What to Expect in the Final Days of Life: 10 Common Changes

One of the earliest changes families observe is increased sleep.

You may notice your loved one:

• Sleep for most of the day
• Speak less
• Become difficult to wake
• Eventually stop responding

How you can help: Continue talking to them, hold their hand and always assume they can still hear you.

When we enter the end of life, our body naturally begins to slow down and no longer requires the same amount of food or fluids.

You may notice your loved one:

• Express little interest in meals
• Refuse favorite foods
• Take only small sips of water

 How you can help: Don’t force food or fluids if your loved one isn’t interested. Instead, focus on comfort by offering mouth care, keeping them clean and comfortable, and asking your hospice team if you have questions.

Breathing patterns often become irregular.

You may notice:

• Rapid breathing
• Long pauses between breaths
• Shallow breathing
• A rattling sound caused by secretions

 How you can help: Stay calm and continue providing reassurance. Although these changes can be difficult to witness, they are a natural part of the dying process. If you’re ever concerned your loved one is uncomfortable, contact your hospice team — they can assess symptoms and recommend ways to improve comfort.

Circulation naturally slows down during the final days.

You may notice:

• Cool hands or feet
• Bluish or purple coloring
• Mottled skin on the legs or feet

 How you can help: Keep your loved one warm with a light blanket if they seem comfortable, but avoid heating pads or electric blankets. These changes are a natural part of the dying process, so focus on comfort rather than trying to restore warmth.

Changes in kidney function are expected near the end of life.

You may notice:

• Less frequent urination
• Darker urine
• Loss of bladder or bowel control

 How you can help: Help keep your loved one clean and comfortable, and don’t hesitate to ask your hospice team for supplies or guidance. They can recommend techniques that preserve comfort and dignity.

Your loved one may seem confused or unaware of their surroundings.

They may:

• Forget where they are
• Lose track of time
• Speak less clearly
• Become less responsive

 How you can help: Speak calmly, gently reorient your loved one if needed, and avoid arguing or correcting them. If confusion changes suddenly or concerns you, let your hospice team know.

Many people naturally begin withdrawing from social interaction.

You may notice they:

• Prefer a quiet atmosphere
• Talk less
• Decline visitors
• Sleep through conversations

 How you can help: Follow your loved one’s lead. Keep visits short and peaceful, and don’t interpret their withdrawal as rejection it’s often their way of conserving energy.

Some people report seeing deceased loved ones or speaking about preparing for a journey.

These experiences are surprisingly common near the end of life.

 How you can help: Listen with compassion rather than trying to explain or correct what they’re experiencing. Offering reassurance and simply being present can be deeply comforting.

Some patients become restless during the final days.

This may look like:

• Repetitive movements
• Fidgeting
• Trying to get out of bed

 How you can help: Stay nearby and create a calm, safe environment. Let your hospice team know if restlessness develops or worsens so they can identify possible causes and recommend ways to improve comfort.

Near the end of life, some people make statements or requests that seem unusual.

They may:

• Reflect on their life
• Talk about being ready
• Ask for certain people
• Express thoughts that don’t immediately make sense

 How you can help: Meet these moments with love and an open heart. Listen without judgment, offer reassurance and use the opportunity to express your own love, gratitude or goodbye if it feels right.