What Happens Towards the End of Life?

The body gradually slows down as someone approaches the end of life. Changes can happen over hours or days, and sometimes over longer periods.

Every person is different. The healthcare team may recognise that someone is entering the final stage of life, but it is usually not possible to predict exactly when death will occur.

Changes during the final weeks

Increasing weakness or tiredness
Sleeping more
Less activity
Eating and drinking less
Needing more personal care
Becoming less mobile
Spending more time in bed or resting

Changes during the final days and hours

As death gets closer, someone may:

Sleep much of the time
Become harder to wake or less responsive
Take very little food or fluid
Develop changes in their breathing
Have cool hands and feet
Develop changes in skin colour
Pass less urine
Become unconscious

These changes can be part of the natural dying process. Several may happen together, but not everyone experiences all of them.

Eating and drinking

Appetite and thirst often reduce naturally. Food and drink can be offered while someone is able and wants to take them, but they should not be forced.

The team can advise about swallowing and mouth comfort.

When someone becomes less responsive

Someone who is very sleepy or unconscious may still be able to hear. You can continue to talk to them, tell them who is there, play familiar music or simply hold their hand and sit quietly.

You don’t need to find the right words.
Your presence can be enough.

Changes in breathing

Breathing may become slower, shallower or irregular, with pauses between breaths.

Some people develop noisy breathing caused by secretions in the throat. This can sound distressing to families, but the sound does not necessarily mean that the person is distressed or struggling.

The healthcare team can assess the person and provide treatment if symptoms are causing distress.

Changes in circulation

Hands, feet, arms or legs may become cool. Skin can become pale or mottled as circulation changes.

Bladder and bowel changes

Someone may pass less urine and may become incontinent. The care team can provide appropriate equipment and personal care while maintaining comfort, dignity and privacy.

What can families do?

Stay with the person if you want to
Talk to them
Hold their hand
Play familiar music
Keep the environment calm
Tell the team if you are worried about something
Ask questions, even if you think they are obvious

You don’t have to do this alone.