What can I expect when death is near?

Although everyone is different, there are some common things that happen as part of the natural process of dying. At this stage, the person who is dying is often unaware of many of these things. But it can help those who care for them if they know what to expect.

People often tell us that they are worried about what will happen when someone they love is close to death. They ask us what they should expect. Each person’s experience is unique, but for most people with a terminal illness, they are peaceful and comfortable when they die.

A patient in a hospice and his family

She was very disorientated and really struggling to breathe. She said she loved us very much and was ready. She then shut her eyes and went to sleep. Mum's spirit had left us but her body continued the shutting down journey of 16 hours.

'Losing my mum so quickly - a quote from our online community

What are the signs that someone is close to death?

It can be very difficult to see these changes happening to someone you love. But they do not mean that the person is uncomfortable or in distress. The changes are a natural part of the dying process.

The healthcare team will do everything they can to make sure that you or your relative or friend is as comfortable as possible.

Wanting to eat and drink less

People who are dying do not seem to need as much energy from food and do not need to eat and drink as much as someone who is well. Seeing someone you love stop eating can be very difficult and hard to accept, but this is a natural part of the body slowing down.

The best thing to do is to let them eat and drink as much or as little as they want - even if it is only a teaspoon-full. It’s fine if they don’t want anything at all. Sometimes people stop eating days or even a couple of weeks before they die.

Sometimes a person may have trouble eating and swallowing, and if this is the case the healthcare team may make suggestions to help them.

Withdrawing from the world

As people become close to death they often seem less in touch with what is going on around them. They may talk less and be less able to concentrate or do things they would normally do, like reading the paper.

Sometimes a person can be quiet all day with their carer, but brighten up and chat more when someone else comes to visit. This is a sign that they feel safe and comfortable with the person looking after them. They don’t have the energy to sustain that level of social engagement the rest of the time.

Sleeping more or being semi-conscious

People who are dying may become drowsy and sleep more and more of the time. Even if they do not seem to be awake, they may still take pleasure from hearing a loved one’s voice or the usual sounds of life - such as music or favourite TV shows.

You can provide care and reassurance by talking to them, holding their hand, and telling them when you enter or leave the room. This can be a good time to give them permission to let go and to say goodbye. It is also important not to say anything that you wouldn’t want them to hear.

People who are towards the end of their life may be asleep or semi-conscious in this way for between two and three days, or sometimes longer.

Changes in breathing

Often people’s breathing changes quite a bit in the last days and hours of life. It can become more laboured or their breaths have a pattern where they become more rapid, then slow right down - with long moments when they don’t breathe.

Their breathing can become noisy and make a rattling sound. This sound is caused by a build-up of fluid at the back of the throat. Although this can be distressing to hear, it does not usually cause them any discomfort or distress.

Sometimes propping their head up on a pillow and turning it to one side can help the fluid to drain away. These changes in breathing might start five minutes before someone dies, or can go on for 24 hours or more – everyone’s different.

Restlessness and agitation

Sometimes people can become restless or agitated shortly before their death. Their doctor or nurse will make sure they have the medication they need to prevent them being in pain, anxious or frightened.

Cold hands and feet

In the final hours, the person’s hands or feet may become cool to touch and become paler or bluish in colour. This happens because their circulation is slowing down.

They may like a blanket or thick socks to help to keep their feet warm.

How long does death take?

Dying is a natural process that is unique to each individual and no-one can tell you how long a person’s final days or hours might be. It can be very hard to see some of the different signs and not know what is happening or when the person might die.

We need to remember that we still can’t fully explain what is going on in a person’s body and mind as they reach the end of their life.

There are physical changes that take place and maybe they are working through things emotionally - getting ready to leave the people that they love, and their life. You can still be a support to the person by letting them know that you are there, talking to them and holding their hand.