If a loved one is dying, you may have a lot of questions about what to expect. Every person's end of life journey is different. Some people linger, while others pass quickly. However, there are some common signs that the end is near. It can be helpful to know that these signs are a normal part of dying.

End of life - final days; Hospice - final days

Palliative care is a holistic approach to care that focuses on treating pain and symptoms and improving quality of life in people with serious illnesses.

Hospice care helps people with illnesses that cannot be cured and who are nearing death. The goal is to give comfort and peace instead of a cure. Hospice care is usually free to Medicare recipients and covered by most commercial insurance plans. Hospice care provides:

• Support for the person and the family
• Relief of the person's pain and symptoms
• Help for family members and loved ones who want to stay close to the dying person

Most hospice patients are in their last 6 months of life.

For a while, signs that death is near may come and go. Family and friends may need help understanding the signs that mean a person is close to death.

As a person gets closer to death, you will see signs that their body is shutting down. This may last anywhere from a few days to a couple of weeks. Some people go through the process quietly, while others may be more agitated.

The person might:

• Have less pain
• Have trouble swallowing
• Have blurry vision
• Have trouble hearing
• Not be able to think or remember clearly
• Eat or drink less
• Lose control of urine or stool
• Hear or see something and think it is something else, or experience misunderstandings
• Talk to people who are not in the room or who are no longer living
• Talk about going on a trip or leaving
• Talk less
• Moan
• Have cool hands, arms, feet, or legs
• Have a blue or gray nose, mouth, fingers, or toes
• Sleep more
• Cough more
• Have breathing that sounds wet, maybe with bubbling sounds
• Have breathing changes: breathing may stop for a bit, then continue as several quick, deep breaths
• Stop responding to touch or sounds, or go into a coma

You can help make loved one's final days more comfortable both physically and emotionally. Your efforts will help to ease your loved one's final journey. Here are ways to help.

• If you do not understand what you see, ask a hospice team member.
• If you think the person would want to see other family and friends, let them visit, even children, a few at a time. Try to plan for times when the person is more alert.
• Help the person get into a comfortable position.
• Give medicine as directed to treat symptoms or relieve pain.
• If the person is not drinking, wet their mouth with ice chips or a sponge. Apply lip balm to ease dry lips.
• Pay attention to signs that the person is too hot or cold. If the person is hot, put a cool, wet cloth on their forehead. If the person is cold, use blankets to warm them. Don't use electric pads or blankets, which could cause burns.
• Apply lotion to soothe dry skin.
• Create a soothing environment. Keep a soft light on, but not too bright. If the person has blurry vision, darkness can be scary. Play soft music that the person likes.
• Touch the person. Hold hands.
• Talk calmly to the person. Even if you get no response, they can probably still hear you.
• Write down what the person says. This may help comfort you later.
• Let the person sleep.

Contact a member of the hospice team if your loved one shows signs of pain or anxiety.

Arnold RM, Kutner JS. Palliative care. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 3.

Colvin LA, Fallon M. Pain and palliative care. In: Penman ID, Ralston SH, Strachan MWJ, Hobson RP, eds. Davidson's Principles and Practice of Medicine. 24th ed. Philadelphia, PA: Elsevier; 2023:chap 8.

Shah AC, Donovan AI, Gebauer S. Palliative medicine. In: Gropper MA, ed. Miller's Anesthesia. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 52.