Are darkened toenail beds a sign that death is near?

3 answers | Last updated: Oct 13, 2016
Jesshelper asked...

My grandmother is dying from cancer. She lost the desire to eat about a month ago. She still is eating but I think its only because she wants to make everyone else happy. I noticed that her toenail beds started to darken earlier this week. About how much longer does she have?

Expert Answers

Audrey Wuerl, RN, BSN, PHN, is education coordinator for Hospice of San Joaquin in California. She is also a geriatric trainer for the End-of-Life Nursing Education Consortium (ELNEC), which promotes education in geriatric nursing and end-of-life care.

There are many signs that death is near, such as loosing the desire to eat for example. This is the body's way of "preparing for death" when a person can no longer metabolize (or digest) food like a healthy person can. Forcing someone to continue eating can actually cause a lot of harm for the person especially if they may be having difficulty swallowing. Often, people continue to eat because they think their family wants them to. Allowing your grandmother to choose not to eat when the end is near, while difficult for the family, can be the kindest thing you can do.

Some other changes you may see in your grandmother are changes in her breathing pattern, her level of consciousness, and so on. You do mention the darkening of her toenail beds, however. Usually dark toenails are a sign of fungus under the nail and you might want to report that to her doctor for treatment. If she is near death or is on hospice care now and at home, the dark toenails really are not a cause for alarm. By themselves, they are not a sign that death is near.

I am wondering if you are seeing changes overall on her feet, including the nail beds. If the feet and undersides of the feet (soles) are turning blue or purple that could be a sign of changes in the skin, such as mottling, which is a late sign of the circulatory system shutting down. No one can accurately predict how long a person has to live, but I've given you a few guidelines. Don't worry too much about the darkened toenails, but concentrate on this special time you have with your grandmother!

Community Answers

Lindasue answered...

I found Ms. Wuerl's response here to be very compasionate. The suggestion that one can't accurately predict death and that whatever the remaining time a loved one has should be made special. . . .

Jessica krant answered...


I'm sure it must be hard watching your grandmother lose her appetite and become weaker. I'm sure she is doing her best to make this time as comfortable for you as possible, not wanting to cause you pain. You did not mention what type of cancer she has, but I just wanted to add that if there is any involvement of her illness with her lungs or heart, darkened toenail beds (if blueish or purplish) can be a sign that less oxygen is getting to her extremities for various reasons. This could be true if her toenails were all fine, and are not misshapen (as they would be with fungus), and this sort of happened all of a sudden.

If she is struggling to breathe, and it would be appropriate to help her, then that is the way to go. But if she is comfortable and doesn't notice the toenail beds changing, then I would not worry too much. I do agree that as long as she seems comfortable, focus on talking to her as much as you can, sharing your time with her so she knows she is loved, and so you can make as many memories as possible to always treasure.