When someone is close to death, physical and behavioural changes may occur. You may also notice a change in their character. It can be disconcerting to observe these changes, but remember this is part of the natural process of the body as it prepares to shut down.


One to three months prior to death:

  • Sleep more or take frequent naps. The person will spend more time asleep and during waking hours have less energy.
  • Less fluid and food intake. A loss of appetite and reduced thirst is common. This becomes more pronounced as death approaches. They may also find it difficult to swallow medicine.
  • Becoming socially withdrawn. The activities they once found pleasurable may no longer interest them. Don’t take it personally if they indicate they want some space. Although adults tend to become less communicative, in children the opposite can happen.


One to two weeks prior to death:

  • Incontinence. The person may lose control of their bladder. This becomes more frequent as death approaches because muscles can relax further.
  • Urine decrease. There is often a gradual decrease in urine output, made more noticeable by the fact that those dying may also be drinking less, as the body prepares to shut down.
  • Restlessness. During the last few days, some people become restless due to the changes occurring in the patient’s metabolism. This can be medicated for.
  • Discolouration of the skin. The skin may be moist, pale, warm or cool, due to temperature fluctuations.
  • Disorientation. As the senses become impaired, they may become confused and experience hallucinations and visions. They may mistake one person for another or talk to people who aren’t there.
  • Change in breathing pattern. As death approaches, breathing can sound more congested. It does not cause any pain to the person. There may also be changes in heart rate and blood pressure.


When death is only days or hours away:

  • Visible pain. They may grimace with the pain of their condition. This pain can be managed by administering pain relief.
  • Darkening of skin. Skin on the hands and feet turns a bluish-purple colour, and the temperature of the skin drops.
  • Drift in and out of unconsciousness. Continue to talk to the person as they will probably still be able to hear you and feel your touch.
  • Eyes can become glazed or weepy.
  • Heart beat may become irregular, and the pulse may be difficult to detect.
  • Breathing will sound obstructed, slow, and then stop entirely.

In children, the symptoms tend to be similar to those observed in adults, however the progression of symptoms can be harder to predict. Children can remain quite alert up until the last few moments.

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