Changes in the last few days of life

Just before death

There comes a point in most people’s lives when death and dying are contemplated.

Perhaps it is our own death or that of someone close to us. But when we do not know what to expect we tend to feel anxious.

Here we describe some typical features of the process of dying. Hopefully it answers some of the questions you may have. We hope it will encourage you to get further help and information.

Typical changes as someone dies

The dying process is unique to each person. But, in most cases, there are common characteristics or changes which help to suggest that a person is dying.

Any one of the signs can be to do with something other than dying. So remember that what we describe here are happening to a person whose illness is already so severe that life is threatened.

The many changes which indicate that life is coming to an end fall into three main categories:

• Less need for food and drink
• Changes in breathing
• Withdrawing from the world

Less need for food and drink

It can be card to accept when someone stops eating and drinking, even when we know they are dying. It is a physical sign that they are not going to get better.

At first, as someone becomes weaker, the effort of eating and drinking may simply become too much. At this stage, help with feeding might be appreciated.

However, eventually, there will come a time when food and drink are not wanted or needed. This can be very distressing for carers, as food and drink are closely associated with nurturing.

Nevertheless, caring can be continued in other ways. For example, it is important to spend time together, or share memories and news of family and friends.

Try not to be discouraged if there is little response. This may be due to weakness, not lack of appreciation. Simply being together can be a great comfort to you both.

Most importantly, being cared for in this way enables people to feel that their lives have been worthwhile and that they will be remembered.

As the person eats and drinks less, there will be less urine produced. This is more obvious if a person has a catheter in place. Do not be concerned, it is a normal part of dying.

Changes in breathing

Less breathless

People who are breathless are often concerned that they will die fighting for their breath. However, towards the end of life, as the body becomes less active, the body needs less oxygen.

Carers often remark that when a loved one is dying their breathing is easier than it has been for a long time.

Of course, breathing difficulties can be made worse by being anxious. Knowing someone is nearby is not only reassuring, it can help reduce breathlessness caused by anxiety.

Noisy breathing

Occasionally, in the last hours of life, there can be a noisy rattle to the breathing.

This is due to a build-up of mucus in the chest, which the person can no longer cough up.

Medication may be used to reduce this. Changing their position may also help.

This noisy breathing may be upsetting to carers, but it doesn’t seem to distress the dying person.

Mouth care

If the person is breathing through the mouth, the lips and mouth become dry.

Moistening the mouth with a damp sponge and applying lip salve will give comfort.

Withdrawing from the world

As someone dies, they will spend more time sleeping. They will often be drowsy when awake.

They will also gradually withdraw from their surroundings and may begin to feel more tranquil. This apparent lack of interest is natural. It is not done to snub loved ones.

Eventually the person may become unconscious. They may stay like this for a surprisingly long time (in extreme cases, many days). But for others it is shorter.

When death is very close (within minutes or hours away), the breathing pattern may change again. Sometimes there are long pauses between breaths. Or the tummy (abdominal) muscles will take over the work. You will see the tummy rises and falls instead of the chest.

If breathing appears hard work, remember that this is more distressing to you than it is to the person dying.

Just before death, the skin can become pale, moist and slightly cool. Most people do not rouse from sleep, but die peacefully, comfortably and quietly.

Care and support

This is a difficult and painful time for you. You are losing someone you love and care for. It is often very hard to know what to say at a time like this.

Nurses, doctors and other staff are there to help you work through your worries and concerns and offer you care and support.