbing the mouth and lips with a sponge to keep them moist. This should be done every few hours at least. If your loved one asks for water, raise the head of the bed a little and give him a couple of sips of water from a syringe or baby cup with a spout. | Do not attempt to force your loved one to eat or drink as doing so can make him feel physically uncomfortable or even choke. Do not continue giving your loved one sips of water if he is coughing or having trouble breathing. |
| Bed Rest | Positioning the bed so that your loved one can see out a window may be comforting. If your loved one is spending all her time in bed, follow the palliative care staffs’ advice on how to correctly position her body so that she is comfortable. Reposition her body as instructed by palliative care staff. Add or remove blankets to make her more comfortable. Change the sheets, pillow cases, pajamas and underclothing as often as necessary for comfort. Try to smooth out the wrinkles. Bring familiar things from home to the palliative hospice. They will provide comfort. For example, blankets, photos and music. If your loved one has a pet, ask palliative care staff if the pet can visit. | Do not position the bed so that your loved one has glaring light shining directly into her eyes. This could be very uncomfortable Do not assume that cold skin means that your loved one is cold. Extra blankets and comforters could her too hot and uncomfortable because of the extra weight. Do not use electric blankets or heating pads as they could cause skin burns. |
| Mouth & Eye Care | Take special care to ensure that the lining of the mouth, the gums, and the tongue, are refreshed every few hours. Products from the pharmacy can be purchased for this purpose, if they are not provided by the palliative hospice. You can also use a wet sponge to rub on his lips and inside of his mouth. If your loved one’s eyes are dry, administer eye drops on a regular basis. Ask a nurse on how to do this properly and how often. | If your loved one bites down on the wet sponge, do not be startled and yank it back. This is normal and he will eventually let go. |
| Communication | Plan to spend time with your loved one during those periods when he seems most alert or awake. (In the final stages of life, many people are more alert at night than during the daytime.) Continue to speak to your loved one, hug and touch him, even if he does not respond. It is important for you both to leave nothing unsaid. If your loved one is confused and disoriented, make sure you identify who you are, and always explain any medical procedure that is about to be done for his comfort—for example: “It is time to take your medications so that you won’t be in pain.” Dying people often want to hear 5 key things: (1) that his responsibilities will be taken care of; (2) his family and friends will be all right; (3) all is forgiven; (4) his life had meaning; and (5) he will always be remembered. It is okay to cry in front of your loved one. It is a natural part of saying goodbye. | Avoid loud noises and sudden movements around your loved one, as he may be startled and distressed. Do not fail to say everything in your heart to your loved one. Telling him how much you love and care is important for you both. |
| Pain | Use pain medication as instructed by your loved one’s doctors. Speak to the doctors if the medication does not appear to be working. If your loved one cannot speak, check for signs that she is in pain, such as frowning, moaning, moving around, or pulling away when touched. If you see any of these signs, let the palliative care staff know. Your loved one might have swollen legs and arms from extra fluid. You can help by keeping her legs and arms raised. Give your loved one gentle, soothing massages. This communicates love to your loved one, even when she is not conscious, and also helps alleviate her pain. Ask the nurses at the hospice about the use of hot and cold packs to alleviate pain. | Don't assume that your loved one's medication regime, which is currently working, won't need to be adjusted in the future as further signs of death appear. |
| Restlessness & Agitation | Try different techniques to keep your loved one calm. They include: holding hands, lightly massaging the forehead, reading to the person, playing soothing music, or providing verbal reassurances that it’s okay to let go. Continue using the techniques that work best for your loved one. Ensure that your loved one has familiar faces around as often as possible. Ask doctors if a sedative should be prescribed. If your loved one is using a sedative, ensure that he is taking it as prescribed. | Do not try and restrain your loved one. |
| Breathing | If you have any concerns about changes in breathing patterns, please discuss them with the palliative care team. | Do not be alarmed by gurgling or moaning sounds made by your loved one. These sounds are normal as death nears. |
Practical Guide for Caregivers
This is a practical guide for every caregiver looking after a loved one inpalliative care. Being a caregiver for a dying loved one is a highly stressful and time-consuming responsibility.
It is vital that you take time out to recharge your batteries and to manage your stress levels. Left unchecked, long-term stress can lead to burnout, depression, and other adverse health consequences.
Keep reading to find practical tips for dealing with emotional and physical stress.
Your Feelings and Reactions
Finding out that someone you love is going to die can be devastating. Even if you were expecting to hear the news it can still come as a big shock.
RELATED: What is Anticipatory Grief? Can We Grieve a Loss Before it Happens?
You may feel a variety of mixed emotions, including anger, fear, worry, sadness, and anxiety.
You may be frightened about how her death will happen and if you will cope when it does.
You might secretly wish for the dying process to end quickly becausewatching her go through the stages of death is painful.
You might be flooded with feelings of relief once your loved one has passed away,which may evoke feelings of guilt.
All of these feelings—sadness, anger, fear, worry, guilt, and anxiety—are normal.
Before embarking on the duties of being a caregiver, it is important to give yourself time to process the news.
You should also try and think about what kind of support your loved one will need.Then letyour loved one know that you will be there to love and support her as much possible.
Being a Caregiver Can Be Difficult
As a caregiver, you may be emotionally and physically exhausted.
You are worried about whether or not your loved one is in pain or depressed, and how to support him.
You are busy providing constant care. You may also be taking care of grieving children or other family members.
Being a caregiver can at times feel like unrelenting hard work, which can cause feelings of stress and guilt. These feelings don’t mean that you are a selfish person or that you don’t love the person enough.
It just means that you are human, like everybody else, and that you will have good days and bad days.
Looking After Yourself
Most caregivers are so busy taking care of their dying loved one and their family that they can forget to take time out to care for themselves.
They may also find it difficult to give themselves permission to do so.
It is not selfish to look after yourself because doing so will give you the emotional and physical resources to help you be a better caregiver for the people around you. It will also ensure that you remain in good health.
Things you can do to take care of yourself include the following:
Eating Healthy Meals Regularly
Caregivers typically do not want to eat, or eat a lot of fast food or comfort food.
You need to replenish your strength with nutritious meals. Be sure to include lots of fruits and vegetables, which will provide antioxidants to protect your health.
Drinking Water Regularly
There is a tendency to drink lots of soda, coffee and teaduring stressful times.
Hospitals can be dry environments because of the air conditioning, therefore, please be sure to drink lots of water too. Adequate water will help your mental clarity.
You should also avoid coping with stress by drinkingtoo much alcohol.
Sleeping or Resting Regularly
Getting some sleep—or at least resting—gives your body a break from stress. Adequate rest isimportant for keeping you in good health.
Exercise
Take time to exercise. It willhelp to relieve stress.
Even something as simple as going for a walk outside at a gentle pace will be good for you. If you cannot go outside, walk up and down the hall.
Seeking and Accepting Support
If possible, surround yourself with supportive friends and family and let them know how they can help you.
You can ask for help with preparing meals, housework, child care, grocery shopping, driving, or sitting with your dying loved one while you have a break.
People are often very eager to help during this difficult time. Accept the support that is offered by your friends and family.
If you feel like you need professional support to cope with your grief, see the palliative care team or your family doctor and ask for a referral to a support or counselling program.
If you are religious or spiritual, seek the support of a spiritual care advisor. Many hospitals have chaplain care services that are available to you.
Taking Breaks
Give yourself permission to take a bit of time for yourself, away from the bedside of your loved one, especially when you are feeling overwhelmed or exhausted.
You should do something that helps ease your stress levels and renews your energy.
Examples of things that you could do include taking a soothing bath, calling a friend, meditating or praying, or getting a massage.
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Organizing Time Away for Yourself
If you are concerned about leaving your loved one alone while you take some time for yourself, organize friends and family to come sit with him or her while you are away.
You can also ask the palliative care team if there are volunteers that will sit with your loved one while you are away.
Let your loved one know when you are leaving and when you will be back.
This will stop him from getting anxious while you are away, and make it emotionally easier for you to give yourself permission to leave for a short break.
When Your Loved One Dies
Even with onset of the signs of death, no onecan know exactly when death will happen.
Some people die when others are there, while others take their last breath when they are alone.
You will know that your loved one has died because there is no breathing, no response to stimulation, and no pulse.
His or her eyes may be slightly opened and unblinking, with a gazed fixed on a certain spot. You may gently close your loved one’s eyelids.
RELATED: A Practical Guide for What You Need to Do if a Loved One Dies at Home
When your loved one dies, all of the muscles of the body completely relax. The face will relax and often look peaceful and serene.
As the jaw has relaxed, your loved one’s mouth will be slightly opened.
Within a short while, a rush of air may be released from the lungs. There may also be a release of bladder or bowel contents.
Sometimes the dying process is so gradual that you may not be sure for a while that your loved one has died.
When it becomes clear that your loved one has died, you can feel a variety of emotions, from peace and relief, to sadness or intense grief.
Even when death is expected, you may feel a sense of shock and disbelief.This reaction is both common and normal.
Resources
The information in this post was largely derived from the following resources:
Check out these resources if you want more information on the signs of death or on caring for your loved one during the last stage of his or her life.
One Final Note
If you are reading this post, chances are you have a loved one who is showing signs death is near. We understand how difficult this time and wish that you, your family, and your loved one, weren’t going through it.
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