Overview

Several physical and emotional changes occur as death nears. Here are some things you can expect. If you have any questions or concerns, talk to your doctor. The more you know, the better prepared you'll be to cope with what is happening.

Emotional and spiritual changes

As death nears, you may feel like being social. You may want to see and connect with people. But it's also common for people to become less interested in the outside world and the specific details of daily life, such as the date or time. You may turn more inward and be less socially involved with others.

You may spend time thinking about people who have already died. Events in the recent past may become mixed with memories from your distant past. You may remember events from years long gone in vivid detail. But you may not remember what happened even an hour earlier.

Facing the end of your life may also cause you to confront your own spiritual questions and issues. Think about what provides comfort and support to you. Don't hesitate to ask for support from friends, family, hospice palliative care workers, or spiritual advisors.

Physical changes

Some of the common physical changes you may experience include:

• Appetite changes. You probably will eat and drink less, or not at all, as death nears. Changes in your metabolism mean that you don't need the same amount of food and fluids that you needed before. You can be offered small sips of fluid or small bites of food as long as you are alert and able to swallow.
• Breathing changes. You may breathe faster or slower. As death nears, your breathing may be moist and noisy. Breathing changes commonly occur when you are weak, and normal secretions in your airways and lungs can collect. Sometimes people feel short of breath. A doctor can prescribe medicines or other therapies to help make sure that these breathing changes aren't uncomfortable.
• Increased weakness and sleepiness. General weakness is common at the end of life. It's not unusual to need more help to walk, bathe, and use the toilet. Later, you may need help turning over in bed. As death nears, you may sleep more and may be harder to wake up. You may enter a stage called a coma, when you do not wake up or respond at all. When you are in a coma, all physical needs (such as bathing, turning, and bowel and bladder care) will be taken care of by someone else.
• Urinary and bowel changes. You will make less urine as death nears. What you do make may be dark brown or dark red. Stools (feces) may be hard and difficult to pass (constipation) as your fluid intake decreases and you get weaker. Medicines (like stool softeners or laxatives) or an enema can help. As you become weaker, you may lose control of your bladder and bowels. Disposable pads and underwear can be supplied by a hospice palliative care program or bought at a drugstore. And if needed, a urinary catheter can be placed in your bladder to continuously drain your urine.
• Vision changes. As you near death, you may notice that you can't see well.

Mental changes

As death nears, you may start to see or hear things that no one else does. You may also become agitated, or be more or less alert at different times. This is known as delirium. Your caregiver will tell a doctor or hospice palliative care worker if you're having delirium. Medicine can be prescribed to help keep you calm and comfortable.