Some family and friends find that having information and knowing about the physical process of dying can help to ease their fear and anxiety when it happens. Other people prefer to take one day at a time and ask health professionals for explanations if and when the need arises.
If you would like to know what to expect when someone dies, this section describes some of the common physical changes that may occur in the last days and hours of life. These physical changes don’t happen in any particular order. In medical terms, the dying process is viewed as the body’s systems closing down.
| Sleeping more | The dying person has less energy, and often they may spend most of the day sleeping or resting. They may still be conscious and able to hear, but have their eyes closed and not be moving. |
| Eating and drinking less | As the body slows down it uses less energy and the person doesn’t need to eat or drink as much. They may begin to resist or refuse food or drink. Giving the person fluids at this time does not help them, but you may moisten their mouth for comfort with a sliver of ice, small sips of water and regular mouth care. |
| Little interest in the outside world | The dying person may gradually lose interest in people nearby. They may find it hard to concentrate and they may stop talking. Withdrawing is part of letting go. Near the end, some people have a sudden burst of alertness. |
| Breathing changes | Breathing may become irregular, laboured, noisy and rattly. You may hear an irregular breathing pattern known as Cheyne-Stokes. This is a loud, deep breath followed by a long pause (which may last from 5 seconds to as long as a minute), before a loud, deep breath starts again. If mucus builds up in the throat, it can create loud, gurgling sounds, which some people call a “death rattle”. Medicines can help dry up any mucus or you can try changing the person’s position in the bed. Listening to this change in breathing pattern can be upsetting, but it is thought that it is not painful for the person. |
| Bladder and bowel changes | As the person eats and drinks less, they will produce less urine and faeces. As the body’s systems slow down, the person may have trouble emptying their bladder. A catheter may be inserted into the bladder to drain urine. Medicines may be prescribed for constipation, a common side effect of some pain medicines. Loss of bladder and bowel control sometimes happens in the last stages of the dying process, but does not always happen. Speak with your health or palliative care team to help you manage any incontinence. |
| Disorientation and confusion | Carers are often unprepared for the person becoming disoriented and confused. This is known as delirium. It can involve a lower level of consciousness; memory loss; hallucinations (seeing or hearing things and people that aren’t actually there); delusions (false beliefs or ideas); mood swings; and 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. The person may drift in and out of consciousness and eventually become unresponsive. Speak to the palliative care team if you notice any of these changes, so they can advise you on managing delirium. 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 |
| Restless moving, twitching, groaning or calling out | These symptoms are part of delirium and may include agitation, anxiety, anguish and anger, all of which can be very distressing for carers to see. These symptoms (sometimes called terminal restlessness) are common and not necessarily uncomfortable for the dying person |
| 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. You can prevent this with regular mouth care, which your health care or palliative care team can teach you. |
| Cool skin, especially the hands and feet | As circulation slows, the hands, feet, fingers and toes (extremities) become cooler and turn a bluish colour. It’s thought that the person will be unaware of feeling cold. |
→ READ MORE: How you can help in the final stages
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Prof Jane Phillips, Head, School of Nursing and Professor, Centre for Healthcare Transformation, Queensland University of Technology and Emerita Professor Palliative Nursing, University of Technology Sydney, NSW; Prof Meera Agar, Palliative Care Physician, Professor of Palliative Medicine, University of Technology Sydney, IMPACCT, Sydney, NSW; Sandra Anderson, Consumer; A/Prof Megan Best, The University of Notre Dame Australia and The University of Sydney, NSW; Prof Lauren Breen, Psychologist and Discipline Lead, Psychology, Curtin University, WA; David Dawes, Manager, Spiritual Care Department, Peter MacCallum Cancer Centre, VIC; Rob Ferguson, Consumer; Gabrielle Gawne-Kelnar, Counsellor, Psychotherapist and Social Worker, One Life Counselling & Psychotherapy, NSW; Justine Hatton, Senior Social Worker, Southern Adelaide Palliative Services, Flinders Medical Centre, SA; Caitlin MacDonagh, Clinical Nurse Consultant, Palliative Care, Royal North Shore Hospital, Northern Sydney Local Health District, NSW; McCabe Centre for Law and Cancer; Palliative Care Australia; Belinda Reinhold, Acting Lead Palliative Care, Cancer Council QLD; Xanthe Sansome, National Program Director, Advance Care Planning Australia; Kirsty Trebilcock, 13 11 20 Consultant, Cancer Council SA.
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