At the end of life, the healthcare team will closely watch a patient’s signs to make sure they are comfortable during the dying phase. They may make changes to medicines.

You may notice the following as your loved one gets closer to death. Talk to your loved one’s healthcare team if you have questions about what to expect or how you can help during this time.

Sleeping longer

Some people sleep longer and be harder to wake up. It’s important to remember that 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.

Skin changes

You may notice that your loved one’s skin look bluish-grey or blotchy and their arms and legs might feel cool. This is normal during dying process because most of the blood is going to the main organs of the body. These changes don’t make your loved one uncomfortable.

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.

Changes to awareness

Your loved one may start to get confused, have trouble concentrating, forget things, or lose interest. They may also:

• have a harder time making decisions
• hear or see things that aren’t real (hallucinations)
• reach out and talk to a person who has already died
• be scared, angry, have trouble resting, or get excited easily for no reason
• 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 the radio.

Bowel and bladder problems

It’s common to lose bowel or bladder control as the body shuts down. You may also notice there is little or no urine.

Even though your loved one may not be eating and drinking, it’s still important to monitor bowel movements. If you feel like your loved one is having problems with constipation or diarrhea, please talk to the healthcare team.

Noisy breathing

You may notice that breathing sounds wet or a snoring-like sound 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). For most people, this isn’t upsetting and it doesn’t prevent them for being able to breathe. In most cases, suctioning and oxygen aren’t needed.

To manage noisy breathing, the healthcare team will:

• turn your loved one in their bed to help clear fluid from the throat and make them more comfortable
• raise the head of the bed a little
• give medicine if their breathing makes them upset
• give less or stop giving extra fluids through a needle into a vein or underneath the skin to make breathing more comfortable

Breathing changes

You may notice there are changes to how fast and deep your loved one breathes. They may even stop breathing for up to a minute at a time. This is a normal part of dying.

When this happens, the oxygen level usually doesn’t need to be checked since it can change so quickly. Giving oxygen is often not needed and can even make the person more uncomfortable. It can help to use a fan or medicines to make breathing more comfortable.

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 medicine. Muscle twitching can also happen as the muscles get weaker and when there are changes to blood flow.

Abnormal heartbeat

As the heart gets weaker, it can cause an abnormal (irregular) heartbeat and pulse. Since changes to the body can happen so quickly, blood pressure doesn’t always need to be checked. Checking blood pressure may also be uncomfortable for your loved one at this time.

High temperature

It’s common to have a higher body temperature as death gets closer. Giving lukewarm sponge baths or using cool facecloths or a fan can help. We can also give medicines to bring down a fever and make your loved one more comfortable.

Confusion and trouble resting

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, or say or do things that are not normal for them. This can be related to dying or may be a sign that their medicine or the dose of 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 okay to let go of life

Eye changes

The eyes may become dry, stay open, or have a white film which can make it hard to see well. It may help to moisten the eye with an eye lubricant, gentle washing, and closing the eyelids may help.

Feelings and beliefs

You may notice your loved one has different feelings as death gets closer. They may:

• talk about their journeys in life
• ask to go home
• tell you they see people that you don’t
• have deep emotions such as fear or anger
• want to deal with past problems in their life such as regrets, losses, and poor relationships
• talk more about life after death