Physical Signs End of Life Is Near

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  • Man holding woman's hand in hospital bed

    Dying is a physical process, and as the body shuts down, a variety of physical changes signify approaching death. Note: None of these signs is definitive. A person who is seriously ill may have one (or more) of these symptoms and recover, especially with intensive medical attention. However, if a number of these signs are present, death may be closer than health.

    Understanding the end-of-life stages can help you and your loved ones know what to expect in the weeks, days, and hours before death.

  • 1
    Shortness of breath
    Senior man on oxygen at palliative care unit

    Feeling short of breath is common toward the end of life, especially in people who have lung disease, advanced cancer, or a buildup of fluid in the abdomen. A person may feel they can’t get enough air, no matter what.

    Medication can help. Some medications (including steroids) decrease inflammation and make it easier to breathe. Opioids can relieve “air hunger” and the fear and anxiety that often accompany shortness of breath. Healthcare providers can also give extra oxygen to patients via a nasal cannula or face mask.

    Moving the patient into an upright position can also help.

  • 2
    Noisy breathing
    Female nurse using stethoscope on senior woman

    As a person’s physical health declines, saliva can build up in the back of the throat because the person lacks the strength and coordination necessary to clear their airway. You may hear a gargling or snoring-like sound with each breath. Sometimes, the sound is loud and intense. At other times, it may be quieter.

    Some people use the term “death rattle” to describe this type of noisy breathing. It usually indicates that death will occur in a few hours or days.

  • 3
    Refusal of food and water
    Senior man being offered cup of water or medicine

    As the body slows, it has less need for energy. It is completely natural and normal for dying individuals to lose interest in food and drink. Eventually, they may also lose the ability to swallow.

    Although it can be distressing to see your loved one go without food or water, it is not safe to try to force food or fluids on a dying person. In fact, eating or drinking may cause more physical discomfort than foregoing food and drink. It is best to follow the patient’s lead.

  • 4
    Decreased urine output
    Hospice nurse checks on senior female patient

    A person who is not eating or drinking much will not urinate much either. Additionally, the kidneys (which normally produce urine) often fail during the dying process. You may notice your loved one requiring fewer trips to the bathroom, or a reduced need to change soiled diapers or bed linens. If the person has a catheter in place, you may notice the urine becoming darker over a period of days. The volume of urine produced may also eventually decrease to just a few drops per day.

  • 5
    Fatigue
    Family member and sick woman

    It is natural for people who are dying to spend more and more time in a sleep-like state. Alert and awake periods may be few and far between, and the individual may tire very quickly. Say “I love you” when you get the chance and know that your presence is likely appreciated even if the person is unable to converse or engage with you.

    A person’s ability to hear often persists past their ability to speak. Be conscious of your conversations.

  • 6
    Delirium
    Elderly woman supporting sick husband

    A dying person may become confused or agitated. Some even report seeing or hearing hallucinations. Delirium may be caused by the underlying disease process (a tumor, for instance, pressing on the brain) or by the dehydration and chemical changes that commonly occur during the dying process.

    Confusion and hallucinations can be disturbing. Do your best to comfort and reassure the patient. If the patient’s behavior is upsetting to you, ask a healthcare provider to sit with them while you take a break.

  • 7
    Cool, mottled skin
    Unseen hospice nurse holding hand of unseen elderly patient

    As the organs of the body shut down, the circulatory system prioritizes available blood to the heart and brain, even at the expense of the rest of the body. Decreased circulation to the hands, arms, legs, and feet is common. The extremities of the body may feel cool to the touch. The skin may take on a slightly bluish-mottled hue.

    At first, only the hands or feet may appear discolored. In another day or so, the mottling may also be apparent on the lower legs and arms. Soft blankets can help warm and comfort your loved one.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 4
  1. A Guide to Understanding End-of-Life Signs and Symptoms. Crossroads Hospice. https://www.crossroadshospice.com/hospice-resources/end-of-life-signs/
  2. Last Days of Life – Patient Version. National Cancer Institute. https://www.cancer.gov/about-cancer/advanced-cancer/caregivers/planning/last-days-pdq#_56
  3. Providing Care and Comfort at the End of Life. National Institute on Aging. https://www.nia.nih.gov/health/providing-comfort-end-life
  4. What Happens When Someone Dies? National Institute on Aging. https://www.nia.nih.gov/health/what-happens-when-someone-dies
  5. Five Physical Signs that Death is Nearing. Crossroads Hospice. https://crhcf.org/insights/five-physical-signs-that-death-is-nearing/
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