Signs and Symptoms at the End of Life

Posted on March 5, 2018

flowersIf you are caring for a loved one at the end of their life, you may be noticing some new signs and symptoms arising. As death approaches, you may find it helpful to familiarize yourself with both physical and emotional changes to better prepare for the end-of-life and to ensure that your loved one has a comfortable and peaceful passing.  


A person with advanced illness goes through many physical changes over time. These are not signs of a medical emergency, but pieces of a natural process. At the end of life, you can expect the following physical changes to occur.

Pain is one of the most feared symptoms at the end of life. Some illnesses, like cancer, tend to lead to more pain than others. Whatever the illness is, it is essential to recognize and help manage pain for your loved one.

As the circulation of blood decreases, hands, arms, feet and legs begin to cool. Be sure to keep your loved one warm and comfortable with blankets.

Changes in Breathing
As death approaches, changes in the breathing pattern occur. Your loved one may take shallow breaths with periods of no breathing for a few seconds to a minute. They may also experience periods of rapid, shallow panting. As muscles weaken, it also becomes more difficult to swallow. The accumulation of mucus and fluids can cause a rattling sound with breathing, commonly referred to as the “death rattle.” While this may seem like a sign of distress, it is completely normal. Elevating their head or turning them on their side may bring comfort.

Reduced Appetite
While your loved one prepares for death, they may want very little food or liquid. Do not force them to eat or drink, as this may make them more uncomfortable. Small chips of ice might be refreshing.

A common change that occurs during the end of life process is the loss of control of urinary/bowel functions. Keep your loved one clean and comfortable, and remember that you can always ask a hospice nurse for advice.

As death nears, your loved one may become increasingly drowsy and sleep for longer periods of time. Even when your loved one seems unresponsive, he or she might very well sense your presence, whether you are sitting quietly nearby, holding hands, or speaking



Delirium can be caused by disease processes, decreased oxygen in the brain, medications, and a host of other reasons. Be sure to treat your loved one with compassion and patience during this time.

Your loved one may say they have spoken to people who are already deceased. They may say they have seen things not visible to you. This is not hallucination or a drug reaction, and it is very common. Instead of contradicting or discounting this experience, affirm them. If the experience frightens your loved one, reassure them it is common and natural.

Saying Goodbye
As your loved one senses that death is approaching, they may say goodbye. Listen and hold them close. Tell them whatever you need to say, whether it be a simple “I love you,” or a recount of your favorite memories together.


Dying may take hours or days. No one can predict the exact time that death will occur, even if the person is exhibiting typical end-of-life signs and symptoms. Here are some physical signs that death has occured:

  • The heart stops beating
  • Breathing stops
  • Body color becomes pale
  • The body cools
  • Muscles relax
  • Urine and stool may be released
  • The eyes may remain open
  • The jaw can fall open

these sign and symptoms are common and natural
Remember, all of these end-of-life signs and symptoms are common and natural. Your loved one may show some of these signs and not others. Or they may be different altogether. If you need advice or an opportunity to talk, contact your local hospice provider. Being prepared to expect these changes will help you provide the best care and compassion as you guide your loved one through their end-of-life journey.

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End With Care Corp is a 501(c)(3), non-profit organization helping to provide end-of-life information and access to resources found
throughout Massachusetts.

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