Skip to main content

Stages of the Dying Process and What to Expect

I was with my grandmother in her final moments. I've also taken care of hospice patients as a home health aide.

Death is a Natural Part of Life

If a loved one dies quickly and unexpectedly, such as in a car accident, we do not have the opportunity to witness the end-of-life process.

On the other hand, when a loved one is slowly dying from an illness or simply as a result of aging, we may have the opportunity to observe the unique process one goes through when it is time to leave this earth. Either way, death is difficult to accept—and yet it is a part of life that we cannot change.

Since we don't often have the opportunity to be present when a loved one dies, typically we do not know what to expect.

It is an extremely emotional experience that can be overwhelming for many. Having a better understanding of the stages of the dying process will hopefully help ease this experience for all involved.

This article is not at all meant to be dark or morbid. Death is a normal part of the life cycle and something everyone will go through.

Being aware of the stages one goes through at the end of life will give loved ones an opportunity to be less fearful. Knowing what to expect will allow you to be present in the moment with much compassion. You may even experience gratitude for opportunity to accompany your loved one through this unique process.

— Sharyn

What to Expect When a Loved One is Nearing the End of Life

Just like each individual’s path in life is unique, so is their path to death. The process of dying may unfold differently for each individual, yet there are physical signs and symptoms that are typically observed.

Understanding what a person and their body are going through when preparing for death will be helpful to those who wish to be close during this time. Recognizing the stages of the dying process will allow you to:

  • participate in the process
  • be able to appropriately comfort your loved one
  • be present in the moment
  • be able to continue taking care of yourself, as well

4-12 Weeks Prior to Death

Sign or SymptomExplanation

Tired and sleeping more

Longer periods of sleep occur more often.

Withdrawal

Start to show lack of interest in the television, newspapers and everyday life. Begin separating from daily routines. Not interested in visiting with company or talking on the phone. Appears to be more content sitting quietly, thinking to self.

Communication

Less talking. Communicating less with speech and more with using touch and gestures may be noticeable.

Not as hungry

No appetite, eating less and less. Simply not hungry as the body needs less and less fuel to keep going. Food that is more difficult to chew and digest will be turned down first. Intake will continue to diminish until only liquids are desired.

1-4 Weeks Prior to Death

Sign or SymptomExplanation

Restlessness

Increased agitation and restlessness, especially noticeable with arm movements.

Disorientation

Sleep even more now causing additional confusing when awake. Confusion regarding time, dates, people, places and events. Possibly talking out loud to someone who is not there. It is common for chatting to occur with a loved one who has already passed on.

Blood pressure

Blood pressure will begin to lower and pulse may begin to rise.

Body temperature

Body temperature will commonly fluctuate from cold to fever causing unusual perspiration.

Color of skin

Will change to a pale yellowish complexion and bluish over the rest of the body.

Breathing

Normal respirations of 16-20 breaths per minute may increase to 50 or decrease to as low as 6 breaths per minute. "Puffing” of the lips when exhaling may be noticeable. Breathing may stop briefly then restart again.

Lung congestion

A “rattling” sound may be present in the lungs and upper throat due to congestion. As congested breathing symptoms come and go, coughing may occur as well.

1-7 Days Prior to Death

Sign or SymptomExplanation

Increased energy

A brief noticeable surge in energy may occur and is common. May show an increase in movement that requires use of excessive energy. May be strangely more alert and less disoriented then they have been in a long time. May talk more, ask questions, request something they would like or people whom they would like to see. May eat and drink more than they have in awhile.

Intensity of signs and symptoms from prior weeks

Changes that began to occur over the past month will intensify. Lack of oxygen in the blood will cause increased restlessness. Breathing is slower and more irregular and may stop for longer periods of time and then start again. Congestion can become very loud. Areas of the body such as toenails, fingernails, elbows, hands, knees, ankles, legs, back and buttocks become blotchy and more bluish or purple in color.

Appear to be in two worlds at once

Those at the end of life may seem to be in two worlds at once. They could talk directly to someone who is in the room with them and the next moment, appear to be speaking or paying attention to someone who is not there. They may use unusual gestures or speech that may not make sense to others.

Urine output

Urine output decreases and turns dark in color from natural dehydration.

Final Day and Hours Prior to Death

Sign or SymptomExplanation

Hearing

Hearing is the last sense that remains. Talk to your loved one even though they are unable to respond back to you.

Eyes

Eyes may be tearing and have a glassy look. They may be partially open but unlikely able to see at this point.

Unable to be awakened

Becomes generally non responsive and is unable to be awakened.

Final breaths

Normal gasping for air, described as a “fish out of water,” will occur. Often these final breaths are followed by a few more breaths that are spaced far apart. Following the final breath, it is normal that the mouth remains open. The eyes may open as well.

Transition

The spirit has now left the physical body.

Scroll to Continue

Read More From Youmemindbody

Things You Can Do to Comfort Your Loved One at the End of Life

As the body goes through the process of shutting down, understanding the signs and symptoms will help in coping with them. There are things you can do to make your loved one more comfortable, enhancing their quality of life in their final weeks.

  • First and foremost, ask for help if necessary. You do not have to do this alone. Talk with your medical provider to discuss what is needed.
  • If they are in pain, speak with your medical provider to determine what can be done to comfort your loved one.
  • Keep the temperature in their room comfortable. Use soft blankets to keep them warm.
  • Keep your loved one clean.
  • Sit with them often so they are not alone.
  • Speak clearly in a normal tone of voice. Always assume they can hear everything that is said.
  • If necessary, remind them who you are by identifying yourself so they are less confused.
  • Be patient.
  • Read to them.
  • Play soothing music for them.
  • Do not force them to eat or drink if they do not want it.
  • Use chips of ice if mouth is dry being sure they are still able to swallow.
  • Placing a cool, moist cloth on their forehead is comforting.
  • Reposition them often in bed to prevent bed sores.
  • Touch and hold their hand.
  • Give your loved one reassurance and permission to let go. Let them know that you will be okay. Say whatever words of love and support that comes from your heart.

Final Thoughts

This is a difficult process and one that most of us wish we did not have to go through. Even when a person is exhibiting many of the usual signs and symptoms of the dying process, no one can predict the exact timing. Therefore, it is important to make sure you take care of yourself. Make sure you eat appropriately and get adequate rest so you can be in the present with your loved one. Best wishes!

This is Sharyn's Slant

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers

Question: I am witnessing my 93-year-old dad dying of old age. He has stopped eating but still wants to take in fluids. He seems very peaceful and not in pain. My sister, on the other hand, thinks he might be in pain and wants to bring in hospice to start him on morphine and take away all fluids and have him on oxygen because she feels like it's time for him to die. Can a person die naturally and not be in pain?

Answer: Yes, absolutely a person can die naturally and not be in pain.

Question: The Mercy Hospice facility has mentioned that feeding the patient ceases during their care period, I think this is inhumane. Am I right?

Answer: No actually and that is something I needed to learn. It's actually inhumane to force feed anyone in this situation. Stopping eating is part of the end of life process. Everything is shutting down. In some cases, a person may get really angry if you try to make them eat because they are done. They have come to the point where they are ready to move on and forcing them to eat is actually what can be looked at as cruel.

Question: If a cancer patient is in pain when turning, could this be avoided?

Answer: I would think that if someone is in that much pain being moved, that instead of actually rolling them, you could use pillows etc. to prop up different parts of the body every so often to try to eliminate adding any sores to their body.

Comments

Sharon Smith (author) from Northeast Ohio USA on April 10, 2019:

Hi Jim,

No not necessarily. There are other factors that will play a part as well. Sorry I do not know more about your situation but wish you the best. Take care!

Jim on April 07, 2019:

When your love one is breathing 6 time in minute does that mean they close to passing away

Sharon Smith (author) from Northeast Ohio USA on May 20, 2018:

Hi Mike,

I totally understand the helplessness. It certainly is a unique process to witness. I appreciate that you feel this article gave you a better understanding. Thank you so much for your feedback!

Sharyn

Readmikenow on May 20, 2018:

I went through this with my dad and my mother-in-law. It's odd to me how accurate your descriptions are of what happens. My father did talk to people when nobody was in the room. He did appear to be in two worlds at once. I'm used to influencing things. My frustration came with the absolute helplessness with what was happening. Once I accepted the helplessness I was okay. Very good article. I'm glad I read it and now understand my experience was far more common that I realized.

Sharon Smith (author) from Northeast Ohio USA on May 20, 2018:

Hi Mary,

Thanks so much for your feedback.

Mary Norton from Ontario, Canada on May 19, 2018:

I think it is important that we are upbeat and not add to their stress and sadness. You are right about taking care of your own self and accepting help offered. As we grow older, this is becoming more of a challenge to be faced.

Bj on August 02, 2017:

My dad died of conjestivd heart faikure at home with his wife and my brother and I. My dad had started not talking to me when I called. When I arrived, he totally shut me out, would not let me bring him food or ice chips and it times yelling at me once saying you can me, but he continued to ask for his wife and my brother and my nephew. I am trying not to take this personal but since my dad and I were always close I'm very confused

Dee Stonelake on February 22, 2017:

Even though my husband and I are Christians who know Christ as our Savior believing in eternal life with God it is still difficult facing the failing health of my husband of 60 years.

For all of you who are facing the difficult days of knowing that soon your dear love one being gone, get Home Care for they not only help the patient but wonderful support for yourself. I found them to be the best and so much better than over other organizations.

Mimi on February 03, 2017:

Going through this now. My girlfriend's dad has cancer and doesn't want to eat. When he drinks water, it comes back up and he can't sleep well. I'm taking care of him when no one else is around.

Laurel on July 31, 2016:

I have just received my diagnosis, terminal brain cancer. The doctors can't give you aNY idea of how much time you have that, and I fully understand why they can't.

I feel that I have tons of things to do so that my hubby will be able to manage. He has recently diagnosed with dementia and I was supposed to be his caregiver so I'm very worried about what's going to happen to him.

Thank you so much for writing this I got a lot os sound information.

Sharon Smith (author) from Northeast Ohio USA on October 21, 2015:

Hi Scotty,

I am so glad you found this article informative. It's very possible that your grandma wanted to be alone at that time. I believe it all works out how it is supposed to. Thank you so much for your kind words and feedback. Take care,

Sharyn

Nikki from Worcester, MA on October 21, 2015:

This was a very informative hub, last year I lost my grandmother to Alzheimer's and it was a long, drawn out process over 4 years and I feel very lucky that the night before she died I was able to say bye to her even though she wasn't "there" . The next morning she passed before we were able to make it to the nursing home , we probably missed it by 10 minutes and I have guilt that she was by herself, I wasn't prepared to see her in the dead state for lack of better words , I know she was ready to go though and am happy it was peaceful.

Sharon Smith (author) from Northeast Ohio USA on February 04, 2015: