What happens in the final days of life?

This section gives information about what happens in the final days of life. There is information about

Common concerns

Knowing that you, or a loved one, is close to dying can be very difficult for everyone involved. People often ask us questions about how someone will die. Especially relatives and friends. They often worry that they will not be able to cope, or know what to do when the person they are caring for dies. We have written this information from the carer’s perspective.

It is very difficult to give exact details of how someone will die. Each person is different and will die in their own unique way. But we can give you some general information about what may happen and what you can do to support your loved one through their process of dying.

Physical changes

The body begins its natural process of slowing down all its functions. How long this takes varies from person to person – it may take hours or days. The dying person will feel weak and sleep a lot. When death is very near the dying person may have

The following are signs and symptoms that suggest a person with cancer may be entering the final weeks of life:

  • Worsening weakness and exhaustion
  • A need to sleep much of the time, often spending most of the day in bed or resting
  • Weight loss and muscle thinning or loss
  • Minimal or no appetite and difficulty eating or swallowing fluids
  • Decreased ability to talk and concentrate
  • Little interest in doing things that were previously important
  • Loss of interest in the outside world, news, politics, entertainment, and local events
  • Wanting to have only a few people nearby and limiting time spent with visitors
  • As the last days of life approach, you may see the following signs and symptoms: 
  • A tendency to drift in and out of consciousness and gradually becoming less and less responsive to touch or voice.
  • Being confused about time, place, and identity of people, including family members and close friends 
  • Seeing or hearing people or things that are not there. This is common and usually normal. It is not a cause for concern unless these hallucinations scare or upset the person who is ill. These dream-like experiences often include traveling, preparing for travel, or being welcomed by people who have died.
  • Restlessness or repetitive, involuntary movements
  • Loss of bladder and bowel control
  • Decreased amount of urine
  • Dryness of mouth and lips
  • Cool skin that may turn a bluish, dusky color, especially in the person’s hands and feet
  • Noisy breathing, with congestion and gurgling or rattling sounds as the person becomes unable to clear fluids from the throat. These sounds may concern others, but the person who is dying is not aware of them.
  • Breathing may slow, sometimes with very long pauses between breaths
  • Sleeping and difficulty waking up
  • cold feet, hands, legs and arms.
  • confusion and disorientation
  • complete loss of consciousness

You can read about all these changes or click on the links above to take you to a specific change.

It can be emotionally very difficult to watch someone go through these physical changes. But they are part of a natural dying process and don’t mean that the person is uncomfortable or in distress. The doctors and nurses looking after the person during this time will be checking regularly for these changes. They will do all they can to make your relative or friend as comfortable as possible during their death. If you are looking after someone at home while they are dying, you should have support from a specialist community nurse, district nurses, and the GP. They can answer your questions and help to make home nursing easier for you.

Sleepiness and difficulty waking (semi conscious)

People who are dying often sleep a lot and may not respond when you try to wake them. But this doesn’t mean they can’t hear you. Hearing may be one of the last senses to be lost. So it is important not to stop talking to them and comforting them. You can sit close to them and hold their hand. It is important not to say anything that you wouldn’t want them to hear. It’s also a good idea to tell them when you go into or leave their room.

Difficulty swallowing or not wanting to eat or drink at all

There will come a time when the dying person will not want to eat or drink anything. It is important not to try and force them to eat or drink. This will make them uncomfortable. If they are still awake you can give them small pieces of ice to suck or sips of fluid to keep their mouth moist. You can put vaseline or lip balm on their lips to help stop them getting dry and sore. If they really can’t take anything into their mouth, you can moisten their lips and mouth every 1 to 2 hours with lemon and glycerine swabs or water . Your GP or district nurse can get you the swabs.

Loss of bladder and bowel control

The dying person may lose control of their bladder and bowel. This happens because the muscles in these areas relax and don’t work as they did. This can be very distressing to see and you will worry that they may feel embarrassed. The nursing staff will do all they can to protect the bed and keep your relative or friend as clean and comfortable as possible. If you are caring for someone at home, the district nurses and specialist nurses can arrange for you to have draw sheets or pads to protect the bed. They may also be able to arrange a laundry service for you, if necessary. As people become very close to death and are not eating or drinking, the amount of urine and stools they produce gets less and less.

Restless movements (as though in pain)

Many people who are dying, and the people around them, worry that they will be in pain. Not everyone dying of cancer has pain. But if they do, it can usually be well controlled and people can be kept very comfortable. The doctors and nurses looking after the dying person will do all they can.

Sometimes restlessness is a sign of being in pain. If the dying person can’t communicate very well and you think they are in pain, the most important thing is to tell their doctors and nurses. They will want your relative or friend to be pain free, so do talk to them. This will help them plan the best way of controlling the pain.

Changes in breathing

When someone is dying their breathing often changes. It may become noisy and irregular. There may be times when they stop breathing for a few seconds. This is called Cheyne Stoke (pronounced chain stoke) breathing. They may breathe with their mouth open and use their chest muscles to help them catch a breath.

It can help to raise the head of the bed with pillows or cushions. Just sitting with them, speaking gently, and holding their hand can be very reassuring for them. If someone is having difficulty breathing, a doctor or nurse may suggest giving a small dose of morphine, even if they are not otherwise in pain. Morphine can help to make breathing easier.

Noisy breathing

You may hear gurgling or rattling sounds as the dying person takes each breath. This is coming from their chest or the back of their throat. It is because there is a build up of mucus and saliva and they don’t have a strong enough cough reflex to cough it up. Raising their head and turning it to the side may help gravity to drain the secretions. Sometimes the fluid can be sucked out through a thin tube put down into their windpipe, but this is not usually needed. Hearing these gurgling sounds can be very upsetting, but they do not usually seem to cause distress to the dying person.

Cold feet, hands, arms and legs

The dying person’s face, hands, arms, feet and legs often become very cool to touch. Their skin may also become pale and look blotchy or mottled. This happens because there is less blood circulation to these parts of the body. Keep them warm with blankets but don’t use an electric blanket as this may become too uncomfortable. Thick socks can help to keep their feet warm. Don’t overheat the room as this can make it stuffy. Just keep it at a comfortable temperature.

Confusion and disorientation

You may hear your loved one say things that make no sense. They may not know what day it is or may not appear to know who you are. They may even say things that are totally out of character. For example, they may shout at you or physically push you away. This can be very hurtful and upsetting. But try to understand that they don’t mean it and are not aware that they are doing these things. It happens partly because of the chemical changes going on inside their body. We have a section which gives more information about managing confusion.

Complete loss of consciousness

At the end of life, the chemical balance of the body becomes completely upset. The dying person then slips into unconsciousness. This is usually right towards the end, maybe only a few hours or days before death. breathing become irregular  and may become noisy. You won’t be able to wake them at all. Their breathing will stay irregular for some time and will at some point stop.

Try not to worry that you are going to do the wrong thing. Just being with your loved one and letting them know you love and care for them is the most important thing.

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