End of Life Signs and Timeline

In the months leading up to death, many people begin to withdraw from the world around them. You may notice your loved one sleeping more than usual and showing less interest in social activities or hobbies they once enjoyed. It’s common for them to eat and drink less, often only nibbling at food or sipping small amounts of fluid.

Common end of life signs include:

• Increased sleep and fatigue
• Reduced interest in socialising or hobbies
• Decreased appetite and weight loss
• Emotional withdrawal and less communication

This period can be emotionally challenging, but it’s also an opportunity to talk about your loved one's wishes and make any necessary arrangements.

Encourage conversations about what’s important to them, including their preferences for care, legal matters like wills, and any specific funeral plans.

As your loved one moves closer to the end, you may notice that their physical decline becomes more apparent.

They may become bed-bound, sleeping for most of the day, and will likely have little to no appetite. It’s important not to force food or drink on them; at this stage, the body naturally requires less energy.

Look out for these end of life signs:

• Extended periods of sleep or unresponsiveness
• Minimal food and water intake
• Confusion or restlessness
• Hallucinations, often involving loved ones who have passed
• Changes in body temperature (cool hands and feet)

Try creating a calm environment with soft lighting and soothing music. It's normal for them to experience these symptoms as their body slows down during this stage of the end of life timeline.

In the final days, physical signs become more pronounced. You might notice changes in breathing patterns, sometimes described as a "death rattle" due to congestion in the lungs or throat. Breathing may become irregular, with long pauses between breaths. Their skin may start to look mottled or pale, particularly on the hands, feet, and knees.

Signs to be aware of include:

• Irregular or laboured breathing (the “death rattle”)
• Cold, mottled, or discoloured skin on extremities
• Decreased or no response to voice or touch
• Weak pulse and fluctuating heart rate
• Loss of bladder and bowel control

During this time, your loved one might not respond to you, but they can often still hear, so continue to speak in soothing tones. Your presence, even in silence, can provide immense comfort.

As death approaches, the body continues to shut down. Your loved one may be unconscious, with shallow or gasping breaths, and their pulse will become weaker. Their hands, feet, and ears may feel cold to the touch due to reduced circulation. It’s possible that their eyes will remain partially open or look glassy.

Final signs may include:

• Shallow, gasping breaths, or long pauses between breaths
• Cold extremities and discolouration of the skin
• Glassy, unfocused eyes
• Complete loss of response to surroundings
• Weak or irregular pulse

At this stage, it’s most important to be present, holding their hand and offering reassurance. A quiet room with dimmed lighting can create a peaceful atmosphere.

If your loved one shows signs of discomfort, speak with their care team, who can help manage any pain.