10 Signs Death Is Near

What to expect and how to respond to the natural dying process
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No one can predict the moment of death. But physicians and nurses involved in end-of-life care know that certain symptoms are usually associated with the body's shutting down. These signs of approaching death are specific to the natural dying process (apart from the effects of particular illnesses the person may have).

Not all dying symptoms show up in every person, but most people experience some combination of the following in the final days or hours:

1. Loss of appetite

Energy needs decline. The person may begin to resist or refuse meals and liquids, or accept only small amounts of bland foods (such as hot cereals). Meat, which is hard to digest, may be refused first. Even favorite foods hold little appeal.

Near the very end of life, the dying person may be physically unable to swallow.

How to respond: Don't force-feed; follow the person's cues even though you may be distressed by a loss of interest in eating. Periodically offer ice chips, a popsicle, or sips of water. Use a moistened warm cloth around the mouth and apply balm to the lips to keep them moist and comfortable.

2. Excessive fatigue and sleep

The person may begin to sleep the majority of the day and night as metabolism slows and the decline in food and water intake contribute to dehydration. He or she becomes difficult to rouse from sleep. The fatigue is so pronounced that awareness of immediate surroundings begins to drift.

How to respond: Permit sleep. Avoid jostling the person awake. Assume that everything you say can be heard, as the sense of hearing is thought to persist, even when the person is unconscious, in a coma, or otherwise not responsive.

3. Increased physical weakness

A decline in food intake and lack of energy leads to less energy, even for activities like lifting one's head or shifting in bed. The person may even have difficulty sipping from a straw.

How to respond: Focus on keeping the person comfortable.

4. Mental confusion or disorientation

Organs begin to fail, including the brain. Higher-order consciousness tends to change. "Few conditions leave people hyperaware when they're dying," says palliative-care physician Ira Byock, author of Dying Well.

The person may not be aware of where he or she is or who else is in the room, may speak or reply less often, may respond to people who can't be seen in the room by others (see Passing Away: What to Expect When Witnessing a Loved One's Death), may seem to say nonsensical things, may be confused about time, or may act restless and pick at bed linens.

How to respond: Remain calm and reassuring. Speak to the person softly, and identify yourself when you approach.

5. Labored breathing

Breath intakes and exhales become raggedy, irregular, and labored. A distinctive pattern called Cheyne-Stokes respiration might be heard: a loud, deep inhalation is followed by a pause of not breathing (apnea) for between five seconds to as long as a full minute, before a loud, deep breath resumes and again slowly peters out.

Sometimes excessive secretions create loud, gurling inhalations and exhalations that some people call a "death rattle."

How to respond: The stopped breathing or loud rattle can be alarming to listeners, but the dying person is unaware of this changed breathing; focus on overall comfort. Positions that may help: the head slightly elevated with a pillow, sitting up well-supported, or the head or lying body tilted to the side slightly. Moisten the mouth with a wet cloth and moisturize with lip balm or petroleum jelly.

If there's a lot of phlegm, allow it to drain naturally from the mouth, since suctioning it out can increase its quantity. A vaporizer in the room might help. Some people are given oxygen for comfort. Be a calm, physical presence, stroking the arm or speaking softly.

6. Social withdrawal

As the body shuts down, the dying person may gradually lose interest in those nearby. He or she may stop talking or mutter unintelligibly, stop responding to questions, or simply turn away.

A few days before receding socially for the last time, the dying person sometimes surprises loved ones with an unexpected burst of alert, attentive behavior. This can last less than an hour or up to a full day.

How to respond: Be aware that this is a natural part of the dying process and not a reflection of your relationship. Maintain a physical presence by touching the dying person and continuing to talk, if it feels appropriate, without demanding anything back. Treasure an alert interlude if and when it occurs, because it's almost always fleeting.

7. Changes in urination

Little going in (as the person loses interest in food and drink) means little coming out. Dropping blood pressure, part of the dying process (and therefore not treated at this point, in tandem with other symptoms), also contributes to the kidneys shutting down. The concentrated urine is brownish, reddish, or tea-colored.

Loss of bladder and bowel control may happen late in the dying process.

How to respond: Hospice medical staff sometimes decides that a catheter is necessary, although not in the final hours of life. Kidney failure can increase blood toxins and contribute to a peaceful coma before death. Add a bed pad when placing fresh sheets.

8. Swelling in the feet and ankles

As the kidneys are less able to process bodily fluids, they can accumulate and get deposited in areas of the body away from the heart, in the feet and ankles especially. These places, and sometimes also the hands, face, or feet, take on a swollen, puffy appearance.

How to respond: Usually no special treatment (such as diuretics) is given when the swelling seems directly related to the dying process. (The swelling is the result of the natural death process, not its cause.)

9. Coolness in the tips of the fingers and toes

In the hours or minutes before death, blood circulation draws back from the periphery of the body to help the vital organs. As this happens, the extremities (hands, feet, fingers, toes) become notably cooler. Nail beds may also look more pale, or bluish.

How to respond: A warm blanket can keep the person comfortable, or he or she may be oblivious. The person may complain about the weight of coverings on the legs, so keep them loose.

10. Mottled veins

Skin that had been uniformly pale or ashen develops a distinctive pattern of purplish/reddish/bluish mottling as one of the later signs of death approaching. This is the result of reduced blood circulation. It may be seen first on the soles of the feet.

How to respond: No special steps need to be taken.


These general signs of impending death can vary in sequence and combination from person to person. If a person is on life support (respirator, feeding tube), the process dying follows can be different. The signs of death listed here describe a natural dying process.

Medically reviewed by Dr. Farrokh Sohrabi


Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and much of the Alzheimer's and caregiving content on Caring. See full bio


16 days ago, said...

My grandma raised me, loved me, nurtured me my whole life. Here I am, 29 years old doing the same for her as she is making her journey Home. There are moments I am crying at the hole that will be left after she is gone, other times I am thanking God to see that she is no longer in pain and resting before she leaves us. I want nothing more than for her to finally be with those who left this family too and for her to be happy. I wish the same for everyone's loved one that is passing right now as they read my letter. And for those who are suffering like me, I pray that you find the comfort that is needed to get through this moment in our lives. Even if it turns out that this message is days, months, years later before you read it, please know that you are not alone and healing is the next step for us all. God bless. -Ash


22 days ago, said...

Wonderful information. Thank you


4 months ago, said...

SKAW: Visions and Hallucinations Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see. This can be unsettling, and loved ones may not know how to respond. its just a symptom


5 months ago, said...

My sister is 80 and on hospice at home. She has been seeing men in black robes with heads shrouded and black mask across their faces. She says she is not frightened because they aren't threatening her or touching her they just sit in chairs or stand around the room staring at her. I have never heard of anything like this..could someone respond if they KNOW what these men could be ?? PLEASE !!


5 months ago, said...

My mother died in October 2016. She had extreme loss of appetite and slept a lot at least 4 months prior. This site was very helpful to my sisters and me since we were confused by mom's symptoms. I sent a link of this site to my sister and said she has the symptoms of someone who is dying. She passed with us by her side.. She lost consciousness hours before, and labored breathing for two days, my sister thought the oxygen monitor battery had gone bad since it didn't register, and we realized her blood pressure had lowered to where it couldn't be read. A little while later her left shoulder raised up and I knew that was when her soul left. I had chills because her suffering was over, and she was ready to go.


6 months ago, said...

This article is very informative. I have seen a rapid decline in my Uncle's health within the last few weeks. He is 75 years of age, and in my opinion, I wouldn't consider that age to be very old. Nevertheless, He is over the Biblical "Three Score and Ten" and blessed to have seen this age. Needless to say, many people around the world don't even reach 70 years. Consultations, being cared for, medication and therapy etc..etc... I thought everything was going fine till he had to go to hospital again. I'm shocked at the rapid decline in his health. To be honest, He had been very sick with many operations, but I was expecting a more gradual process to all of this. He may still get through this, but it's up to the Lord Jesus now. He's in control of it all. Just to finish.... I'm glad that I came across this site. I see that many people go on the net when their loved ones are passing away. May the Lord Jesus give us the strength to cope in their final days. God bless.....John.


9 months ago, said...

I start with condolences and prayers to other commenters. Two months ago my father was working full time at 66 as a contractor and began complaining of leg pains. He ended up having an embolism and we discovered he had advanced B cell Lymphoma While recovering from the surgery for the aforementioned embolism. He spent a month in the hospital while beginning a chemotherapy regiment and after complications stemming from my father's Hepatitis, low renal function, and chemotherapy he rapidly declined to the point where we just said, we'll bring him home. I was curious as to how close he was to saying goodbye, because upon consultation from our home nurse she essentially said to get ready for it, so I found this just clicking info on Bing. I'll miss my dad but however painful this article was to read (because it was 10 out of 10 my old man isn't missing a symptom listed) it was extremely informative, and helpful in terms of having myself put things into perspective and in making sure my father has the most comfortable and loving care possible while we see him off. LongLiveHootie


11 months ago, said...

I had never heard of "Failure to Thrive" so I looked it up. This link warns of using it as a diagnosis. I'm hoping you have a team of doctors looking after your mother. When you don't feel well, you give up. From reading this, I would see if she might drink a nutritional energy drink such as Boost or Ensure to get some protein in her. You didn't mention any underlying illness or whether she is in hospice, but I wouldn't give up. http://www.todaysgeriatricmedicine.com/archive/110310p8.shtml


11 months ago, said...

My mom was diagnosed with Failure to Thrive. She barely eats, maybe one or two bites at the most and hardly drinks. She sometimes stares and doesn't respond to you, like she is looking straight past you at something else, she sleeps a lot, now she says she can't get comfortable in a chair, bed, or anything. She will say nothing is working and that she doesn't know what to do. Then she will get upset and cry. Is this a normal process and if so, at what point is she in the dying process?


12 months ago, said...

My relative has been diagnosed with stage 4 cancer (primary cancer is from the stomach and has liver metastases) with a prognosis of 6 to 12 months. It started when her annual medical checkup showed a high cancer marker rating. An appointment was scheduled with the oncologist was made but the pain from her abdomen got so bad that she was hospitalised before the appointment date. Things took a turn for the worse as the symptoms of advanced cancer suddenly came. Vomit, swelling, liver showing signs of failure. The doctors decided to let her start chemo immediately. The side effects if chemo came in, high blood pressure, low blood count, ulcers and thrush in the mouth. She vomited blood. Had diahrrea. Blood transfusions & plasma drips were given. Radiotherapy is scheduled to help stop the internal bleeding. Fentanyl and painkillers injection helps manage her pain. Days ago, they removed most drips from her and we notice the soles of her feet starting to turn purplish. Reading this article, I find it assuring that it is a natural dying process. I just pray she gets to go home soon, get all the comfort we can give to transit & find peace in her heart.


about 1 year ago, said...

My mom is dying of pancreatic cancer. we are seeing her decline quite rapidly. Hospice is a wonderful resource for us as we navigate this new situation. I am an only child. I wasn't prepared for much of the things happening, it's happened so fast. My question is, is it normal for the person to become paranoid that we are all out to hurt her somehow? she wakes up accusing me of terrible things and imagining that I am lying, killing, or starving her ! This is so distressing for me to hear as I'm trying so hard to take good care of her. I know she would never say or think that in her normal right mind but it's still very upsetting to hear say. I'm unsure how to respond when she has those paranoia episodes directed at me.. Any thoughts and advice please? Thank you


about 1 year ago, said...

My mom would lose cerculation in her fingers and they'd turn purple or blue. Shed bend down and try to get my blanket. When I'd get it for her and try to lay her down shed say no. Shed run into things and shed start talking normally then shed muble words and quietly speak and close her eyes. She passed away May 24th 2015. I'm 13. I turned 13 two days ago. If you have a mom, tell her you lobe her because you never know how much you love or appreciate her until she's gone. I miss you mom. So so much.


about 1 year ago, said...

Hi new here, Ive been caretaker for my mother in law for the past 5 months, she has colon cancer met to lung, 3 1/2 years now, never had treatment, 2 weeks ago she was in pain & agitated, her appetite was once huge, she started eating less, 9 days ago she went into a coma like state has not eaten or drank, eyes open, mouth open, breathing is ok now I noticed her left foot/leg is very swollen.