At the end of life, your healthcare team will closely watch your loved one to make sure they're comfortable. They may make changes to treatments and medicines.
You may notice the following as your loved one gets closer to death. Talk to your healthcare team if you have questions about what to expect or how you can help during this time.
Feelings and beliefs
Your family or friends may have different feelings as death gets closer. They may talk about their decisions and journey in life. They may feel deep emotions such as fear or anger.
Many people as they get closer to dying feel the need to deal with past problems in their life such as regrets, losses, and poor relationships. Or they'll talk more about life after death.
The best thing is to let them talk. If you don't feel you can help them or listen to these thoughts, you can ask for someone from spiritual care to come. You may also wish to see a leader from your cultural or spiritual community. Spiritual care staff can help arrange any practices, rituals, or connections with community leaders you might need or want.
Sleeping longer
Some people sleep longer and may be harder to wake up. Even if you can't tell if your loved one knows you're there, they may still hear you. Be aware of what you say when you are near.
- Talk to your loved one when they're awake and alert and let them rest when they need to.
- Sit quietly beside them when you visit. Just being there can be a comfort
Eating and drinking less
As death gets closer, it's common to eat and drink less. This happens as the body begins to shut down and the normal jobs of the body get slower. It may also be harder to swallow.
- When your loved one is fully awake and able to swallow, offer them small amounts of food, drinks, or ice chips.
- Keep their mouth moist (using a sponge tipped oral swab, oral lubricant, or the corner of a damp washcloth) and put lip balm on their lips.
Bowel and bladder problems
It's common to lose bowel or bladder control as the body shuts down. You may also notice there's little or no urine.
Even though your loved one may not be eating and drinking, monitor bowel movements. If you feel like they are having problems with constipation or diarrhea, talk to your healthcare team.
Heartbeat changes
As the heart gets weaker, it can cause an irregular heartbeat and pulse. Checking blood pressure is often not necessary at this stage since changes to the body can happen so quickly. Checking blood pressure may also be uncomfortable for your loved one at this time.
High temperature
Having a higher body temperature as death gets closer is common. Using cool facecloths on the forehead may provide comfort. Sometimes medicine is given to bring down a fever and make your loved one more comfortable.
Eye changes
The eyes may become dry, stay open, or have a white film. It may help for comfort to moisten the eye with an eye lubricant, gentle washing, or gently closing the eyelids.
Skin changes
You may notice that your loved one's skin looks bluish-grey or blotchy. Their hands, arms, knees, legs, and feet might feel cool. This is normal during the dying process. Most of the blood goes to the main organs of the body. These changes usually don't make your loved one uncomfortable.
Muscle twitches
Sudden muscle movements (called twitches) are often caused by medicines. Muscle twitches can be managed by making changes to medicines or the dose of a medicines. Muscle twitching can also happen as the muscles get weaker and when there are changes to blood flow. These twitches are usually not painful. For safety keep objects like cups of water or side tables away from the limbs that are twitching.
Changes to awareness and confusion
Your loved one may start to get confused, have trouble concentrating, forget things, or lose interest in what used to be important to them. They may also:
- have a harder time making decisions
- be scared, angry, have trouble resting, or get excited easily for no reason
- ask to go home
- hear or see things that aren't real (hallucinations)
- reach out and talk to a person who has already died
- have strange thoughts that may bother them
To help lessen confusion, try to keep the room quiet. Use a low volume when watching TV or listening to music.
Confusion and restlessness
A dying person may be confused, anxious, or have trouble resting. They may try to climb out of bed or grab at things. They may see things that others don't see or say or do things that aren't normal for them to say. This can be related to dying or maybe a sign that their medicine needs to be changed.
To help your loved one cope, you can:
- let them know in a calm and gentle way that they are safe and cared for
- offer to listen if they want to talk about any problems in their life
- let them know that it's OK to let go of life
Noisy breathing
You may notice that breathing sounds are wet or sound like snoring if saliva collects at the back of the throat. This can happen as the neck muscles relax or if the lungs get filled with fluid (get congested). Often this doesn't upset the person, and it doesn't prevent them from being able to breathe. In most cases, suctioning and oxygen aren't needed.
To manage noisy breathing, the healthcare team may:
- turn them onto their side to help clear fluid from the throat
- raise the head of the bed or prop them up with pillows
- give medicine if their breathing makes them upset
- give less or stop giving extra fluids
Breathing changes
Near the end of life, you may notice changes to how fast and deep your loved one breathes. They may even stop breathing for up to a minute at a time or give little gasps. This is a normal part of dying.
When this happens, the oxygen level can change so quickly that checking the levels isn't helpful. Giving oxygen is often not recommended as it can make the person more uncomfortable. It can help to use a fan or medicines to make breathing more comfortable.
