What are the signs someone is dying?

Changes that may occur when someone is dying

These changes may occur during the last days or hours of life, but they do not happen in exactly the same way for everyone. Some changes can come and go, and it can be difficult even for healthcare professionals to predict precisely when death will occur.

• Becoming increasingly tired and sleepy

A person may spend much more time sleeping and may have less energy for conversation or activities. They may drift in and out of sleep and gradually spend more time asleep than awake. Eventually, they may become difficult to wake or may remain unconscious.

Even when someone appears unconscious, they may still be able to hear voices or sense that someone is nearby. You can continue to talk to them, reassure them and hold their hand if this feels right.

• Eating and drinking less

It is very common for someone who is dying to lose interest in food and drink. They may eat only small amounts, take longer to eat or stop eating altogether. They may also drink less and eventually stop drinking. As the body slows down, it needs less energy and may no longer process food and fluid in the same way.

You do not need to force someone to eat or drink. If they are able and want to eat or drink, offer what they would like. If they can no longer drink safely, mouth and lip care can help keep them comfortable. Ask the healthcare team to show you what is appropriate.

• Changes in breathing

Breathing often changes as someone gets closer to death. It may become slower, shallower or irregular, with pauses between breaths. There may also be periods of deeper or faster breathing followed by a pause.

You may hear a rattling or gurgling sound caused by saliva or mucus collecting because the person is no longer able to swallow or clear secretions effectively. Although this sound can be distressing for family members, it does not necessarily mean the person is suffering. Tell the healthcare team if you are worried.

• Changes in consciousness and awareness

Someone who is dying may become less aware of what is happening around them. They may become confused or disorientated, have hallucinations, drift in and out of consciousness or become unable to communicate.

If someone seems confused or is seeing or hearing things you cannot, try not to argue or correct them. Reassure them calmly. New or worsening confusion, agitation or distress should be discussed with the healthcare team because there may be treatable causes.

• Becoming weaker and withdrawing

As the body slows down, the person will usually become increasingly weak. They may need help with washing, dressing, moving around, eating, drinking or using the toilet. Eventually they may spend most or all of their time in bed or a chair. They may also lose interest in conversation, visitors or their surroundings.

This does not necessarily mean they do not want you there. Sometimes simply sitting quietly beside them, holding their hand, talking gently or listening to music can be comforting.

• Changes in the hands, feet and skin

As circulation slows, hands and feet may become cold. The skin may become pale, bluish or mottled, particularly on the hands, feet, arms and legs. These changes can be difficult to see but are often a natural part of the dying process.

• Changes in urine and bowel movements

As someone drinks less and their body slows down, they may pass much less urine. They may also become constipated or lose control of their bladder or bowels. The healthcare team can help manage these symptoms and protect the person’s dignity and comfort.

What happens in the final hours?

As death gets very close, several of these changes may become more pronounced. The person may be mostly or completely unconscious, stop eating and drinking, pass very little or no urine, have cold hands and feet, develop changes in skin colour, and have very irregular breathing with longer pauses between breaths. Their pulse may become weaker.

Eventually, their breathing will stop and their heart will stop beating. There is no precise timetable. These changes can occur over hours, but sometimes the process takes longer.

Does dying hurt?

Dying does not necessarily mean that someone will be in pain. Some people do experience pain or other symptoms as they approach death, but healthcare professionals can assess and treat many symptoms. If you think someone is uncomfortable, tell their GP, community nurse, hospice or palliative care team.

What can I do if someone I love is dying?

You do not need to know exactly what to say or do. Often the most important thing is simply to be there.

When should I contact the healthcare team?

If someone is known to be approaching the end of their life, you should have information about who to contact if you are worried. Contact their GP, community nursing team, hospice or palliative care service if they seem uncomfortable or distressed, their symptoms suddenly change, you are unsure what is happening, or you need advice about medication or care.

If the situation is an emergency and you cannot access the appropriate healthcare team, call 999.