End of Life Concerns What Loved Ones Should Know About the End of Life What to Expect, What to Do, and How to Cope By Chris Raymond Chris Raymond Verywell Health's Twitter Chris Raymond is an expert on funerals, grief, and end-of-life issues, as well as the former editor of the world’s most widely read magazine for funeral directors. Learn about our editorial process Updated on April 10, 2023 Medically reviewed by Forest Miller, MSOT, OTR/L Medically reviewed by Forest Miller, MSOT, OTR/L Verywell Health's LinkedIn Forest Miller, MSOT, is an occupational therapist specializing in geriatric rehabilitation and upper extremities. Learn about our Medical Expert Board Fact checked by Marley Hall Fact checked by Marley Hall Verywell Health's LinkedIn Marley Hall is a writer and fact checker who is certified in clinical and translational research. Her work has been published in medical journals in the field of surgery, and she has received numerous awards for publication in education. Learn about our editorial process Print Table of Contents View All Table of Contents Approaching the End of Life Practical Considerations When Death Is Near Once Death Occurs Next Steps Grief and Loss Despite death being inevitable, most people avoid learning about and discussing end-of-life care, whether for themselves or a loved one. While it may be uncomfortable to explore the subject, it can also be empowering and reduce the uncertainty and fear that often come along with this process. This, of course, is especially important if the end of one's life is known to be near. While everyone experiences death uniquely, there are some commonalities that are worth knowing about. There are also practical considerations to be dealt with, as well as emotional ones for those left behind. manonallard / Getty Images Approaching the End of Life Many factors will affect the dying experience for each individual. Some things that influence the end-of-life process include: Presence of disease, illness, or other medical condition Type of healthcare he or she is receiving Medication(s) and/or life-prolonging treatments Palliative care and/or entering a hospice program Cause of death itself Psychological buildup and coping mechanisms of the particular patient For some people, the dying process might take a few weeks, several months, or even longer. For others, the transition from apparent good health to death might occur swiftly—within days or even hours. Remember, the end-of-life process neither conforms to a timetable nor gives specific signals that indicate exactly how much longer a loved one will live. That said, while there is no universal dying experience common to all, many people still exhibit some similarities as death approaches. Below are just a few. Interactions With Others Often, an individual might start to withdraw from family members, friends, and other loved ones, or show little or no interest in the social interactions, hobbies, and/or physical activities he or she once enjoyed. Others might still socialize and receive visitors, but uncharacteristically display anger or make it difficult to interact with them or to provide care. Those who are dying often reflect on their lives and might attempt to resolve a troubled relationship or deal with any regrets. Working through The Five Stages of Dying can help individuals say goodbye to loved ones, find a sense of closure, and achieve a sense of peace as death approaches. Psychological Changes Sometimes a dying person might experience changes in sensory perception that result in delusions or hallucinations. The patient might manifest this, for example, by: Hearing or seeing things that don't exist, resulting in fears about hidden enemies Speaking to people who are not in the room (or who have already died) Incapacity to follow a line of thought or a conversation without getting easily distracted, referred to as "inattention" Appearing agitated and picking at their clothing or bed sheets Making random gestures or movements that seem senseless to onlookers Awareness Some dying people might experience a phenomenon known as nearing death awareness—a recognition that something is happening to them, even if he or she cannot express it adequately. Sometimes dismissed by caregivers as delirium or terminal restlessness, the dying patient might talk or act as if he or she needs to prepare for a journey or share a vision about seeing a deceased loved one or a beautiful place. Ways to Recognize That a Loved One Is Dying Practical Considerations While this is a natural process, there are some tasks that may need to be tended to and daily life challenges that present themselves. Paperwork and Planning During the end-of-life process, it is not uncommon for people to get their affairs in order, if they haven't already (or for a trusted individual to help with this). For instance, these steps might involve highly practical matters, such as: Creating or finalizing a legal will Establishing an advance healthcare directive or Do Not Resuscitate order Preplanning a funeral or memorial service That said, it's not uncommon for some people to avoid these things altogether, despite their usefulness. Visitors In terms of spending time with others, some people who are dying want to see friends and acquaintances and others do not. This preference can even change from day to day. If you are acting as a gatekeeper for that individual, always ask permission before allowing visitors so you can respect your loved one's wishes as best you can. Everyday Life When someone you love is dying, it is perfectly natural to put your normal life on hold. You might want to spend as much time with them as possible and find it hard to think about anything other than helping them through this time. You may also feel on 'high alert' when you're apart, waiting to hear news you dread. All of these things are normal and a natural part of your feelings. Explain as best as you can to your family, friends, and co-workers what you are going through. Be sure they know that additional stresses, strains, or demands may be difficult for you to handle right now. Also, be honest about when you might need assistance. Would it help to have your children pick up some of the chores at home? Can a friend provide dinners for your family? People often offer to help, but do not know what you need. This is your opportunity to let them know. How You Can Help a Dying Friend or Loved One When Death Is Near As death grows imminent, those who are dying often lose their appetite—even for their favorite foods or beverages—and lose weight. While this might prove alarming to the patient's loved ones, this is a perfectly natural part of the end-of-life journey because the individual's body requires less energy. In fact, the chemistry of the human body can change at this point and actually produce a mild sense of euphoria within the dying person. In addition to not eating or drinking, the dying individual will generally speak little, if at all, and might fail to respond to questions or conversations from others. They also might sleep a great deal, and physical activity will grow limited if not become absent completely. Physical Signs Near the end of the dying process, the individual's body will generally begin to exhibit some or all of the following: A drop in body temperature by one or more degrees A gradual decrease in blood pressure An irregular pulse that might run faster or slower An increase in perspiration A decrease in blood circulation, which affects skin color and is often most noticeable around the lips and nail beds as they become pale and bluish or grayish Breathing that grows more irregular, often slower, and can include Cheyne-Stokes breathing (rapid breaths followed by periods of no breathing at all) Congestion in the throat and airways, which can cause loud, wet respirations or the so-called death rattle As the individual's body begins to shut down, his or her hands and feet might become purplish and blotchy in appearance. This mottled skin tone might also slowly spread upward along the arms and legs. The person's eyes might remain open or half-open, but he or she will not see their surroundings and will usually become unresponsive. Experts generally believe that our sense of hearing is the last sense to cease before death occurs. Loved ones may sit and talk to the dying individual during this time, if desired. Once Death Occurs Eventually, the patient's breathing will cease altogether and his or her heart will stop beating. Death has occurred. At this point, the human body immediately begins a series of physical processes. These include: Dilation of the pupilsA relaxation of the muscles and eyelidsA growing paleness to the skin's normal color as blood drains from the smaller veins in the skinIf the body remains undisturbed for long enough (several hours), the blood will pool in the areas of the body nearest the ground and, eventually, chemical changes in the body's cells will result in rigor mortis—a temporary stiffening of the muscles. What to Do If the individual died at home, contact your local police department or call 911.If he or she received hospice care at home, call your hospice agency.If the death occurred in a caregiving facility, such as a hospital or nursing home, then personnel there will handle the necessary procedures. Next Steps When a loved one dies, there are numerous tasks that survivors might need or want to handle immediately, as well as various duties they will need to accomplish in the days and weeks that follow the death. Unfortunately, most people avoid talking about death during their lifetimes and therefore never hold a conversation about their final wishes with a loved one, relative, or friend. Because of this, you might need to make arrangements entirely on your own. Final Disposition The first decision you should make (if a directive wasn't left for you) is to choose what you would like to do with your loved one's body—what's called the form of final disposition. You have several options: Alkaline hydrolysis A casketed below-ground burial in a cemetery or memorial park A casketed above-ground burial in a mausoleum (Note: This is not available in all locations.) Cremation Natural or green burial If the deceased person chose to donate their body (e.g., for medical research), arrangements for that needed to be made before the death occurred. Funerals and Memorial Services The immediate family or the deceased's next-of-kin usually plan a funeral or memorial service. If your loved one preplanned or prearranged his or hers, then you should contact the chosen provider to discuss the details and finalize the arrangements. Some families will work with a professional provider, such as a funeral director or celebrant, during a funeral arrangement conference to create a fitting, meaningful service that enables loved ones to honor and remember the deceased while comforting and supporting each other. While arranging the service, you will be asked to provide the information needed to write an obituary, and you might decide to write and deliver a eulogy during the funeral or memorial service as well. Other families choose to forego any such services for various reasons. In these cases, they might select direct or immediate burial or direct cremation. They might then consider having a private affair to honor the individual. As a consumer, you should review and understand the Federal Trade Commission's Funeral Rule, which protects your rights when purchasing goods or services from certain providers (primarily funeral homes). How to Talk About Death With a Dying Person Grief and Loss Grief is a powerful, multifaceted, and often uncontrollable response that people experience following a personally painful or traumatic event, such as the death of a loved one. While grief is a perfectly normal and necessary reaction to loss, each person will mourn in his or her unique way and time. The Four Phases and Tasks of Grief Despite the deeply personal nature of grief, most mourners still tend to exhibit some of the following characteristics during the days, weeks, and months following the death of a loved one: Tears, crying, or sobbingSleep-pattern disruptions, such as insomnia, too little sleep, or too much sleepAn overall loss of energyFeeling lethargic or apathetic about the day's necessary tasks or life in generalAppetite changes, such as not feeling hungry or eating too much (particularly junk food)Withdrawing from normal social interactions and relationshipsTrouble concentrating or focusing on tasks, whether at work, in personal life, or hobbiesQuestioning spiritual or religious beliefs, job/career choices, or life goalsFeelings of anger, guilt, loneliness, depression, emptiness, or sadness The sadness and pain caused by grief can create genuine physical effects on your body, such as digestive problems, pain and discomfort, and weight gain or loss. You might even find it challenging to return to your job or office while you're mourning. Because you might have trouble thinking clearly at this time, there are several life decisions you should delay making for a while, if possible. Some people prefer to grieve by themselves and do not want or need outside assistance. Others might seek and find comfort in sharing the pain, anger, depression, and other emotions they feel following a loss by joining a bereavement support group or speaking with a therapist. Remember that if your loved one died under the care of hospice, grief counseling may be available to you at no cost through the hospice agency. There are no predictable stages of mourning. Instead, your reaction to the death of a loved one is deeply personal. You must find ways to cope that work for you. Tips to Help Yourself in Times of Grief A Word From Verywell If you would like to provide support and comfort to a grieving family member or friend, there are many practical ways you can help them as they cope with their loss. While it generally seems difficult to find the right words to comfort a griever, there are meaningful, uplifting expressions of sympathy you can offer. But perhaps the most valuable gift you can offer to someone mourning a death is your quiet, physical presence and your unwavering, non-judgmental support. Helpful Things to Say After a Death 11 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. Department of Health, State Government of Victoria, Australia. At The End - Dying Explained. Bramati P, Bruera E. Delirium in Palliative Care. Cancers (Basel). 2021 Nov 23;13(23):5893. doi:10.3390/cancers13235893 Palliative Care Network of Wisconsin. Near Death Awareness. Hospice Foundation of America. Signs of Approaching Death. Hospice Foundation of America. A Caregiver's Guide to the Dying Process. Department of Health, Government of Western Australia. Understanding the Dying Process. 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 The University of British Columbia. UBC research shows hearing persists at end of life. National Health Service. Symptoms of Bereavement, Grief and Loss. Children's Bereavement Center. Physical Impacts of Grief. Hospice Foundation of America. Grief - Commonly Asked Questions. Additional Reading Barbara Karnes, R.N. Gone From My Sight: The Dying Experience. Barbara Karnes Publishing, 2014. National Council for Palliative Care. Practicalities to Think About When Someone Is Dying. Dying Matters Coalition. 2018. Sherwin B. Nuland, M.D. How We Die: Reflections of Life's Final Chapter. Paw Prints Publishing. 2018. The Hospice Foundation of America. Signs of Approaching Death. 2017. The Hospice Foundation of America. A Caregiver's Guide to the Dying Process. 2011. By Chris Raymond Chris Raymond is an expert on funerals, grief, and end-of-life issues, as well as the former editor of the world’s most widely read magazine for funeral directors. 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