How to Recognize That a Loved One Is Dying (2024)

The dying process usually begins well before death takes place. Generally, there are end-of-life stages that follow a general timeline during the last 40 days or so. For some people, it may take weeks. In other cases, death approaches more quickly, in just a few hours or days.

Knowing more about the end-of-life process may help you to better prepare for what's to come. It also can benefit your loved one if you can anticipate and identify the physical, mental, and emotional changes they experience as death approaches. A healthcare provider may be able to give you a sense of your loved one's expected timeline as the stages progress.

The Early Stages: 40 to 90 Days Before

The dying process often comes into view about 40 to 90 days before death. Experiences that take place at this first, more visible end-of-life stage are broadly common but the specifics can differ for each individual.

Physical Changes

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

• Reduced appetite
• Reduced thirst
• Increased need to sleep
• 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. Their energy needs decrease when they stop regular activities and start sleeping more.

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.

Mental and Behavioral Changes

Social and cultural factors help shape a person's dying experience. For example:

• Research suggests males are less likely than females to talk openly about their mortality and end-of-life wishes. In one study, males tended to delay talking of death and wanted "hard facts" rather than feelings.
• Females lean toward "soft facts" but also find death talk challenging, even though they seek more information.
• Religious and cultural backgrounds can influence how someone feels about dying. Certain practices, rituals, and customs can be steps along the end-of-life timeline for some people.
• Personal reflection becomes important. The dying person often thinks back over their life and revisits old memories. They might also be going over the things they regret.

Withdrawal is common as someone starts to realize death is approaching. They're beginning the process of separating from the world and the people in it.

The Middle Stages: 1 to 2 Weeks Before

The dying process starts to move faster in the last week or two of life. The acceleration can be frightening for loved ones, especially with mental status changes. As death approaches, you may:

• Want to "correct" your loved one if they say things that don't make sense. At this stage, it's better to listen to and support your loved one rather than to risk upsetting them or starting an argument.
• 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. This can interfere with medication. If they have been taking pain medications, they may need liquid morphine now to manage pain.

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

• Body temperature that's one or more degrees lower than normal
• Cold hands and feet
• 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
• Less or no talking
• Sudden arm or leg motions
• Constipation
• Incontinence
• Nausea
• Pain

Breathing changes, often with a rattling sound and cough, can occur in this stage. These sounds can be alarming to caregivers but are not uncommon when someone is dying.

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.

The End Stages: Days to Hours Before

In their last days or hours, the dying person may go through several possible stages. Some people experience a sudden surge of energy that can surprise their loved ones. 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. These energy bursts are usually short and represent a dying person's final physical acts before moving on.

The previous signs of being close to death return more strongly once the energy has been spent. 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. It can help to know that as death nears, this does not cause your loved one pain.
  
• 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.
• Their lips and nail beds may turn bluish or purple, and their lips may droop.
• They may have their eyes open but not be able to see their surroundings. They are generally unresponsive.

When your loved one stops breathing and their heart stops beating, death has occurred. Other signs of death include fixed eye gaze, bowel or bladder release, and no muscle tension.

How to Cope with Loss

People deal with grief in different ways. You can:

• Expect to have mixed feelings. You may feel relief after years of caregiving, guilt or anger about moving on alone, and sadness due to the loss of your loved one, all at the same time.
• Take time to ease into your new experience. Be kind to yourself when it comes to expectations of how much you can or want to do in the days and weeks of transition. Consider a journal to help you identify your emotions and process your experiences.
• Establish a routine to support healthy eating, exercise, and sleep.
• Accept help from others, but don't hesitate to set boundaries.
• Online or communitysupport groups can be helpful. They're not for everyone, so decide for yourself (rather than pleasing someone else) if you want to try one.
• Stress management and mindfulness strategies may help. Try deep breathing exercises, yoga, or even just taking time to be alone and think.

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, and help your loved one as they move through the process of death.

Summary

Signs of the dying process can emerge up to 90 days before someone's death. Knowing these signs may help you prepare for 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.

In the week or two before death, the dying process speeds up. In the final days or hours of life, many people have a brief surge of energy. However, once the surge passes, they may appear worse. You may notice breathing changes and skin discoloration. Don't hesitate to reach out for support as your loved one approaches death.