The physical and mental changes that you will be seeing may seem frightening and distressing. Each person’s death is different. Changes may occur quickly or slowly, may appear and then disappear only to reappear again. People die when they are ready. In general, people die as they have lived. If a person is cheerful and copes well, then they will probably approach the end of life in the same way.
Usually within the last 3-6 days of someone’s life, the person is less hungry and their body can no longer process food. The person will eat very little, or have a total lack of interest in food. The body is shutting down and no longer requires nutrition. Fluid intake continues, but usually not to the point of death. The person becomes unable to swallow and mouth care is needed at this point. Due to the lack of fluid intake, urine output decreases and becomes more concentrated. Bloating, water retention and swelling can also occur.
Changes in strength and awareness are other signs of death. The person may drop things or experience twitching and jerking of their hands and legs. The jerking and twitching will be most noticeable to caregivers and family, more so than to the person who is dying. Weakness increases. The person may shift in their experience of reality. They may talk to someone who is not present, or relate that they have seen someone who is dead. They may talk of a bright light. They may appear unaware of who is with them. The person can also appear confused, repeating sentences that do not seem to make sense. Some people become restless, pull at their bed linens and/or try to get up. This is known as ‘pre-death restlessness’. The person will start sleeping longer and sometimes have trouble waking or responding. The person may have a fixed stare and can become non-verbal.
All senses start to fail and hearing is the last to go. Always assume the dying person is alert and can hear everything you say.
The dying person’s circulation will slow and the body temperature will drop. The skin may become cool and clammy. Most people die by slipping into a coma before the moment of death. Active dying can take hours or days. Even when many of the signs are present, it is not always possible to predict when death will occur. These ups and downs can be emotionally and physically draining on the family and caregivers.
Summary of signs of death
- Sleeps longer, sometimes difficulty waking. Eventually slips into coma
- Reduced intake of fluid and food
- Appears confused, does not recognize familiar people or surroundings
- Weakness becomes profound, difficulty responding verbally, difficulty swallowing or forgetting to swallow
- May have a fixed stare
- Breathing becomes irregular and shallow
- Periods when breathing stops and starts
- Breathing is moist, may develop a rattle, may gasp for air. This noise is often troubling to family and friends, less so to the dying person.
- Pulse becomes irregular, weak, then absent
- Hands and feet become cool
- Skin color may be pale, bluish or mottled
- Urine output will decrease or even be absent for 24-48 hours
- May lose bladder control
- Bowel movements may be absent, or uncontrolled oozing of soft or liquid stool