Changes In The Last Hours And Days

Overview

As a person's body naturally begins to slow down at the end of life, they may go through a series of physical, emotional, and mental changes. This final stage is sometimes called 'the dying process.' It is a personal and unique experience for everyone, but there are common signs that loved ones can look out for to understand what is happening and how to provide comfort.

Every person who dies goes through this final phase, but the timing and the signs can vary a lot from person to person.

It affects the person nearing the end of life, and it also deeply affects their family, friends, and caregivers who are watching and supporting them.

Symptoms

Common symptoms

• Sleeping more and becoming harder to wake up
• Less interest in food and drink
• Changes in breathing – it may become shallow, irregular, or have long pauses
• Cold or mottled hands, feet, or legs (the skin may look blotchy)
• Confusion, restlessness, or seeing or talking to people who are not there
• Loss of bladder or bowel control
• Congestion or a rattling sound in the chest or throat
• Eyes that are half-open or not focusing

Symptoms in children

• Children nearing the end of life may show similar signs, such as increased sleepiness and withdrawal.
• They may become irritable or restless and may have changes in breathing or skin colour.
• They might not be able to say how they feel, so watch for signs of pain like moaning, grimacing, or guarding a body part.

Symptoms in older adults

• Older adults often become weaker and more fatigued over days or weeks.
• They may have long periods of semi-consciousness and may drift in and out of sleep.
• Their skin may become pale, cool, or mottled, and their pulse may become weak or irregular.

Causes

Main causes

• The underlying life-limiting illness (such as advanced cancer, heart failure, or dementia) begins to affect the body's organs.
• The body naturally starts to shut down – organs slow, energy drops, and the brain becomes less responsive.
• Changes in blood flow, breathing, and digestion are all part of the normal dying process.

Risk factors

• Having an advanced, progressive illness that cannot be cured
• Choosing not to pursue further life-prolonging treatments
• Being in a state of frailty or extreme old age

When to see a doctor

See a doctor urgently if:

• If the person suddenly seems to be in severe pain or distress
• If breathing becomes very difficult or noisy and you are worried
• If the person has a seizure, or any symptom that feels like an emergency

Book a routine appointment if:

• If you have questions about what to expect as the person's condition changes
• If you are unsure how to manage symptoms like pain, restlessness, or mouth dryness
• If you want to discuss care preferences and advance care planning

Diagnosis

Recognising the last hours and days is not a single test or diagnosis. Doctors, nurses, and palliative care teams look at how the person's overall condition is changing – their level of alertness, breathing, skin appearance, and ability to swallow – to help confirm that the body is entering this final phase.

Tests that may be done

• Doctors may not order any tests, because the signs are usually clear from careful observation.
• If there is uncertainty, they might check vital signs like blood pressure, heart rate, and oxygen levels.
• They may review the person's medical history and the course of their illness.

What to expect at your appointment

During this time, the care team will focus on comfort – assessing pain, easing anxiety, and helping with breathing or secretions. They will also speak with family about what they are seeing and what might happen next, so you never feel alone in the journey.

Treatment

The goal of care in the last hours and days is comfort and quality of life. Treatment shifts from trying to cure the illness to managing symptoms and ensuring the person is as peaceful and free from distress as possible. This involves physical care, emotional support, and attention to the family's needs as well.

Self-care at home

• Offer small sips of water or ice chips if the person is awake and can swallow – but do not force them to eat or drink.
• Keep the person's lips moist with a damp cloth or lip balm.
• Gently position the person to help them breathe more easily – a slightly raised head may help.
• Reduce noise, bright lights, and unnecessary interruptions.
• Play soft music or hold a hand – touch and presence can be very reassuring.
• Check that the room feels comfortable – not too hot or cold.

Medical treatments

Doctors and palliative care specialists may prescribe medicines to ease pain, reduce anxiety, or dry up chest secretions. These are given in the most comfortable way, often as small under-the-tongue drops or via a syringe pump. The exact medicines depend on the person's symptoms and are always tailored to what they need – never a one-size-fits-all approach. They may also guide you on the right position to ease breathing.

Living with this condition

In the last hours and days, the routine becomes about being present. Spend time with the person in a quiet, calm way. Speak softly, say what you need to say, and do not feel you have to talk – simply being there is enough. Many people can still hear even when they cannot respond, so speak as if they can hear you and let them know they are loved.

Lifestyle tips

• Take breaks – ask other family members or friends to share the watch.
• Take care of yourself, too – eat, rest, and ask for help.
• Let yourself feel whatever you feel – sadness, anger, fatigue, or relief – these are all normal.
• Keep a spray bottle of water or a wet cloth near the bed for mouth care.
• Consider playing the person's favourite music or reading something they loved.

Diet and exercise

The person may lose interest in food and drink near the end of life. This is a natural part of the process – their body is using less energy. You do not need to push them to eat. If they are awake, you can offer small sips or soft foods they enjoy. Exercise is not relevant at this stage; instead, gentle positioning and moving to prevent stiffness or pressure sores is important.

Mental health and emotional wellbeing

Watching someone you love go through these changes can bring up heavy emotions – grief, anxiety, exhaustion, and even helplessness. It is common to feel overwhelmed. It is okay to step away, cry, or talk to someone you trust. This is hard, and you do not have to be strong all the time.

Prevention

The dying process cannot be prevented – it is the natural end of life. What can be prevented, or at least eased, is unnecessary suffering. Good palliative (comfort) care can help manage symptoms like pain, breathlessness, and agitation, so the person can be as comfortable and peaceful as possible.

Complications

If left untreated

• If pain or other symptoms are not well managed, the person may experience distress or restlessness.
• Families may feel confused or frightened if they do not understand what is happening.
• Poor communication can lead to unnecessary medical interventions.

Long-term outlook

While the last hours and days are a time of loss and sadness, they can also be a time of closeness, love, and meaning. With good palliative care and the people they love nearby, most people can pass peacefully and with dignity. Every journey is different, but you can feel hope in knowing that you are doing everything possible to support your loved one.

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