What to expect when approaching death

When a terminal illness progresses people become weaker and frailer and need more support from the people caring for them. Giving up their independence isn’t easy but understanding what happens when they are approaching death will help them to anticipate the care they need.

Some of the things that happen at this time may seem strange or frightening especially if people are not expecting them. People are individual so it is not easy to say exactly what will happen and what order changes might occur but we can explain what may happen in the last few days and hours of life.

Eating and drinking

As people become weaker, the effort of eating and drinking may be too much and they may need help. They may feel sick or find it difficult to swallow, if this happens it is important they tell their nurse or doctor as this may stop them wanting to take medication.

As people get nearer the end of their life they often don’t want to eat or drink, this is normal and their doctor can arrange for their medication to be given in a different way.

Sleeping

As a person’s illness progresses they are likely to get weaker each day and become very sleepy. When this happens they will spend more time sleeping and be drowsy when awake and not able to talk or join in things that are happening around them.

Even if they are drowsy or asleep, they may still hear what’s going on and can take comfort from hearing the usual sounds of life around them or hearing someone talking to them.

Towards the end some people may lapse into unconsciousness and cannot be roused at all. How long they are unconscious before they die varies from person to person. Some people will never lose unconsciousness and die in their sleep.

Breathing

People may experience changes to their breathing in the last days of their life. People who have had difficulty breathing may find it easier to breath as the body needs less oxygen because it is less active.

Breathing may be made worse if they are anxious. People who are very drowsy or unconscious may experience noisy breathing because of a build up of mucus in the back of the throat, which they are no longer able to cough up.

When death is near

When death is very close (within minutes or hours), breathing pattern may change again. Breaths become shallow and irregular. Sometimes there are long pauses between breaths or the abdomen rises and falls instead of the chest. Gradually there will be longer pauses between each breath until the last one is taken.

There may be a decrease in the amount of urine a person produces and it will become darker in colour as they drink less. Muscle weakness may cause them to lose control over their bladder. If this happens the nurse will give advice on how to manage this.

Some people may become restless, agitated or confused. If this happens the nurse or doctor can assess the person’s condition and medication.

Arms and legs may become cool to the touch and bluish and the underside of a person’s body may become much darker as a result of blood circulation slowing down.

The body’s ability to regulate its temperature may be affected which means the skin can become hot or cool. The skin may also become dry or moist and clammy.

Most people die peacefully, comfortably and quietly.