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Palliative Care Center

Journey's End: Active Dying

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Symptoms and Signs that Death Is Near continued...

When death is imminent – within days or hours:

  • Your loved one may not want food or drink.
  • There may be little or no bladder or bowel activity.
  • Pain may show as grimaces, groans, or scowls and should be managed.
  • Eyes may tear or become glazed.
  • If not already unconscious, your loved one may drift in and out of consciousness. It's important to continue talking to your loved one and holding his or her hand since he or she probably can still hear and feel.
  • Pulse and heart beat may be irregular or difficult to detect.
  • Body temperature will drop and the skin of the knees, feet, and hands will become a mottled bluish-purple. Once the mottling starts, death often occurs within 24 hours.
  • Breathing, punctuated by gasping starts and stops, will slow until it stops entirely.

For children and teens, the signs and symptoms are more or less the same as for adults. However, the course of dying is harder to predict in children. They often remain fairly active and ask a lot of tough-to-answer questions right up until the end is near. 

In the last days or hours, your loved one may experience what doctors call terminal delirium: heightened activity and confusion often accompanied by hallucinations so distressful they may cry out, strike out, or try to climb out of bed. Since your loved one could hurt him or herself,  it's important to try to stop it with medications or with other non-drug interventions.

Make sure the room is well lit, but not brightly lit; also make the room as quiet and peaceful as possible and constantly assure your loved one that you are there.

Ironically, in the last days or hours, a loved one may also experience a period of clarity and lucidity.

During the journey to death, the signs and symptoms of approaching death are unique to each person and his or her condition. Some people have a very gradual decline. Others have a more rapid decline, and their signs and symptoms are usually more pronounced.

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