Recognizing when someone is dying isn’t always straightforward. In their final days, many people go through physical and behavioral changes that can begin gradually and change over time.
The signs below don’t follow a set order, but noticing them can help families make thoughtful choices and feel a little less uncertain.
Decreasing Appetite
Many people stop wanting food or drink. This reflects reduced energy needs as the body slows. A study found that loss of appetite is among the earliest indicators of decline in hospice patients. It means that things have taken their natural course.
Reduced Bathroom Use
A decline in eating and drinking also means less urine and stool. Kidneys may start shutting down, and bowel activity slows dramatically. If control becomes difficult, hospital staff can suggest catheters or absorbent pads. Although most of these changes may feel uncomfortable to discuss, they’re medically expected.
Extended Sleep
Staying awake eventually takes effort, and rest becomes the default. In case your loved one seems unresponsive, don’t assume they’re unaware. You can read aloud, play familiar music, or just sit quietly nearby. There’s no need to wake them or keep them engaged. Letting them sleep eases the strain on their body.
Shallow Breathing
Breaths tend to come farther apart, grow shallower, or make a soft rattling sound. Despite the unusual sounds, people mainly aren’t aware of their breathing at this stage and aren’t struggling. Just remember that their oxygen needs are low, and the body is trying to adjust naturally.
Hallucinations
Someone may begin speaking to people who have already died or describe places no one else sees. It is possible that these visions scare you, but they are not necessarily terrifying for them. There are even times when such hallucinations appear peaceful or reassuring. Avoid arguing or correcting. There’s no treatment required unless the person becomes distressed or confused.
Weakness
You might remember how your parent or grandparent would once sit up without effort or lift a glass with one hand. Now, even those small movements are becoming increasingly difficult for them. During times like this, support matters more than reminders to try harder. Offer a straw for drinking, plump pillows to ease pressure, and assist with repositioning gently.
Fevers Without Clear Infection
Rising temperatures don’t always signal infection. The body can heat up due to inflammation, reduced hydration, or modifications in how the brain regulates temperature. Skin becomes warm and flushed, though no sickness is present. This response is common in the final days, but you can always talk to a nurse or a doctor to find non-invasive ways to make things easier.
Cool Hands and Feet
When blood flow moves inward to support the heart and other vital organs, the skin on the hands, feet, arms, and legs often cools down. Such areas may also look pale or develop a mottled, patchy appearance. While the shift can appear alarming, it rarely causes discomfort. Unless the person says they are cold, heavy blankets aren’t necessary.
Silent Signs of Pain
Even without speech, signs like facial tension or clenched hands can point to pain. Swallowing pills might no longer be possible, but the relief efforts don’t have to stop. Transdermal patches deliver medication through the skin over time, while sublingual drops absorb quickly under the tongue. Injections or rectal options can also be used if needed.
Restlessness
Some people become unusually active, like tossing in bed, tugging at clothes, or reaching into the air. These actions look aimless to you, but are mostly an indicator of physical discomfort, low oxygen, or internal distress. The behavior, known as terminal restlessness, can be unsettling to watch, but quite more so to experience.
Fading Interest in People
An individual who used to throw dinner parties, laugh easily with guests, and thrive on conversation could be spending long hours alone at the end of their life. This transformation follows the weakening of the body, as the mind begins to let go of daily routines. Socializing can look unimportant and exhausting.
Confusion
It is difficult to see how your grandmother, who once remembered every birthday and told your favorite stories by heart, now struggles to recognize your face. This isn’t typical memory loss—it happens as the brain slows and processes less. The best way to help is by identifying yourself before speaking. Familiar photos, soft music, or treasured objects nearby can also gently bring her back to something that feels known.
Eyes May Appear Glassy
According to a study, the loss of visual focus was reported in numerous patients nearing death. The eyes may appear glassy or fixed, and they often stop tracking movement. Though it can appear like they’re staring past you, awareness sometimes lingers. This is a hard moment to witness, but staying calm and acting naturally helps.
Mouth Stays Open
As muscle control fades, the mouth falls open, and swallowing becomes infrequent. This can lead to dryness or visible discomfort around the lips and tongue. While this change isn’t painful on its own, it can cause irritation if not addressed. Caregivers can gently swab the inside of the mouth with a moistened sponge or apply balm to the lips to prevent cracking.
Giving Things Away
The act of giving things away can portray an unspoken understanding that time is limited. Many hospice workers observe this as a common part of emotional preparation. It primarily includes passing on meaningful items, settling personal affairs, or organizing belongings with care. Gestures of this kind are less about possessions and more about connection, closure, and control.