When Time is Short

Activity Level Decreases Significantly

The person may speak and move less, often sleeping for a greater portion of the day, becoming resistant to movement or activity of any kind. While gentle turning and repositioning will help to alleviate problems such as muscle stiffness and pressure injury to the skin, as death becomes near, the need for repositioning lessens. If the dying person verbalizes discomfort during movement, or you observe signs of pain (such as grimacing) with movement/activity in non-verbal persons, pre-medicating with appropriate pain
management will help alleviate discomfort during repositioning. Your healthcare provider can provide instruction on how to do this safely, either by timing their turning and repositioning around their current pain management schedule or by adding additional pain medication to be used as needed.

Interest in Surroundings Fades

The person may not respond to questions or may show little interest in previously enjoyable activities or contact with family members, caregivers, or friends. This phenomenon has been described as “detaching” as the dying person withdraws, bit by bit, from life. Keeping the person’s environment as calm and peaceful as possible by dimming lights, softly playing the person’s favorite music, and some gentle touch and/or kind words, can be soothing as the
dying person transitions. Caregivers, family, and healthcare providers should always act as if the dying person is aware of what is going on and is able to hear and understand voices. Hearing is one of the last senses to lapse before death.

Desire for Food and Drink Ceases

The person may have little, if any, appetite or thirst and may have problems swallowing, resulting in coughing and choking with any attempt to ingest medications, food, or fluids. Lack of interest in food and fluids is normal and expected. Food and fluids should never be pushed, as this can increase risk for choking, pneumonia, and abdominal discomfort as the gastrointestinal system slows down along with the rest of the body’s systems. Caregivers can provide comfort care by maintaining good oral hygiene, keeping the mouth and lips
moist with damp sponges, and applying lip balm to prevent lips from chapping.

To learn more about the following symptoms, download the Signs of Approaching Death PDF below. 

• Bowel and Bladder Changes
• Body Temperature Can Decrease by a Degree or More
• Blood Pressure, Heart Rate, and Respiration (Breathing) Rates Gradually Decrease
• Increases in Pain Due to Progression of Disease, Worsening of Chronic Conditions such as Arthritis or Stiff/Inflamed Joints, or Increase in Pressure Wounds to Skin
• Skin of Knees, Feet, and Hands May Become Purplish, Pale, Grey, and Blotchy or Mottled
• Periods of Rapid Breathing, and No Breathing for Brief Periods of Time, Coughing or Noisy Breaths, or Increasingly Shallow Respirations, Especially in Final Hours or Days of Life
• Other Changes in Breathing
• Agitation and Periods of Restlessness
• Consciousness Fades
• Sensory Changes