What are the signs that death is near?

What changes come first?

As the body weakens, your person may:

• Sleep much more and be harder to wake
• Eat and drink less, or stop wanting food at all
• Lose interest in visitors, TV, or what is happening around them
• Answer slowly, or seem confused at times

This pulling inward is a normal part of dying. It is not a sign that they are upset with you. You can read more about why appetite fades.

What are the signs in the final days or hours?

Common physical changes include:

• Breathing changes. Breaths may become very shallow, deep and fast, or stop for short periods and then start again.
• A rattling sound. Saliva can collect in the throat when a person is too weak to clear it. This is often called the death rattle.
• Cool, blotchy skin. Hands, feet, arms, and legs may feel cool and look blotchy, darker, or bluish.
• Less urine, which may be dark in color.
• Not responding for long stretches.
• Restlessness or confusion in some people.

These signs don't happen to everyone, or in the same order. That is why it can be hard to know exactly when death is near.

Is my person uncomfortable?

The rattling sound does not seem to be painful, and in most cases it does not upset the dying person, even though it can be hard for family to hear. Turning your person on their side or raising their head may help, and your nurse can suggest medicine.

If breathing seems hard, raising the head of the bed or using a fan may help, and medicine can ease the feeling of breathlessness. Ask your hospice nurse what is right for your person.

Can they still hear me?

Most people are thought to still be able to hear after they can no longer speak. Keep talking to them. Tell them who is in the room. Hold their hand, play music they love, or simply sit together.

What can I do?

• Keep their lips and mouth moist.
• Add or remove a blanket based on clues like shivering or pushing covers off. Avoid electric blankets and heating pads.
• Say what you want to say, at any time.
• Take turns resting. You don't have to stay every minute.

When should I call hospice?

Call your hospice's 24-hour number if your person seems to be in pain, struggles to breathe, is very restless, or if anything worries you. You never need a reason to call.