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What Happens in the Final Days?
No two people experience dying in exactly the same way. Changes may happen gradually over several weeks or more quickly over a few days or hours, depending on the person's illness and general health.
Knowing about some of the changes that commonly happen can make them less frightening for the person who is dying and for those around them. Many of these changes are a natural part of the body slowing down and do not necessarily mean that the person is uncomfortable or distressed. If you are worried about any new symptom or think the person is in pain or distress, speak to their doctor, nurse or care team.
Becoming Weaker
As someone approaches the end of life, they will often have less energy and need increasing amounts of rest.
They may spend more time in bed or asleep and may need help with things they previously managed themselves, such as washing, dressing, moving around or going to the toilet.
In the last days, they may become very drowsy and spend much of the time asleep. They may wake for shorter periods or become increasingly difficult to wake.
This does not mean that there is nothing you can do for them. Sitting quietly with someone, holding their hand, talking to them or playing familiar music can still provide comfort.
Even when someone no longer appears to respond, it may still be reassuring to speak to them calmly and let them know that you are there.
Changes in Eating/Drinking
It is very common for people to lose interest in food and drink as they approach the end of life.
This can be difficult for family and friends because offering food is such a familiar way of caring for someone. However, the body's needs change as it begins to slow down, and a person who is dying should not be pressured to eat.
They may also find chewing or swallowing increasingly difficult. If swallowing medicines becomes difficult, the healthcare team can consider other ways of giving them.
Small sips may be welcome if the person is able and wants them. Moistening the mouth and lips can also help someone feel more comfortable.
If you are worried that someone is thirsty, unable to swallow or uncomfortable, ask their nurse or doctor for advice. Decisions about additional fluids or nutrition should be made individually with the clinical team.
Physical Changes
As someone becomes more unwell and their body begins to slow down, you may notice a number of physical changes. These are a normal part of the dying process, although not everyone will experience all of them and they may happen gradually or quite quickly.
The person may become much weaker and need more help moving, washing, dressing or using the toilet. They may spend more time in bed and sleep for longer periods. Their hands and feet can feel cooler as circulation changes, and their skin may become paler or develop some mottling or changes in colour, particularly on the arms and legs. They may pass less urine, and it may become darker, because they are drinking less and the kidneys are working differently.
Breathing can also change. It may become shallower or less regular, and there may sometimes be pauses between breaths. Some people develop noisier breathing because they are less able to swallow or clear normal secretions from the throat. Although this can sound worrying to family and friends, it does not necessarily mean that the person is distressed or uncomfortable. Nurses and doctors can advise on positioning, medication or other measures if needed.
The person may also become increasingly drowsy and communicate less. Even if they no longer respond in the way they did before, it can still be comforting to talk to them, hold their hand or simply sit nearby.
These changes can be difficult to see, particularly if you have not experienced them before. If anything concerns you, or you think the person may be in pain, distressed or uncomfortable, speak to their doctor, nurse or care team. They can explain what is happening and help make sure the person remains as comfortable as possible.
Symptom Management
As someone approaches the end of life, the focus of their care is usually on keeping them as comfortable as possible. Symptoms can change as the body becomes weaker, and the healthcare team will review what the person needs and adjust their care accordingly.
Pain is often one of the things families worry about most, but not everyone who is dying will experience severe pain. Where pain is present, medicines can usually be adjusted to help control it. Other symptoms such as breathlessness, nausea, anxiety, agitation, constipation or increased secretions can also often be relieved or reduced.
As swallowing becomes more difficult, medicines may need to be given in a different way. This might include liquid medicines, patches, injections or a small pump called a syringe driver, which can provide a steady dose of medication over a period of time. A syringe driver does not mean that death is necessarily imminent. It is simply another way of giving medicines when tablets are no longer practical or comfortable.
Doctors and nurses may also prescribe medicines in advance so they are available if particular symptoms develop. This can be especially helpful when someone is being cared for at home, as it means treatment can often be started quickly without waiting for a new prescription.
If you think the person is uncomfortable, in pain, unusually restless or experiencing a new or worsening symptom, tell their doctor, nurse or care team. Even when someone can no longer explain how they feel, healthcare professionals can look for signs of discomfort and adjust their care.
Communication and Reassurance
As someone becomes weaker, they may talk less, sleep for longer periods or find it more difficult to communicate. They may sometimes appear confused, restless or less aware of what is happening around them.
Try to follow the person's lead. Some people want to talk openly about dying, their fears, their family or things that matter to them. Others may prefer to talk about ordinary things, listen rather than speak, or simply have someone nearby.
There is no need to find the perfect words. Sitting quietly together, holding a hand, playing familiar music, looking at photographs or simply letting someone know that you are there can all be comforting.
If the person becomes confused, it can help to keep things calm and familiar. Speak gently, explain who you are and reassure them that they are safe. There is usually no need to correct them if they say something that does not make sense or appear to see or hear something that you cannot.
As someone becomes very drowsy, they may eventually stop responding altogether. It is not always possible to know exactly what they can hear or understand at this stage, so family and friends are often encouraged to continue speaking to them naturally and reassuringly.
If there are things you want to say, you do not need to wait for a particular moment. Simple words of affection, reassurance or thanks can be enough.
Final Hours
It is not always possible to know exactly when someone will die. Even experienced healthcare professionals can usually only give an indication rather than a precise timetable.
In the final hours, the person will usually become increasingly sleepy and may eventually become unconscious. They may stop wanting food and drink and may no longer be able to swallow. Their breathing may become slower or less regular, with occasional pauses between breaths, and their hands and feet may feel cooler as circulation slows.
Although these changes can be difficult for family and friends to see, they are usually part of the body's natural process of shutting down. The care team will continue to focus on comfort and can explain what is happening if you are unsure or worried.
You can continue to sit with the person, speak to them, hold their hand or simply be nearby. Some people want family and friends around them, while others seem to prefer a quieter environment. There is no right way for these final hours to look.
Eventually the person's breathing will stop and their heart will stop beating. If their death was expected, there is usually no need to do anything immediately. Take the time you need, then follow the guidance you have been given by their healthcare team about who to contact.
The practical steps that follow, including verification and registration of the death, are covered in the After a Death section of this website.
Useful Resources
These organisations provide clear information about what may happen as someone approaches the end of life: