What to Expect When Your Loved One Is Dying

Medically Reviewed by Jabeen Begum, MD on May 22, 2024
9 min read

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

As your loved one nears the end of life, your role is to be present, provide comfort, and reassure them with soothing words and actions that help maintain their comfort and dignity.

When your loved one's health care team recognizes that they are likely within 6 months of dying, they may recommend switching to hospice. Hospice can offer 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 family members.

Some signs you may notice as someone gets closer to death include:

Changes in breathing

Being less active means you need less oxygen. You may notice your loved one's breathing becomes shallow, and more time passes between each breath.

On the other hand, if they're feeling anxious, their breath could get faster.

Sometimes, their breathing gets louder and they may make a rattling sound. This happens because their body can't reabsorb fluids in their throat or chest as well as it used to. It doesn't mean they're in discomfort or struggling to breathe. It may bother you more than it bothers them.

Not eating or drinking

Near the end of life, it's normal to experience loss of appetite and reduced thirst. People need less fuel when they're not moving around much. Your loved one might have trouble swallowing, or feel that eating and drinking just takes too much effort.

Never pressure them to eat or drink, as this could lead to gastrointestinal pain or even choking. If they want to and are able to swallow, you can offer them sips of liquid or small tastes of food. If their mouth seems dry, try:

  • Giving them ice chips
  • Putting on lip balm to prevent chapping
  • Helping them drink with a straw or teaspoon
  • Using a damp sponge to moisten their lips

Skin color changes

Changes in circulation might cause their hands, feet, and knees to look blotchy and pale, purplish, or grey, depending on their skin tone. You might also see dark blotches at the bottom of their spine that look similar to bruising. This usually doesn't cause pain or discomfort.

Sleeping a lot

Your loved one may sleep for most of the day and seem sleepy even when they're awake. They may lose consciousness for a little while or several days. Try to provide a soothing and calm environment by keeping lights dim, perhaps playing some soft music they enjoy, and holding their hand. While they might seem detached, they may still be able to hear you. Try speaking to them gently and soothingly.

Being restless

Sometimes, people go through a period of restlessness, agitation, and confusion as they get closer to death. They may not recognize you, or see and hear things that aren't there. Medications and chemical changes in the brain can lead to this. So can sleeping so much that it becomes hard to tell the difference between dreams and reality. Medications can help with agitation. You may also be able to calm your loved one by:

  • Ensuring they have a peaceful environment
  • Speaking to them clearly
  • Not correcting them if they get something wrong (you can gently remind them who you are if necessary)
  • Just staying nearby

Constipation or trouble peeing could also make someone feel agitated. Tell their health care team if you think this might be the case.

Bathroom needs

It's not unusual for people to lose control of their bladder and bowels near the end of life. They may need to use incontinence pads or have a catheter inserted. They may also poop less often or have darker-colored pee if they're eating and drinking less.

Other end-of-life signs

A person who is dying may have other changes, such as:

  • They may be in pain, causing them to clench their hands or teeth, grimace, or cry out. Their health care team can give them pain-relieving medication.
  • Their vital signs, such as heart rate and blood pressure, become irregular.
  • Their skin, body fluids, and breath take on an odor that smells like nail polish remover. This results from metabolism changes.
  • Their hands, feet, nose, and ears may feel cold to the touch due to circulation changes.
  • They have sensory changes, such as hallucinations or delusions. They may talk about preparing for travel, or about seeing religious figures or deceased loved ones.

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.

Months before death

During 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)

If you haven't done so already, this is the time to make sure your loved one has made the end-of-life arrangements they'll need. Ask them:

  • Whether they have an advance care directive
  • If they've named someone to make decisions about their medical care
  • Whether someone knows where their important paperwork is and what their essential online passwords are
  • If they have a current will
  • If they have funeral preferences and whether they want to be buried or cremated

Weeks before death

During 1 to 2 weeks before death, the person may feel tired and drained all the time, so much so 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.

Last 24 hours before death

In their last day before dying, 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
  • Their pulse and heartbeat are irregular or hard to feel or hear
  • A drop in their body temperature
  • The skin on their knees, feet, and hands turns a mottled gray or bluish-purple color 
  • Their 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.

Signs of death within hours

Shortly before death, your loved one might:

  • Look very pale
  • Keep their eyes closed most of the time
  • Switch off between loud and quiet breathing
  • Relax the muscles in their face so their jaw drops open
  • Go a long time between breaths until they eventually stop breathing

Your loved one may be unconscious. If not, many people become very calm. Others become restless and confused. They can have hallucinations so upsetting they may cry out, strike out, or try to climb out of bed.

No matter how they react, 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. Turn off the television and make the room as quiet and peaceful as possible. Constantly assure them that you're there.

Your loved one might become clear-headed in their final days, hours, or minutes. They may seem to have a surge of energy and alertness. This is called terminal lucidity, and doctors aren't sure why it happens. How long it lasts varies from person to person.

Does a person know when they are dying?

Many people are aware that they're in the process of dying. They may think and talk about getting ready to take a trip. They may say they look forward to seeing friends and family members who've died, or to seeing God or other figures who are important in their religion.

One of the hardest decisions is when to call in people to say goodbye 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, including what will happen to your loved one and how you might feel physically and emotionally. 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 they couldn't let go while their loved ones were still there.

It can be hard to know what to say to someone who is dying. But some experts say that those who are dying most want to hear four simple sentiments:

  • “I love you.”
  • “Please forgive me.”
  • “I forgive you.”
  • “Thank you.”

Remember that hearing is the last sense to go. So, even if your loved one seems unresponsive, they may understand what you say to them.

Support from the care team

It's often difficult and distressing to say goodbye to a friend or family member. If your loved one is in hospice, their care team can help provide emotional support. They can also help you find other professionals and resources to help with the grief process.

When death does arrive, you and other friends can remain with your loved one for a little while if that feels right. You might prefer to be along with your loved one, or you might want to have someone else there.

A death that's expected isn't an emergency. If your loved one is in hospice or a hospital, notify their health care team when you're ready. If they died at home, call their doctor, the local health department, or a funeral home to find out what your next steps should be. An official will need to officially pronounce your loved one's death and fill out the forms needed for their death certificate.

If your loved one had an advance directive or otherwise left instructions about their wishes, you'll know what steps to take next. Someone will also need to notify other friends and family members.

Everyone grieves in their own way and in their own time. It's important to accept your feelings and the ways you deal with them. You might cry, talk to others about your sadness, or just try to stay busy. It's also normal to feel relieved, especially if your loved one was ill or in pain.

If your feelings bother you, or you feel like grief is getting in the way of your life, you can find support. Your doctor may be able to recommend a support group or mental health professional. Local hospices are also good community resources, and some employers offer employee assistance programs that can help.

Caregivers, families, and friends of someone who is dying can get information about support from:

Everyone's journey to death is unique. But there are some signs that death is probable, including changes in breathing, skin, and behavior. When a loved one is dying, it helps to create a calm and comforting environment and let them know you're with them.

How long does active dying last?

The process of death can last weeks or just a few hours. “Active dying” is usually defined as when a person's body is shutting down. Your loved one's health care team can help you understand the signs.

What are the stages of death?

Doctors don't divide the process of death neatly into stages. And everyone's death takes a different course. But some symptoms you might notice at different times could be:

Early stage. The person eats and drinks less, sleeps more, and may seem to withdraw.

Middle stage. They may look pale and have cold hands and feet. They could have changes in their vital signs and bathroom patterns.

Late stage. They could become restless or confused. Their breathing becomes irregular and may make a rattling sound.