Signs that Death Is Near: How to Prepare for the End-of-Life Process

Nobody wants to spend time thinking about the death of their loved ones. We all have a unique relationship with death, and being a primary family caregiver adds an extra layer of difficulty to an already emotional topic. If you’re one of the more than 30 million people in the United States who have taken on the responsibility of caring for an aging family member, you may wonder how you will know when they’re getting close to the end.

Although thinking about the passing of a loved one is difficult, learning the common signs that death is approaching can help caregivers provide a more comfortable passing for their loved ones.

End-of-Life Signs & Symptoms

Decreased desire for food

It is very common for a loved one to eat less in the early stages of dying, even two to three months before death occurs. Because they’re less active, their body requires less energy and so their need for food and water decreases. 

Be patient with them and keep their lips hydrated by using wet sponges and lip balm. If their lack of appetite worsens symptoms or discomfort, talk to your medical team to discuss options, including soft diets or a feeding tube.

SHOP FEEDING TUBES 

Increase in sleep

As the body prepares for death, tiredness and inactivity are common. Create a comfortable sleeping environment for your loved one and plan activities that allow you two to spend quality time together whenever they’re usually awake. 

Incontinence

Incontinence is very common at the end of life. It occurs when someone can no longer control urination and bowel movements. Although common, it can be overwhelming for you and your loved one if they haven’t experienced it before.

Remember, first and foremost, to keep your loved one clean and comfortable. There are many products on the market made specifically for adult incontinence. Work with your loved one to find what works best for both of you. You also may consider joining a local caregiver support group, where the sometimes touchy issue of incontinence (among other caregiving topics) can be freely discussed with people who share your experiences. 

SHOP INCONTINENCE PRODUCTS

Changes in urine

The amount of urine produced and its color will likely change during the dying process and often stops completely hours or even days before death. Your healthcare team can advise whether your family member requires catheterization to prevent bladder or kidney problems.

Skin changes

As dehydration occurs, your loved one’s skin may feel dry and papery and even cold to the touch (though they may not feel cold themselves). You may also notice red or purple splotches spread across their skin, called mottling, which is caused by a decrease in blood circulation. 

Comfort is key. Provide a comfortable resting area for your family member with soft, warm blankets, and have them dress in loose clothing. Apply gentle, unscented lotion or healing ointment to dry patches of skin.

SHOP LOTIONS

Muscle spasms

You may see sudden, involuntary twitching of the muscles close to death. These twitches are called myoclonic jerks and happen when the body begins to lose control of muscles and reflexes. Fortunately, myoclonic jerks are not painful, but there are medications that help reduce these movements to provide comfort.

Pain

Pain control should be top of mind when caring for a loved one nearing death. Pain levels can vary widely depending on where they are in the dying process and the types of illness or disability they have. Your loved one’s medical team may prescribe a number of pain medications to increase their comfort. 

Remember to always administer pain medications as prescribed and talk to your medical care team about effectiveness and side effects. You may also consider combining medication-based pain management with alternative pain management therapies like mindfulness and meditation, massage, music and art therapy, and CBD- or THC-based treatments.

Vision changes

Eyesight can get worse as the end of life approaches and can even become blurry or dark. Your loved one may strain towards light sources to see more clearly. Blinking also often decreases, which can cause dry eyes. Keep their room fully but softly lit to relieve eye strain, and administer eye drops to avoid irritation caused by dry eyes.

SHOP EYE DROPS

Breathing changes

In the days and hours before death, shallow and irregular breaths become more common. Breathing patterns may also get more abnormal as it becomes harder to swallow and clear the throat. You may notice several seconds and sometimes even minutes go by between breaths. 

While the sound of labored breathing can be concerning, this change in their breathing pattern usually does not cause pain or discomfort. Breathing challenges can be avoided early on by sitting your family member up at a 45-degree angle if possible. Some patients also benefit from oxygen therapy.

Psychological & emotional changes

While their body is doing the difficult physical work of preparing for death, your loved one may also experience deep psychological and emotional experiences during this time. In the months before death, it’s not uncommon to see an increased withdrawal from life and no interest in social interaction. In the more active stages of dying, hallucinations or visions may occur. This is a normal part of the dying process and is not cause for alarm. 

Allow your loved one to have these moments without brushing them off or interfering with the experience. If a dying loved one seems distressed by hallucinations or visions, comfort and reassure them. It can be helpful to let your loved one know that it is okay to “let go” and remind them of the meaningful relationships and experiences they had during their life.

What to expect in the moments before death

In the last moments before death, you may notice your loved one’s eyes begin to look glassy or glazed. Sometimes the eyes flutter or remain slightly open yet unfocused. Irregular breathing patterns can increase, and you may hear what is known as a “death rattle,” which sounds like labored, noisy breaths caused by the throat muscles relaxing. 

Your loved one may also have vivid hallucinations or speak about things as if in another time or place. Comfort and stay close to them, if possible. One of the best things you can do is help calmly guide them into death, and whatever may come next.

How will I know when death has occurred?

The final stages of the dying process can be emotionally draining, and it may be difficult to tell if your loved one has passed. Ask your hospice or health care team. They will be able to tell you when death has occurred and will note the day and time. You can usually expect some final gasping breaths and eyes and mouth to remain open. 

Plan in advance for things like religious or spiritual rituals you want to take place, music to play, or items or mementos that should be present at the moment of death. They can help bring some emotional readiness to both the dying and those present.

Conclusion

Experiencing the death of a loved one can be a very emotional and traumatic experience, but it can also be incredibly meaningful. Knowing the signs of the end of life can help you feel better prepared to help with the dying process as both a caregiver and a loving family member.