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 can offer slivers of ice or sips of water. |
| 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 many health professionals believe this is not painful for the person. |
| Bladder and bowel changes | As the person eats and drinks less, they will produce less urine and faeces (pee and poo). 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 healthcare 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 healthcare 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 may turn a bluish colour. It’s thought that the person will be unaware of feeling cold. |
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Fiona Wiseman, Senior Social Worker, Peter MacCallum Cancer Centre, VIC; Grace Berwald, Consumer; Peta Brydon, Metastatic McGrath Breast Care Clinical Nurse Consultant, The Kinghorn Cancer Centre, NSW; Kate Bunyan, Social Worker, Psychosocial Lead, Cancer and Palliative Supportive Care, Canberra Region Cancer Centre, ACT; Hayden Christie, Medical Oncologist and Clinical Director Cancer Care Service and Clinical Lead of the VAD Service for Wide Bay Hospital and Health Service, QLD; John Clements, Consumer; Claire Davies, Spiritual Care Practitioner, Peter MacCallum Cancer Centre, VIC; Joanne Dean, Nurse Practitioner, PEACE Team, Clare Holland House, ACT; A/Prof Michael Franco, Medical Oncologist and Palliative Medicine Physician, Deputy Head – Monash Medical School, Monash University, VIC; Dr Sally Greenaway, WSLHD Director of Supportive and Palliative Care, Senior Staff Specialist Clinical Haematology and Clinical Ethics Service, NSW; Maree Grier, Clinical Psychologist, Royal Brisbane and Women’s Hospital, QLD; Dr Catherine Joyce, National Manager, Advance Care Planning Australia; Mattesse Kitchin, Consumer; Penny Neller, Project Manager, End of Life Law for Clinicians, Australian Centre for Health Law Research, Queensland University of Technology, QLD; Caitriona Nienaber 13 11 20 Consultant, Cancer Council WA; Palliative Care Australia; A/Prof Joel Rhee, Head of Discipline of General Practice, School of Clinical Medicine, University of New South Wales, NSW.
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