If a person isnear death, they will go through certain changes as the organs of their body start to shut down. This will lead to common symptoms like anxiety, fatigue, constipation, and changes in bowel movement before progressing to end-of-life symptoms such as delirium and characteristic breathing sounds known as the “death rattle.”
This article will discuss 12 signs that a person is nearing the end of their life. It also suggests ways to help your loved one manage through the final stages of life.
1
Pain
Thomas Odulate / Getty Images
Pain control near the end of death should involve addressing all of these factors as part ofhospiceorpalliative care. If medications are needed for severe pain,opioid analgesicslikemorphineare typically the first-line option.
How to Recognize and Assess Pain
2Shortness of BreathThanasis Zovoilis / Getty ImagesShortness of breath, also known asdyspnea, is one of the most common end-of-life symptoms. Even if a person doesn’t have lung disease, dyspnea can occur because the organ systems of the body are interconnected.For example, if your heart is slowing down due toheart failureand less oxygen is being delivered to the body, you can become breathless with minimal physical activity.Deep breathing exercisesandrelaxation techniquescan help in the early stages. As the condition progresses, medications andoxygen therapymay be needed.Managing Dyspnea at the End of Life
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Shortness of BreathThanasis Zovoilis / Getty ImagesShortness of breath, also known asdyspnea, is one of the most common end-of-life symptoms. Even if a person doesn’t have lung disease, dyspnea can occur because the organ systems of the body are interconnected.For example, if your heart is slowing down due toheart failureand less oxygen is being delivered to the body, you can become breathless with minimal physical activity.Deep breathing exercisesandrelaxation techniquescan help in the early stages. As the condition progresses, medications andoxygen therapymay be needed.Managing Dyspnea at the End of Life
Shortness of Breath
Thanasis Zovoilis / Getty Images
Shortness of breath, also known asdyspnea, is one of the most common end-of-life symptoms. Even if a person doesn’t have lung disease, dyspnea can occur because the organ systems of the body are interconnected.
For example, if your heart is slowing down due toheart failureand less oxygen is being delivered to the body, you can become breathless with minimal physical activity.
Deep breathing exercisesandrelaxation techniquescan help in the early stages. As the condition progresses, medications andoxygen therapymay be needed.
Managing Dyspnea at the End of Life
3AnxietyIgor Novakovic / Getty ImagesAnxietyis normal at the end of life as a person contemplates their own death or struggles through the stages of dying. This is commonly expressed as agitation, worrying, sweating, stomach upset, nausea, sleeping problems, shortness of breath, andheart palpitations.Counseling and therapy can go a long way toward easing anxiety. Medications like antidepressants,anxiolytics, andbenzodiazepinescan also be prescribed.Managing End-of-Life Anxiety
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AnxietyIgor Novakovic / Getty ImagesAnxietyis normal at the end of life as a person contemplates their own death or struggles through the stages of dying. This is commonly expressed as agitation, worrying, sweating, stomach upset, nausea, sleeping problems, shortness of breath, andheart palpitations.Counseling and therapy can go a long way toward easing anxiety. Medications like antidepressants,anxiolytics, andbenzodiazepinescan also be prescribed.Managing End-of-Life Anxiety
Anxiety
Igor Novakovic / Getty Images
Anxietyis normal at the end of life as a person contemplates their own death or struggles through the stages of dying. This is commonly expressed as agitation, worrying, sweating, stomach upset, nausea, sleeping problems, shortness of breath, andheart palpitations.
Counseling and therapy can go a long way toward easing anxiety. Medications like antidepressants,anxiolytics, andbenzodiazepinescan also be prescribed.
Managing End-of-Life Anxiety
4Decreased Appetite and ThirstGetty / Lucy LambriexAs a body starts to shut down, it no longer needs as many calories and nutrition to function at such lowered levels. Although it is normal for people to refuse food and drink near the end of life—either because they have no desire for it or find the effort of eating or drinking to be too much—it can still be upsetting for families.The important thing to remember is that when someone is dying from aterminal illness, a disinterest in food is natural and does not really speed up the process of death.Loss of Appetite at the End of Life
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Decreased Appetite and ThirstGetty / Lucy LambriexAs a body starts to shut down, it no longer needs as many calories and nutrition to function at such lowered levels. Although it is normal for people to refuse food and drink near the end of life—either because they have no desire for it or find the effort of eating or drinking to be too much—it can still be upsetting for families.The important thing to remember is that when someone is dying from aterminal illness, a disinterest in food is natural and does not really speed up the process of death.Loss of Appetite at the End of Life
Decreased Appetite and Thirst
Getty / Lucy Lambriex
As a body starts to shut down, it no longer needs as many calories and nutrition to function at such lowered levels. Although it is normal for people to refuse food and drink near the end of life—either because they have no desire for it or find the effort of eating or drinking to be too much—it can still be upsetting for families.
The important thing to remember is that when someone is dying from aterminal illness, a disinterest in food is natural and does not really speed up the process of death.
Loss of Appetite at the End of Life
5
Nausea or Vomiting
Nicolevanf / Getty Images
Anti-nausea medicationsmay help, but it’s important to pinpoint the underlying cause to help make your loved one more comfortable. Getting fresh air, eating smaller meals, sippingginger tea, and avoiding off-putting smells from foods like cabbage or fish can also help.
Managing Nausea in Palliative Care
6
Constipation
Alvis Upitis / Getty Images
Medications used to treat pain and shortness of breath can causeconstipation. Other causes include a lack of physical activity, dehydration, decreased fiber intake, and the progression of the underlying terminal illness.
Changes in diet, increased fluid intake, and simply taking short walks can help. The use ofstimulant laxativesas well as alow enemacan provide relatively fast relief.
7Fatiguemediaphotos / Getty ImagesFatiguenear the end of life is not a surprising symptom for most people to grasp but one that can be increasingly worrisome when watching a loved one spend more and more time in bed.As much as illness, medications, and sleep problems can cause fatigue, so can emotional issues such as depression.To this end, it is important to not only ask your loved one what they are feeling buthowthey are feeling emotionally.Providing a loved one with sunlight and fresh air, and keeping their living space cheerful and clean can help lift fatigue to a certain degree.It is equally important to accept fatigue as a natural part of the dying process. You shouldn’t force your loved one to do things that may only add to their tiredness.
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Fatiguemediaphotos / Getty ImagesFatiguenear the end of life is not a surprising symptom for most people to grasp but one that can be increasingly worrisome when watching a loved one spend more and more time in bed.As much as illness, medications, and sleep problems can cause fatigue, so can emotional issues such as depression.To this end, it is important to not only ask your loved one what they are feeling buthowthey are feeling emotionally.Providing a loved one with sunlight and fresh air, and keeping their living space cheerful and clean can help lift fatigue to a certain degree.It is equally important to accept fatigue as a natural part of the dying process. You shouldn’t force your loved one to do things that may only add to their tiredness.
Fatigue
mediaphotos / Getty Images
Fatiguenear the end of life is not a surprising symptom for most people to grasp but one that can be increasingly worrisome when watching a loved one spend more and more time in bed.
As much as illness, medications, and sleep problems can cause fatigue, so can emotional issues such as depression.To this end, it is important to not only ask your loved one what they are feeling buthowthey are feeling emotionally.
Providing a loved one with sunlight and fresh air, and keeping their living space cheerful and clean can help lift fatigue to a certain degree.
It is equally important to accept fatigue as a natural part of the dying process. You shouldn’t force your loved one to do things that may only add to their tiredness.
8Isolation and Drifting AwayAriel Skelley / Getty ImagesAs someone nears death, they naturally start to focus inward and may separate from the world around them, including friends and family. While this may be a reasonable response, it can be of concern if it amplifies feelings of anxiety or depression.It is important to remember that any and all emotions are normal when someone is dying. This doesn’t mean that you should back away.By just being there, you may find that certain feelings are causing your loved one to drift away. There may be unspoken regrets or worries. Or, they may simply be emotionally worn out.While you may not be able to help them sort out these feelings, studies show that being there almost invariably makes end-of-life care less complicated and taxing on your loved one.
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Isolation and Drifting AwayAriel Skelley / Getty ImagesAs someone nears death, they naturally start to focus inward and may separate from the world around them, including friends and family. While this may be a reasonable response, it can be of concern if it amplifies feelings of anxiety or depression.It is important to remember that any and all emotions are normal when someone is dying. This doesn’t mean that you should back away.By just being there, you may find that certain feelings are causing your loved one to drift away. There may be unspoken regrets or worries. Or, they may simply be emotionally worn out.While you may not be able to help them sort out these feelings, studies show that being there almost invariably makes end-of-life care less complicated and taxing on your loved one.
Isolation and Drifting Away
Ariel Skelley / Getty Images
As someone nears death, they naturally start to focus inward and may separate from the world around them, including friends and family. While this may be a reasonable response, it can be of concern if it amplifies feelings of anxiety or depression.
It is important to remember that any and all emotions are normal when someone is dying. This doesn’t mean that you should back away.
By just being there, you may find that certain feelings are causing your loved one to drift away. There may be unspoken regrets or worries. Or, they may simply be emotionally worn out.
While you may not be able to help them sort out these feelings, studies show that being there almost invariably makes end-of-life care less complicated and taxing on your loved one.
9Incontinencekrisanapong detraphiphat / Getty ImagesBothurinary incontinence(loss of bladder control) andfecal incontinence(loss of bowel control) are common near the end of life.Incontinence can be a result of surgery or illness, or because the person is simply too weak to go to the bathroom. At the very end, when the urinary and bowel muscles relax entirely, the person will have no control over these functions.If a loved one soils or pees on themselves, it is important to clean them immediately to prevent irritation, sores, and infections that cause pain.
9
Incontinencekrisanapong detraphiphat / Getty ImagesBothurinary incontinence(loss of bladder control) andfecal incontinence(loss of bowel control) are common near the end of life.Incontinence can be a result of surgery or illness, or because the person is simply too weak to go to the bathroom. At the very end, when the urinary and bowel muscles relax entirely, the person will have no control over these functions.If a loved one soils or pees on themselves, it is important to clean them immediately to prevent irritation, sores, and infections that cause pain.
Incontinence
krisanapong detraphiphat / Getty Images
Bothurinary incontinence(loss of bladder control) andfecal incontinence(loss of bowel control) are common near the end of life.
Incontinence can be a result of surgery or illness, or because the person is simply too weak to go to the bathroom. At the very end, when the urinary and bowel muscles relax entirely, the person will have no control over these functions.
If a loved one soils or pees on themselves, it is important to clean them immediately to prevent irritation, sores, and infections that cause pain.
10Skin ChangesEmilija Manevska / Getty ImagesHands and feet may become colder and the skin may look blotchy, purplish, and mottled as a person nears. These changes happen because the heart is no longer able to pump blood as effectively to the limbs.Over time, the mottling may work its way up the arms and legs, while the lips and nails may turn bluish due to the lack of oxygen (referred to ascyanosis). The swelling of the legs and ankles (peripheral edema) is also common.Oxygen therapy may help ease cyanosis, whilecompression socksmay help reduce edema and possibly pain as well.
10
Skin ChangesEmilija Manevska / Getty ImagesHands and feet may become colder and the skin may look blotchy, purplish, and mottled as a person nears. These changes happen because the heart is no longer able to pump blood as effectively to the limbs.Over time, the mottling may work its way up the arms and legs, while the lips and nails may turn bluish due to the lack of oxygen (referred to ascyanosis). The swelling of the legs and ankles (peripheral edema) is also common.Oxygen therapy may help ease cyanosis, whilecompression socksmay help reduce edema and possibly pain as well.
Skin Changes
Emilija Manevska / Getty Images
Hands and feet may become colder and the skin may look blotchy, purplish, and mottled as a person nears. These changes happen because the heart is no longer able to pump blood as effectively to the limbs.
Over time, the mottling may work its way up the arms and legs, while the lips and nails may turn bluish due to the lack of oxygen (referred to ascyanosis). The swelling of the legs and ankles (peripheral edema) is also common.
Oxygen therapy may help ease cyanosis, whilecompression socksmay help reduce edema and possibly pain as well.
11
Delirium
ImagesBazaar / Getty Images
There may even be episodes ofhallucinationwhere they see or hear things that are not there
Kidney failurecommon near the end of life can also flood the body with chemicals that affect the brain. Even constipation anddehydrationcan trigger delirium in people approaching death.
Delirium is often a sign of impending death. Effort is typically placed on making your loved one as comfortable as possible.
Terminal Restlessness and Delirium at the End of Life
12The “Death Rattle"Erik Isakson / Getty ImagesThe"death rattle"is a sign that death is near. Also known as “end-stage wet respirations,” it is when saliva and mucus build up in the airways due to the weakening of the muscles in the lungs andtrachea(windpipe). With each breath, the passing of air through these fluids causes a rattling sound.At this stage, the focus will be placed on preventing your loved one from choking, This may involve turning them on their side or elevating their head.
12
The “Death Rattle"Erik Isakson / Getty ImagesThe"death rattle"is a sign that death is near. Also known as “end-stage wet respirations,” it is when saliva and mucus build up in the airways due to the weakening of the muscles in the lungs andtrachea(windpipe). With each breath, the passing of air through these fluids causes a rattling sound.At this stage, the focus will be placed on preventing your loved one from choking, This may involve turning them on their side or elevating their head.
The “Death Rattle”
Erik Isakson / Getty Images
The"death rattle"is a sign that death is near. Also known as “end-stage wet respirations,” it is when saliva and mucus build up in the airways due to the weakening of the muscles in the lungs andtrachea(windpipe). With each breath, the passing of air through these fluids causes a rattling sound.
At this stage, the focus will be placed on preventing your loved one from choking, This may involve turning them on their side or elevating their head.
SummaryWhen someone is nearing the end of their life, they will experience a variety of characteristic symptoms. Pain, shortness of breath, anxiety, constipation, loss of appetite, fatigue, and change in skin tone and texture are just a few. Death is considered imminent with the loss of bowel control, delirium, and the “death rattle.”
Summary
When someone is nearing the end of their life, they will experience a variety of characteristic symptoms. Pain, shortness of breath, anxiety, constipation, loss of appetite, fatigue, and change in skin tone and texture are just a few. Death is considered imminent with the loss of bowel control, delirium, and the “death rattle.”
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Carr D, Luth EA.Well-being at the end of life.Annu Rev Sociol.2019 Jul;45:515–534. doi:10.1146/annurev-soc-073018-022524Hendriks SA, Smalbrugge M, Galindo-Garre F, Hertogh CMPM, van der Steen JT.From admission to death: prevalence and course of pain, agitation, and shortness of breath, and treatment of these symptoms in nursing home residents with dementia.J Am Med Directors Assoc.2015;16(6):475-481. doi:10.1016/j.jamda.2014.12.016Sandvik RK, Selbaek G, Bergh S, Aarsland D, Husebo BS.Signs of imminent dying and change in symptom intensity during pharmacological treatment in dying nursing home patients: a prospective trajectory study.J Am Med Directors Association. 2016;17(9):821-827. doi:10.1016/j.jamda.2016.05.006Hui D, Dev R, Bruera E.The last days of life: symptom burden and impact on nutrition and hydration in cancer patients.Curr Opinion Supportive Palliative Care. 2015;9(4):346-354. doi:10.1097/SPC.0000000000000171Dzierżanowski T, Ciałkowska-rysz A.The occurrence and risk factors of constipation in inpatient palliative care unit patients vs. nursing home residents.Prz Gastroenterol. 2018;13(4):299-304. doi:10.5114/pg.2018.79809Crockett SD, Greer KB, Heidelbaugh JJ, Falck-Ytter Y, Hanson BJ, Sultan S.American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation.Gastroenterology. 156(1):218-226. doi:10.1053/j.gastro.2018.07.016Abedini NC, Choi HJ, Wei MY, Langa KM, Chopra V.The relationship of loneliness to end of life experience in older Americans: a cohort study.J Am Geriatr Soc.2020 May;68(5):1064–1071. doi:10.1111/jgs.16354Hui D, dos Santos R, Chisholm G, Bansal S, Souza Crovador C, Bruera E.Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study.Cancer. 2015;121(6):960-967. doi:10.1002/cncr.29048Hosker CMG, Bennett MI.Delirium and agitation at the end of life.BMJ. :i3085. doi:10.1136/bmj.i3085Bramati P, Bruera E.Delirium in palliative care.Cancers (Basel).2021 Dec;13(23):5893. doi:10.3390/cancers13235893
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Carr D, Luth EA.Well-being at the end of life.Annu Rev Sociol.2019 Jul;45:515–534. doi:10.1146/annurev-soc-073018-022524Hendriks SA, Smalbrugge M, Galindo-Garre F, Hertogh CMPM, van der Steen JT.From admission to death: prevalence and course of pain, agitation, and shortness of breath, and treatment of these symptoms in nursing home residents with dementia.J Am Med Directors Assoc.2015;16(6):475-481. doi:10.1016/j.jamda.2014.12.016Sandvik RK, Selbaek G, Bergh S, Aarsland D, Husebo BS.Signs of imminent dying and change in symptom intensity during pharmacological treatment in dying nursing home patients: a prospective trajectory study.J Am Med Directors Association. 2016;17(9):821-827. doi:10.1016/j.jamda.2016.05.006Hui D, Dev R, Bruera E.The last days of life: symptom burden and impact on nutrition and hydration in cancer patients.Curr Opinion Supportive Palliative Care. 2015;9(4):346-354. doi:10.1097/SPC.0000000000000171Dzierżanowski T, Ciałkowska-rysz A.The occurrence and risk factors of constipation in inpatient palliative care unit patients vs. nursing home residents.Prz Gastroenterol. 2018;13(4):299-304. doi:10.5114/pg.2018.79809Crockett SD, Greer KB, Heidelbaugh JJ, Falck-Ytter Y, Hanson BJ, Sultan S.American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation.Gastroenterology. 156(1):218-226. doi:10.1053/j.gastro.2018.07.016Abedini NC, Choi HJ, Wei MY, Langa KM, Chopra V.The relationship of loneliness to end of life experience in older Americans: a cohort study.J Am Geriatr Soc.2020 May;68(5):1064–1071. doi:10.1111/jgs.16354Hui D, dos Santos R, Chisholm G, Bansal S, Souza Crovador C, Bruera E.Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study.Cancer. 2015;121(6):960-967. doi:10.1002/cncr.29048Hosker CMG, Bennett MI.Delirium and agitation at the end of life.BMJ. :i3085. doi:10.1136/bmj.i3085Bramati P, Bruera E.Delirium in palliative care.Cancers (Basel).2021 Dec;13(23):5893. doi:10.3390/cancers13235893
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Carr D, Luth EA.Well-being at the end of life.Annu Rev Sociol.2019 Jul;45:515–534. doi:10.1146/annurev-soc-073018-022524Hendriks SA, Smalbrugge M, Galindo-Garre F, Hertogh CMPM, van der Steen JT.From admission to death: prevalence and course of pain, agitation, and shortness of breath, and treatment of these symptoms in nursing home residents with dementia.J Am Med Directors Assoc.2015;16(6):475-481. doi:10.1016/j.jamda.2014.12.016Sandvik RK, Selbaek G, Bergh S, Aarsland D, Husebo BS.Signs of imminent dying and change in symptom intensity during pharmacological treatment in dying nursing home patients: a prospective trajectory study.J Am Med Directors Association. 2016;17(9):821-827. doi:10.1016/j.jamda.2016.05.006Hui D, Dev R, Bruera E.The last days of life: symptom burden and impact on nutrition and hydration in cancer patients.Curr Opinion Supportive Palliative Care. 2015;9(4):346-354. doi:10.1097/SPC.0000000000000171Dzierżanowski T, Ciałkowska-rysz A.The occurrence and risk factors of constipation in inpatient palliative care unit patients vs. nursing home residents.Prz Gastroenterol. 2018;13(4):299-304. doi:10.5114/pg.2018.79809Crockett SD, Greer KB, Heidelbaugh JJ, Falck-Ytter Y, Hanson BJ, Sultan S.American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation.Gastroenterology. 156(1):218-226. doi:10.1053/j.gastro.2018.07.016Abedini NC, Choi HJ, Wei MY, Langa KM, Chopra V.The relationship of loneliness to end of life experience in older Americans: a cohort study.J Am Geriatr Soc.2020 May;68(5):1064–1071. doi:10.1111/jgs.16354Hui D, dos Santos R, Chisholm G, Bansal S, Souza Crovador C, Bruera E.Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study.Cancer. 2015;121(6):960-967. doi:10.1002/cncr.29048Hosker CMG, Bennett MI.Delirium and agitation at the end of life.BMJ. :i3085. doi:10.1136/bmj.i3085Bramati P, Bruera E.Delirium in palliative care.Cancers (Basel).2021 Dec;13(23):5893. doi:10.3390/cancers13235893
Carr D, Luth EA.Well-being at the end of life.Annu Rev Sociol.2019 Jul;45:515–534. doi:10.1146/annurev-soc-073018-022524
Hendriks SA, Smalbrugge M, Galindo-Garre F, Hertogh CMPM, van der Steen JT.From admission to death: prevalence and course of pain, agitation, and shortness of breath, and treatment of these symptoms in nursing home residents with dementia.J Am Med Directors Assoc.2015;16(6):475-481. doi:10.1016/j.jamda.2014.12.016
Sandvik RK, Selbaek G, Bergh S, Aarsland D, Husebo BS.Signs of imminent dying and change in symptom intensity during pharmacological treatment in dying nursing home patients: a prospective trajectory study.J Am Med Directors Association. 2016;17(9):821-827. doi:10.1016/j.jamda.2016.05.006
Hui D, Dev R, Bruera E.The last days of life: symptom burden and impact on nutrition and hydration in cancer patients.Curr Opinion Supportive Palliative Care. 2015;9(4):346-354. doi:10.1097/SPC.0000000000000171
Dzierżanowski T, Ciałkowska-rysz A.The occurrence and risk factors of constipation in inpatient palliative care unit patients vs. nursing home residents.Prz Gastroenterol. 2018;13(4):299-304. doi:10.5114/pg.2018.79809
Crockett SD, Greer KB, Heidelbaugh JJ, Falck-Ytter Y, Hanson BJ, Sultan S.American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation.Gastroenterology. 156(1):218-226. doi:10.1053/j.gastro.2018.07.016
Abedini NC, Choi HJ, Wei MY, Langa KM, Chopra V.The relationship of loneliness to end of life experience in older Americans: a cohort study.J Am Geriatr Soc.2020 May;68(5):1064–1071. doi:10.1111/jgs.16354
Hui D, dos Santos R, Chisholm G, Bansal S, Souza Crovador C, Bruera E.Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study.Cancer. 2015;121(6):960-967. doi:10.1002/cncr.29048
Hosker CMG, Bennett MI.Delirium and agitation at the end of life.BMJ. :i3085. doi:10.1136/bmj.i3085
Bramati P, Bruera E.Delirium in palliative care.Cancers (Basel).2021 Dec;13(23):5893. doi:10.3390/cancers13235893
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