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Physical Signs at the End of Life

Hospice Caregiving
A nurse helps a patient get comfortable in bed by elevating his feet with a pillow.

Many families wonder and worry about the physical changes that will occur in the days and hours before death. As your loved one’s condition changes, their hospice nurse can provide guidance about what to expect and what end-of-life signs to look for. The hospice care team can help you understand these changes and keep your loved one comfortable in their final days.

Decline moves at a regular pace. Death from disease is gradual and orderly. (Convulsions, a heart attack, or hemorrhage are unusual events and are not the normal pattern.) At first, your loved one may become less active and prefer sitting to walking around. Their appetite will start to decrease, and they will likely prefer softer foods. Your loved one will become less interested in things that were once important to them.

Physical Signs of Approaching Death

There are some physical signs that the body has begun to shut down and the end of life is approaching. These signs are not medical emergencies, but are expected and don’t mean that your loved one is suffering. In fact, most people are often unaware of the signs.

Your loved one may:

  • Not be hungry or thirsty
  • Spend most or all of their time in bed
  • Have decreased urine output, with urine becoming concentrated and tea colored
  • Have cool, clammy, or bluish skin, especially in the arms and legs, as circulation decreases
  • Gradually slip into unconsciousness
  • Experience hallucinations or become restless or anxious, which is caused by circulatory or metabolic changes
  • Have noisy breathing (producing a rattling sound) because of mucus collecting in the throat
  • Have changes in breathing patterns — unusually slow or unusually fast or a combination of both

Even when many of these signs are present, predicting how much time a person has left can difficult. In the days prior to death, your loved one’s hospice nurse will begin to visit more often to help your loved one feel comfortable, supported, and cared for during their last days and hours.