End of Life Concerns The Dying Process 12 Signs That Someone Is Near the End of Their Life How to help your loved one—and yourself—cope By Angela Morrow, RN Angela Morrow, RN LinkedIn Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse. Learn about our editorial process Updated on May 23, 2022 Medically reviewed by Kimberly Brown, MD, MPH, FAAEM Medically reviewed by Kimberly Brown, MD, MPH, FAAEM Facebook LinkedIn Twitter Kimberly Brown, MD, MPH is an emergency medicine physician, speaker, and best-selling author. Learn about our Medical Expert Board Print It's terrible to learn that a loved one is reaching the end of their life. But knowing what to expect can make you more prepared for what will happen. If you've hired hospice professionals (healthcare providers for people nearing the end of life), they can help make your loved one's last months, weeks, and days as comfortable as possible. They can also support you as you go through this difficult time. This article will discuss 12 signs that a person is nearing the end of their life. It also suggests ways you can help your loved one cope with the final stages. Does a Person Know When They Are Dying? 1 Pain Thomas Odulate / Getty Images Pain is probably the most feared symptom at the end of life. Dying of cancer is often painful, but this isn't true for every terminal illness. Fortunately, there are many medicines that can effectively manage pain. Whatever the sickness is, the ability to recognize and help manage pain for your loved one is extremely important. How to Recognize and Assess Pain 2 Shortness of Breath Thanasis Zovoilis / Getty Images Shortness of breath or breathing difficulties are among the most common symptoms at the end of life. Some amount of breathlessness is common in most people as they near death. Luckily, there are a few simple and effective treatments that can bring quick relief, such as deep-breathing exercises, relaxation techniques, oxygen, and medications. Dyspnea or Shortness of Breath at the End of Life 3 Anxiety Igor Novakovic / Getty Images Anxiety is perfectly normal at the end of life. A person may experience pain or shortness of breath during the dying process. This is something that can be upsetting and scary. End-of-Life Anxiety 4 Decreased Appetite and Thirst Hero Images / Getty Images As a person's body naturally shuts down and prepares for death, it no longer needs the calories and nutrition that food provides. Even though it's normal for people to refuse food and drink at the end of life, this can be upsetting for their families. Since providing food is such a huge part of caregiving (and caring) it often feels strange for a loved one to care for the patient and not feed them. The important thing to understand is that when someone is dying from a terminal illness, the desire for less food is something natural and does not really speed up the process of death. Most patients experience a dramatic decline in the desire for food. Loss of Appetite at at the End of Life 5 Nausea or Vomiting Nicolevanf / Getty Images Sicknesses, medications, and other treatments can lead to nausea with or without vomiting. This can be distressing for both you and your loved one. Nausea medications, fresh air, eating small meals, and limiting odors are among the treatments you can try to help your loved one manage these symptoms. Managing Nausea and Vomiting in Palliative Care and Hospice 6 Constipation Alvis Upitis / Getty Images If you've ever been constipated, you know how uncomfortable it can be. Medications used to treat pain and shortness of breath can cause constipation. Other causes of constipation are not enough physical activity, decreased fiber and fluid intake, and the progression of the disease. Constipation is a symptom you have to stay on top of to prevent it from becoming severe. Ask your loved one's doctor or nurse how best to manage it. Constipation at the End of Life 7 Fatigue mediaphotos / Getty Images A dying patient may sleep a lot because they don't have enough energy. It may also be because the body is shutting down. Medications they take can cause drowsiness too. Trouble sleeping is also common. Changes in Sleep as You Age 8 Drifting Away From Loved Ones Ariel Skelley / Getty Images As someone nears death, they naturally start to focus inward and separate from the world around them. This includes friends and family. On the other hand, others may crave closeness with those they love. Either way, try to respect and take care of their needs. 9 Delirium and Restlessness ImagesBazaar / Getty Images Confusion, agitation, and inability to sleep can happen with some people at the end of life. Delirium (suddenly acting confused and disoriented) can be caused by the progression of the disease, less oxygen reaching the brain, or medications. Sometimes constipation (trouble having bowel movements) or dehydration (not enough water in the body) may even trigger delirium. The person may nervously pick at their sheets and clothing. They may even hallucinate and see people and things that aren't there. Let your healthcare provider know if your loved one is showing any of these behaviors. Terminal Restlessness and Delirium at the End of Life 10 Incontinence krisanapong detraphiphat / Getty Images Both urinary and bowel incontinence are common near the end of life. When you have incontinence, you can't control your urine or bowel movements. This can be a result of surgery or illness, or because the person is simply too weak to use the bathroom. At the very end, when the muscles relax entirely, the patient will often release the contents of their bowels. 11 Cold Hands and Feet and Skin Mottling Emilija Manevska / Getty Images Hands and feet may become colder and the skin may look blotchy and purplish (mottled). It happens because the heart is no longer able to pump blood as well. As a result, blood pressure goes down and the skin grows colder. This mottling may slowly work its way up the arms and legs. The lips and nail beds can turn blue or purple too. 12 The "Death Rattle" Erik Isakson / Getty Images As uncomfortable as it is to call this symptom the "death rattle," it's a correct description. "End-stage wet respirations" is the medical term for saliva and mucus that build up in the airway when an individual becomes too weak to clear those secretions out. The collection of mucus and fluids causes a rattling sound when the person breathes. This can upset family and friends who hear it. But most of the time, the patient isn't feeling any pain or suffering. Summary When someone is nearing the end of life, they experience a variety of symptoms. Pain, shortness of breath, anxiety, incontinence, constipation, delirium, and restlessness are just a few signs that a loved one is going through the dying process. A Word From Verywell No one wants their loved one to die from a terminal illness. It's a frightening experience for everyone involved. Talking with your loved one's doctor and knowing what to expect can help you make them as comfortable as possible during the final stages of life. 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Cancer Society. What to expect when a person with cancer is nearing death. Hendriks SA, Smalbrugge M, Galindo-Garre F, Hertogh CMPM, van der Steen JT. From admission to death: prevalence and course of pain, agitation, and shortness of breath, and treatment of these symptoms in nursing home residents with dementia. Journal of the American Medical Directors Association. 2015;16(6):475-481. doi:10.1016/j.jamda.2014.12.016 Sandvik RK, Selbaek G, Bergh S, Aarsland D, Husebo BS. Signs of imminent dying and change in symptom intensity during pharmacological treatment in dying nursing home patients: a prospective trajectory study. Journal of the American Medical Directors Association. 2016;17(9):821-827. doi:10.1016/j.jamda.2016.05.006 Glare P, Miller J, Nikolova T, Tickoo R. Treating nausea and vomiting in palliative care: a review. Clin Interv Aging. 2011;6:243-59. doi:10.2147/CIA.S13109 Dzierżanowski T, Ciałkowska-rysz A. The occurrence and risk factors of constipation in inpatient palliative care unit patients vs. nursing home residents. Prz Gastroenterol. 2018;13(4):299-304. doi:10.5114/pg.2018.79809 Hui D, Dev R, Bruera E. The last days of life: symptom burden and impact on nutrition and hydration in cancer patients. Current Opinion in Supportive & Palliative Care. 2015;9(4):346-354. doi:10.1097/SPC.0000000000000171 Hosker CMG, Bennett MI. Delirium and agitation at the end of life. BMJ. :i3085. doi:10.1136/bmj.i3085 Hui D, dos Santos R, Chisholm G, Bansal S, Souza Crovador C, Bruera E. Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study. Cancer. 2015;121(6):960-967. doi:10.1002/cncr.29048 Additional Reading Memorial Sloan Kettering Cancer Center. Toward the end of life: What you and your family can expect. By Angela Morrow, RN Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit