Here are four common signs in detail:
1. Decreased Appetite and Thirst
One of the earliest signs is that the person gradually stops wanting food and drinks.
What happens:
- They eat only a few bites or refuse meals.
- They drink very little.
- Swallowing may become difficult.
- They may sleep through meal times.
Why it happens:
As the body’s organs begin to slow down, it needs less energy. The digestive system becomes less active, so forcing food or fluids usually does not improve comfort.
What caregivers can do:
- Offer small sips of water or ice chips if they can swallow safely.
- Keep the lips and mouth moist with oral swabs or lip balm.
- Avoid pressuring them to eat.
2. Increased Sleep and Reduced Responsiveness
The person may spend most of the day asleep and become harder to wake.
What happens:
- Sleeping for long periods.
- Speaking less.
- Confusion about time or place.
- Limited response to voices or touch.
- Eventually, they may not respond at all.
Why it happens:
Reduced blood flow and changes in brain function make it harder to stay awake.
Important note:
Even when a person does not respond, hearing may remain intact until very late. Many hospice professionals encourage family members to continue speaking calmly and reassuringly.
3. Changes in Breathing
Breathing often changes noticeably during the last hours or days.
Common patterns include:
- Slow or irregular breathing.
- Long pauses between breaths (called apnea).
- Periods of rapid breathing followed by slower breathing.
- A rattling sound from mucus collecting in the throat because the person can no longer clear secretions effectively (sometimes called the “death rattle”).
Why it happens:
The brain’s control of breathing changes, and muscles become too weak to clear saliva or mucus.
What caregivers can do:
- Reposition the person onto one side if appropriate.
- Keep the head slightly elevated.
- Medications may be used in hospice care if secretions cause discomfort, although the sound itself is usually more distressing to family members than to the dying person.
4. Changes in Skin Color, Temperature, and Circulation
As circulation slows, blood is directed toward vital organs.
What happens:
- Hands and feet become cool to the touch.
- Skin may appear pale, bluish, or gray.
- Mottling (a blotchy, purplish pattern) may develop, especially on the knees, feet, and hands.
- Pulse becomes weaker and harder to feel.
Why it happens:
The heart is no longer pumping blood as effectively to the extremities.
What it means:
These changes often occur during the last hours to days of life, though the timing varies considerably from person to person.
Other signs that may occur
- Reduced urine output, with urine becoming darker.
- Loss of bladder or bowel control.
- Restlessness or agitation in some people.
- Moments of clarity or brief bursts of energy before becoming weaker again (not everyone experiences this).
When to seek medical support
If someone is receiving hospice or palliative care, contact the care team if:
- They appear to be in pain.
- They are very agitated or distressed.
- You have questions about what you’re observing.
- You need guidance on keeping them comfortable.
These physical changes are generally considered a natural part of the dying process. The primary focus at this stage is usually on comfort, symptom relief, and supporting both the person and their loved ones.