Please note: This is a general picture. Individual experiences are unique and influenced by many factors, such as the particular illness and the types of medications being taken, but there are some physical changes that are fairly common. For some, this process may take weeks; for others, only a few days or hours.
For most, activity decreases significantly in the final days and hours of life. You will notice:
When a person is just hours from death, you will notice changes in their breathing:
Because the central nervous system is directly impacted by the dying process, your loved one may sometimes be fully awake and other times be unresponsive. Caregivers, family, and physicians should always act as if the dying person is aware of what is going on and is able to hear and understand voices. In fact, hearing is one of the last senses to lapse before death.
Often before death, people will lapse into a coma. A coma is a deep state of unconsciousness in which a person cannot be aroused. Persons in a coma may still hear what is said even when they no longer respond. They may also feel something that could cause pain, but not respond outwardly.
Learn more about hospice:
If you'd like more information about the sequence of events leading up to the moment of death, we suggest the book How We Die by Sherwin Nuland, M.D. (New York: Knopf, 1993). "Signs of Approaching Death" by William Lamers, MD., was revised in part for clarity by Hank Willner, MD, Hospice Foundation of America's Medical Adviser in 2017. About William Lamers: William Lamers, MD, died in 2012 at the age of 80. Dr. Lamers was a long-time consultant to HFA, where he answered questions from families and patients as part of the organization's "Ask HFA" service. A pioneer in U.S. hospice care, Dr. Lamers founded Hospice of Marin (now Hospice by the Bay) in Northern California. Dr. Lamers was a frequent panelist on HFA's Living with Grief ® programs and contributor to its Living with Grief ® books. About Hank Willner: Hank Willner, MD, is Medical Adviser to Hospice Foundation of America, Chief Medical Director at Holy Cross Home Care and Hospice, and Palliative Care Consultant at Holy Cross Hospital in Silver Spring, Maryland. Certified in both Hospice and Palliative Medicine and in Family Practice, Dr. Willner is a Clinical Assistant Professor of Family Practice at Georgetown University Medical School and is a member of the Maryland State Advisory Council on Quality Care at the End of Life.
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