What to Expect When Your Loved One Is Dying

Each person's journey to death is unique. Some people have a very gradual decline; others will fade quickly.

As death approaches, your role is to be present, provide comfort, and reassure your loved one with soothing words and actions that help maintain their comfort and dignity.

Hospice Care

When your loved one's health care team recognizes that he or she is likely within 6 months of dying, they may recommend switching to hospice, a more specialized care for people with a terminal illness who are expected to die.

Your loved one will still get treatment for pain relief and comfort, but hospice also offers emotional and spiritual support for them as well as you and close family.

Signs That Death Is Near

There are changes you can expect to see as an adult body stops working. These are a normal part of dying.

Children and teens have a similar process, but it can be harder to predict. They often stay fairly active and continue to ask a lot of tough-to-answer questions.

1 to 3 months before death, your loved one is likely to:

  • Sleep or doze more
  • Eat and drink less
  • Withdraw from people and stop doing things they used to enjoy
  • Talk less (but if they're a child, more)

1 to 2 weeks before death, the person may feel tired and drained all the time, so much that they don't leave their bed. They could have:

  • Different sleep-wake patterns
  • Little appetite and thirst
  • Fewer and smaller bowel movements and less pee
  • More pain
  • Changes in blood pressure, breathing, and heart rate
  • Body temperature ups and downs that may leave their skin cool, warm, moist, or pale
  • Congested breathing from the buildup in the back of their throat
  • Confusion or seem to be in a daze

Breathing trouble can be distressing for family members, but often it isn't painful and can be managed. Pain can be treated, too. But your loved one may have a hard time taking medicine by mouth.

Hallucinations and visions, especially of long-gone loved ones, can be comforting. If seeing and talking to someone who isn't there makes the person who's dying happier, you don't need to try to convince them that they aren't real. It may upset them and make them argue and fight with you.

Continued

When death is within days or hours, your loved one may:

  • Not want food or drink
  • Stop peeing and having bowel movements
  • Grimace, groan, or scowl from pain

You may notice their:

  • Eyes tear or glaze over
  • Pulse and heartbeat are irregular or hard to feel or hear
  • Body temperature drops
  • Skin on their knees, feet, and hands turns a mottled bluish-purple (often in the last 24 hours)
  • Breathing is interrupted by gasping and slows until it stops entirely

If they're not already unconscious, your loved one may drift in and out. But they probably can still hear and feel.

At the End

In the last days or hours, your loved one may become restless and confused and have hallucinations so upsetting they may cry out, strike out, or try to climb out of bed. Stay with them. Try to keep them calm with soothing music and gentle touch. Sometimes medication helps.

The room should be well lit, but not bright. Make it as quiet and peaceful as possible. Constantly assure them that you're there.

Ironically, a loved one may also become clear-headed in their final hours.

When to Say Good-bye

One of the hardest decisions is when to call in people to say good-bye and to make memories for the future.

Let family members and close friends know as soon as it's obvious that death is near. The care team can help you all prepare for what's coming, both what will happen to your loved one and your own physical and emotional reactions. Being together allows family members to support each other, too.

Even though you've gathered, don't assume it means you'll be there at the end. Often the person doesn't die until those who sat with them for hours have left, as if he or she was unable to let go while the ones they loved were there.

Help and Support

Caregivers, families, and friends of someone who is dying can turn to:

  • Family Caregiver Alliance
  • Hospice Foundation of America
  • National Caregivers Library
  • National Hospice and Palliative Care Organization
WebMD Medical Reference Reviewed by Carol DerSarkissian on July 30, 2018

Sources

SOURCES:

Philip Higgins, MSSW, LICSW, director of palliative care outreach, Adult Palliative Care Service, Dana Farber/Brigham & Women's Cancer Center, Boston.

Ursula Braun, MD, MPH, director, in-patient palliative care unit, Michael E. DeBakey VA Medical Center Houston; assistant professor of medicine and medical ethics, Baylor College of Medicine, Houston.

Jennifer Clark, MD, professor of palliative medicine, departments of internal medicine and pediatrics, University of Oklahoma College of Community Medicine, Tulsa.

Andrea Holtzer, RN, palliative care nurse coordinator, St. Mary's Hospital, Amsterdam, NY.

Carol Lovci, RN, MSN, VP, long-term care and special services, San Diego Hospice and The Institute of Palliative Medicine, San Diego.

Byock, I. Dying Well, Riverside Books, 1997.

Hospice Foundation of America. The Dying Process: A Guide for Caregivers, revised, 2007.

Karnes, B. Gone From My Sight: The Dying Experience, Barbara Karnes Books Inc., 1986.

Lynn, J. Handbook for Mortals, Oxford University Press, 1999.

Hallenbeck, J. Journal of the American Medical Association, May 11, 2005.

Lynn, J. Annals of Internal Medicine, Jan. 15, 1997.

Morrison, S.R. New England Journal of Medicine, June 17, 2004.

Ohio Hospice and Palliative Care Organization. Choices: Living Well at the End of Life, 4th ed., 2004.

Medical College of Wisconsin: "Diagnosis and Treatment of Terminal Delirium, Factsheet," "Syndrome of Imminent Death."

American Geriatrics Society: "Dying at Home."

Hospice and Palliative Nurses Association: "Final Days."

"Hospice Palliative Care Program Symptom Guidelines: Delirium/Restlessness," Fraser Health, 2006.

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