Compassion and Support


Patients & Families

Signs of Dying

The Body

There are many physical signs of dying.
  • Hands, feet and legs may feel cool or cold to the touch.
  • Blood pressure gradually goes down and heart rate gets faster but weaker.
  • Fingers, earlobes, lips and nail beds may look bluish or light gray.
  • A purplish or blotchy red-blue coloring on knees and/ or feet (mottling) is a sign that death is very near.
  • Because the body no longer needs large amounts of energy and because the digestive system is slowing down, the need for and interest in food (and eventually fluids) gradually lessens.
  • As eating and drinking taper off, the body naturally becomes dehydrated. When this occurs, the dying person becomes sleepier and may be less aware of pain or discomfort. This is a normal part of the dying process and there are ways to keep the person comfortable throughout this time.
  • Fever may or may not occur, but is common nearer to death.
  • Secretions usually thicken and build up in the lungs and/or the back of the throat.
  • Breathing may sound moist, congested or like a rattle.  This may come and go and is rarely bothersome to the dying person closer to the time of death. 
  • Changes in breathing will occur – changes in the rate, depth and rhythm of breathing, periods of not breathing for 5-30 seconds or a distinct pattern of breathing that is slow and shallow, then becoming faster and deeper, then slowing down again to 10-20 seconds.
  • Because the kidneys and bowels eventually stop working, there is a smaller amount of urine and it is darker in color.
  • Bowel movements become less frequent, but not having one for three to four days could become uncomfortable.
  • Vision may be blurred.
  • Always assume the dying person can hear, even if they are unable to respond. 
  • Although verbal and nonverbal communication becomes more limited, gentle touch is an effective way to remain present.

The Mind

There are mental changes and emotional-social changes that accompany dying.

Mental changes include:
  • Restlessness or agitation which may be a result of less oxygen to the brain, metabolic changes or physical pain.
  • Occasional or constant confusion which may be related to separation from the normal routines of living.  It may also be the result of a disease, or the dying process.
  • Levels of consciousness (being alert and aware) which may vary.
  • Sleepiness, but being able to be awakened and have awareness of the surroundings.  The senses may be dulled and there may be little awareness of what is happening in the environment. Sleep may be so deep that the dying person cannot be awakened and is unresponsive.
During the dying process, changes affecting a person’s inner feelings and interpersonal relationships may take place. 

Emotional-social changes might include:
  • Looking back at one’s life in search of meaning and contributions – life review.
  • Saying good-bye to people and places, forgiving and being forgiven, facing regrets – life closure.
  • Acceptance or coming to terms with ongoing losses and eventual death.
Some individuals may not want or be able to do these things.  It is important to take cues from the dying person and be able to listen, to share memories and find ways to say good-bye.

The Spirit

A person’s spirituality is very unique and personal. Each person interprets death and dying differently and the language and rituals used to express it are different for each dying person and family member.   

Early in the dying process, the person may face many issues, which draw from his or her spirituality, such as examining:
  • The meaning of life, hope, suffering and death.
  • Acceptance of ongoing losses and eventual death.
  • Grieving these losses.
  • Forgiving and being forgiven.
It is not unusual for a dying person to speak in metaphors about dying, for example speaking about death in terms of travel or a journey, getting to the door, or finding the key. It is not uncommon to see a dying person calling or reaching out to a deceased family member or to a religious figure or speak of visits from or dreams about those who have died before them.  These reports have almost always been comforting to the dying person. Rather than deny these descriptions, or correct these reports, it is important to try to listen and accept what is being said.

Remember that the person dies at just the right moment whether it is alone or surrounded by others. Some individuals may seem to hold off or bring on the moment of death…that is, dying just after a close relative arrives from out-of-town or after an anticipated event such as a birthday occurs. Likewise, for someone who has been private or independent in life, death may come when everyone steps out of the room momentarily.  Sometimes people die at a time that spares certain loved ones from the actual dying event.

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