End of life care

Changes in the last hours and days

Physical changes are likely to occur when you are dying. These happen to most people, whatever condition or illness they have, during the terminal phase. This can last hours or days. 

Becoming drowsy

You will start to feel more tired and drowsy, and have less energy. You will probably spend more time sleeping, and as time goes on you will slip in and out of consciousness.

Not wanting to eat or drink

Not wanting to eat is common in patients who are dying. At this stage, you may also find it difficult to swallow medication by mouth. Your healthcare professionals can discuss alternative ways of taking medication with you and your carers, if necessary.

Your family and carers may find it upsetting or worrying if you do not eat, especially if they see you losing weight, but they do not need to make you eat. As you get closer to dying, your body will not be able to digest food properly and you will not need to eat.

If you cannot swallow to drink, your carers can wet your lips with water. 

Changes in breathing

Your breathing may become less regular. You may develop Cheyne-Stokes breathing, which is when periods of shallow breathing alternate with periods of deeper, rapid breathing. The deep, rapid breathing may be followed by a pause before breathing begins again.

Your breathing may also become more noisy due to the build-up of mucus. The body naturally produces mucus in your breathing system, including the lungs and nasal passages, and when you are healthy, this mucus is removed through coughing. When you are dying and no longer moving around, the mucus can build up and cause a rattling sound when you breathe.

Confusion and hallucinations

Medications or changes in the chemical balance of your brain can cause confusion or hallucinations. A hallucination is when you see or hear things that are not there. If you become confused, you may not recognise where you are or the people who are with you.

Some people may experience restlessness or seem to be in distress. For example, they may want to move about, even though they are not able to get out of bed, or they may shout or lash out. This can be out of character, and distressing for family and carers.

The medical team can rule out or treat any underlying causes, such as pain, breathing problems or infection, or calm the person who is dying. If no underlying cause can be identified, there are medications that can be used.

Cold hands and feet

Your feet and hands may feel cold, due to changes in your circulation. Extra blankets over your hands and feet can keep you warm. Your skin may look slightly blue in colour, due to a lack of oxygen in your blood; this is known as cyanosis.

More information

For further help, read What to expect when someone important to you is dying, which is a guide for carers, families and friends of people who are dying.

The National Institute for Health and Care Excellence (NICE) has published new guidance for the care of adults in the last two to three days of life.

Find out what to expect from end of life care.

Page last reviewed: 15/09/2014

Next review due: 30/09/2017

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