End-of-Life Stages Timeline

What to expect as someone nears death

The dying process usually begins well before death takes place. It's common to move through certain end-of-life stages that follow a general timeline.

Being tuned in to the physical, mental, and emotional changes of your loved one can help you recognize the signs that they're dying. Knowing more about the end-of-life process may help you better prepare for what's to come.

Still, nothing about that process is certain or applicable to everyone. The dying journey has several milestones, but not everyone stops at them all. A healthcare practitioner may be able to give you a sense of your loved one's expected timeline as they move through these stages.

This article explains a typical end-of-life timeline and what happens to someone mentally, behaviorally, and physically. While some people may follow this closely, others may cycle through these stages far faster (even within days) or for months.

Signs: 40 to 90 Days Before Death

The dying process often comes into view about one to three months before death. Many of the experiences that take place at this first end-of-life stage are broadly common but the specifics can depend on the individual.

Physical Changes

As the body starts to slow down, a dying person may have the following physical signs:

  • Reduced appetite
  • Reduced thirst
  • Increased sleeping
  • Weight loss
  • Mild sense of happiness and well-being (euphoria) due to natural changes in body chemistry

The reduced appetite and weight loss can be alarming, but it helps to know your loved one isn't suffering in any way by not eating. This is a natural and expected part of their journey.

The reason it's okay is that their body no longer needs as much energy. That need also decreases when they stop regular activities and start sleeping more.

Mental and Behavioral Changes

Social and cultural factors help shape a person's dying experience. For example, gender roles can be a factor.

Talking Openly About Death

Research suggests men are less likely than women to openly talk about their mortality and end-of-life wishes. One reason might be that men find it more difficult to ask for help and don't want to come across as "needy."

These differences aren't necessarily unique to one gender identity, though. Plenty of women struggle to talk about their death and don't want anyone to feel "burdened" by caring for them.

Religious and cultural backgrounds can influence how someone feels about the dying process. Depending on their beliefs, certain practices, rituals, and customs can be steps along the end-of-life timeline.

Withdrawal and Reflection

As they start to accept their mortality and realize death is approaching, they may start to withdraw. They're beginning the process of separating from the world and the people in it.

During this stage, your loved one may say no to visits from friends, neighbors, and even family. When they do accept visitors, it might be hard for them to interact. That may make you feel rejected, which is especially hard when you know your time with the person is limited.

This stage is also one of reflection. The dying person often thinks back over their life and revisits old memories. They might also be going over the things they regret.

Signs: 1 to 2 Weeks Before Death

mental and physical changes before death

Verywell / Cindy Chung

The dying process starts to move faster in the last week or two of life. The acceleration can be frightening for loved ones.

As death approaches, you may want to "correct" them if they say things that don't make sense—but it's better not to. At this stage, it's better to listen to and support your loved one rather than to risk upsetting them or starting an argument.

For example, your loved one might say that they see or hear a person who died before them. In those moments, just let your loved one tell you about it.

You might feel frustrated because you can't know for sure whether they're hallucinating, having a spiritual experience, or just getting confused. The uncertainty can be unsettling, but it's part of the process.

Physical Changes

At this point in the end-of-life timeline, a dying person's body has a hard time maintaining itself. Your loved one may need help with just about any form of activity.

For example, they may have trouble swallowing medications or refuse to take them. If they have been taking pain medications, they may need liquid morphine now.

During this end-of-life stage, signs that death is near include:

  • Body temperature that's one or more degrees lower than normal
  • Lower blood pressure
  • An irregular pulse that may slow down or speed up
  • Increased sweating
  • Skin color changes, with lips and nail beds that are pale, bluish, or, in people of color, purplish
  • Breathing changes (e.g., a rattling sound and cough)
  • Less or no talking
  • Sudden arm or leg motions

Mental and Behavioral Changes

During this stage of the end-of-life timeline, people tend to:

  • Sleep most of the time
  • Become confused
  • Have altered senses
  • Experience delusions (fearing hidden enemies, feeling invincible)
  • Continue or begin having hallucinations (seeing or speaking to people who aren't present or who have died)
  • Become restless (pick at bedsheets or clothing, have aimless or senseless movements)

It can be hard for you to witness these changes, but it's important that you remain supportive.

Signs: Days to Hours Before Death

In their last days or hours, the dying person may go through several possible stages.

Surge of Energy

The last few days before death can surprise family members. At this stage, your loved one may have a sudden surge of energy. They may want to get out of bed, talk to loved ones, or eat after having no appetite for days or weeks.

You may take these actions as signs that a dying person is getting better, but the energy will soon go away. It can be hurtful to watch this happen but know that this is a common step within the end-of-life timeline. These energy bursts are a dying person's final physical acts before moving on.

The surges of activity are usually short. The previous signs of being close to death return more strongly once the energy has been spent.

Breathing Changes

At this stage, a dying person's breathing becomes slower and less regular. Rapid breaths followed by periods of no breathing at all (Cheyne-Stokes breathing) may occur. You may also hear a "rattling" sound when they breathe.

These changes can be unpleasant to witness but you should try to remember that these are not signs your loved one is uncomfortable.

Change in Appearance

Your loved one's hands and feet may start looking blotchy, purplish, or mottled. The changes in skin appearance may slowly move up their arms and legs.

Also, their lips and nail beds may turn bluish or purple, and their lips may droop.

Unresponsiveness

At this end-of-life stage, a dying person usually becomes unresponsive. They may have their eyes open but not be able to see their surroundings.

It's widely believed that hearing is the last sense to stop working. Knowing this can remind you that it's still valuable to sit with and talk to your dying loved one during this time.

Reaching the End

When your loved one stops breathing and their heart stops beating, death has occurred. They have reached the end of their journey.

Summary

Signs can be evident one to three months to three months before someone's death. Physical, mental, and behavioral changes are common.

In the week or two before death, the dying process speeds up. They may start being confused and periodically not making sense. Their bodily process may slow down or become erratic, but the person may also appear restless.

In the final days or hours of life, many people have a brief surge of energy and seem like they're doing better. However, once the surge passes, they may appear worse. You may notice breathing changes and skin discoloration.

Knowing these signs may help you prepare for your the end of a loved one's life and bring you comfort as you face the physical and mental changes that happen along the end-of-life timeline.

A Word From Verywell

Supporting a loved one at the end of their life can be difficult, but you don't have to go through it alone. Reach out to a hospice, social worker, or clergy member to help you navigate the process. They can help you recognize and understand some of the changes that are happening as your loved one moves through the process of death.

Frequently Asked Questions

  • How long does the pre-active stage of dying last?

    The pre-active stage of dying can last around three weeks. That said, there are many factors that contribute to how long the entire process of dying takes for each person, such as their illness and medications.

  • What are common signs of the end of life?

    There are some physical signs at the end of life that means a person will die soon, including:

    • Breathing changes (e.g., shortness of breath and wet respirations)
    • Cold hands and feet 
    • Constipation
    • Decreased appetite and thirst
    • Delirium
    • Fatigue
    • Incontinence
    • Nausea
    • Pain
    • Restlessness
  • Why does someone lose their appetite near the end of life?

    As the body slows down to prepare for death, the metabolism slows down and requires less food. The digestive tract is also less active, which means a dying person won't feel hungry or thirsty.

  • How long after someone stops eating will they die?

    When a person near the end of life stops eating entirely, it is a sign that death is near. It can be as quick as a few days or up to 10 days. However, some people survive for a few weeks after they stop eating.

  • Should you leave a dying person alone?

    That's not necessary and is a personal choice. A dying person will become unconscious, but that does not always mean they are completely unaware of their surroundings. It may bring you (and perhaps, them) some comfort to stay, if you'd like to.

4 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.
  1. Skulason B, Hauksdottir A, Ahcic K, Helgason AR. Death talk: gender differences in talking about one’s own impending deathBMC Palliative Care. 2014;13(1). doi:10.1186/1472-684x-13-8

  2. Hartogh GD. Suffering and dying well: on the proper aim of palliative care. Med Health Care Philos. 2017;20(3):413-424. doi:10.1007/s11019-017-9764-3

  3. Wholihan D. Seeing the light: End-of-life experiences-visions, energy surges, and other death bed phenomena. Nurs Clin North Am. 2016;51(3):489-500. doi:10.1016/j.cnur.2016.05.005

  4. Blundon EG, Gallagher RE, Ward LM. Electrophysiological evidence of preserved hearing at the end of life. Sci Rep. 2020;10(1):10336. doi:10.1038/s41598-020-67234-9

Additional Reading

By Angela Morrow, RN
Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse.