Providing physical support

Some family and friends find that information about the physical process of dying helps them prepare. Others prefer to take one day at a time and ask health professionals for explanations as the need arises. If you would like to know what to expect, this section describes the physical changes in the last days and hours of life.

Each death is unique, but as a person nears the end of life they often show common signs. In medical terms, the dying process is viewed as the body’s systems closing down.

Sleeping more 
The dying person has less energy, often spending most of the day sleeping or resting.

Loss of appetite 
The body needs less energy to keep going and appetite decreases. The person may begin to resist or refuse meals or liquids, and weight loss can occur.

Little interest in the outside world 
The dying person may gradually lose interest in those nearby. They may find it hard to concentrate and stop talking. Withdrawing is part of letting go. Near the end, some people have a sudden burst of alert behaviour.

Breathing changes 
Breath intakes and exhalations often become rattly, irregular and laboured. You may hear a pattern of breathing known as Cheyne-Stokes: a loud, deep inhalation followed by a pause of not breathing (which may last from five seconds to as long as a minute), before a loud, deep breath resumes and again slowly fades out.

Sometimes excessive secretions create loud, gurgling inhalations and exhalations, which some people call a ‘death rattle’. Various medicines can help dry up new production of secretions but not what is already there; however, it is thought that this breathing pattern is not painful.

Bladder and bowel changes 
As the body’s systems slow down, the person may have trouble emptying the bladder, so a nurse or doctor may need to insert a catheter into the bladder to drain the urine and avoid a blockage. The doctor can also prescribe medicine to help with constipation, a common side effect of some pain medicines.

As the person eats and drinks less, they will produce less urine and faeces. Loss of bladder and bowel control may happen in the last stages of the dying process, but not always. Special disposable incontinence sheets can be used.

Disorientation and confusion 
Carers are often unprepared for the delirium that can occur in people who are dying. This delirium can involve:

• a lower level of consciousness
• memory loss
• hallucinations (seeing or hearing things that aren’t there) and delusions (false beliefs)
• mood swings
• sleep disturbances.

A person who is dying may not be aware of where they are or who else is in the room, may speak or reply less often, or may respond to people who can’t be seen by others in the room. The person may drift in and out of consciousness and possibly enter a coma.

Delirium may occur when waste chemicals (toxins) build up in the brain as vital organs begin to shut down, but it can also have a range of other causes, such as fever or constipation. Talk to the palliative care team about how the delirium can be controlled.

Restless moving, twitching, groaning or calling out 
These symptoms are part of terminal restlessness, a type of delirium that may include agitation, anxiety, anguish and anger, all of which can be very distressing for carers. However, these symptoms are common and not necessarily uncomfortable for the dying person.

Cool skin, especially the hands and feet 
As circulation slows down, the hands, feet, fingers and toes (the extremities) become cooler and turn a bluish colour. It’s thought that the person will be unaware of feeling cold.

Dry mouth and dry or cracked lips 
This can happen if the person is dehydrated or has been breathing through their mouth, or it may be due to some medicines.