What happens in the final days of life?

What happens in the final days of life?

Carers often worry that they will not be able to cope or will not know what do when their loved one dies. Knowing what will happen in the final days of life may prepare you for and reassure you about what is ahead.

While it is difficult to predict exactly how someone will die, there are some physical changes that are often experienced when a person is nearing death. It can be very difficult to watch a loved one go through these changes, but it is important to remember that they are a natural part of the dying process and do not mean that the person is in pain or distressed.

How long the dying process takes varies from person to person. It may take just a few hours, or might take several days, and the dying person may experience some or all of the physical changes described below.

Drowsiness

The dying person will become very sleepy and may drift in and out of consciousness. This doesn’t mean that they can’t hear you, so it is important to keep talking to them and comforting them. You can sit close to them, hold their hand and reassure them that you are there.

Difficulty swallowing or not wanting to eat or drink at all

Eventually the dying person will not want to eat or drink anything. Don’t try to force them to eat or drink, as this will make them uncomfortable. If they are still awake you can give them ice chips to suck or sips of fluids to keep their mouth moist. You can put vaseline or lip balm on their lips to help stop them getting dry and sore. If they really can’t take anything into their mouth you can moisten their lips and mouth using water or lemon and glycerine swabs every 1 to 2 hours.

Loss of bladder and bowel control

The dying person may lose control of their bladder and bowel, because the muscles in these areas relax. This can be very distressing to see and you may worry that they may feel embarrassed. If you are caring at home, you might want to arrange in advance to have drawsheets or pads to protect the bed (the nurses will take care of this in a hospital).

Darkened urine or decreased amount of urine

This is caused by slowing of kidney function and/or decreased fluid intake. You may want to talk to a doctor or nurse about the need to insert a catheter to avoid blockage.

Restless movements

The person may move involuntarily (called myoclonus), or pull at bed sheets or clothes, as if they are in pain. In fact, these movements do not necessarily indicate pain, and not everyone dying of cancer will have pain at the time of death. If they do, it can usually be well controlled. If you think the dying person is in pain, tell the doctors and nurses.

Turning the head towards light

This is caused by decreasing vision. It is best to leave soft, indirect lights on in the room.

Changes in breathing; rattling or gurgling sounds

When someone is dying their breathing often changes, because of decreased fluid consumption, a build-up of mucus and saliva and a weakened cough reflex. The person’s breathing may become noisy, shallow and irregular, alternating between fast and slow. There may be times when they stop breathing for a few seconds, or they might breathe with an open mouth and use the chest muscles to help them catch a breath.

Hearing these sounds can be very upsetting, but they do not usually seem to cause distress to the dying person. It can help to raise the person’s head with pillows or cushions and if necessary, turn it to the side to help drain the secretions.

Just sitting with the person, speaking gently and holding their hand can be very reassuring. If someone is having difficulty breathing, a doctor or nurse may suggest giving a small dose of morphine, even if they are not otherwise in pain. Morphine can help to make breathing easier.

Cold feet, hands, arms and legs

The dying person’s face, hands, arms, feet and legs often become very cool to touch. The skin may also become pale and look blotchy or ‘mottled’. This happens because there is less blood circulation to these parts of the body. Keep the room at a comfortable temperature, and warm the person with blankets and thick socks. Don’t use an electric blanket as this can cause burns and may be uncomfortable.

Confusion and disorientation

You may hear your loved one say things that make no sense. They may not know what day it is or who you are, or may see and hear things that aren’t there.

They may shout at you or push you away, which can be very hurtful and upsetting. Try to understand that they don’t mean it and are not aware that they are doing these things. It happens partly because of the chemical changes going on inside their body.

Gently remind the person of the time, date, and people who are present. If the person is agitated, don’t try to restrain them.

Speaking calmly may help to re-orient the person.

Complete loss of consciousness

At the end of life, the chemical balance of the body becomes completely upset. The dying person then slips into unconsciousness. This is usually right towards the end, maybe only a few hours or days before death. Breathing becomes irregular and may become noisy. You won’t be able to wake them at all. Breathing will stay irregular for some time and will at some point stop.

Emotional and spiritual changes

As death gets closer they may begin to let go more and seem more at peace with things. Others may become very anxious, fearful or angry. Some people may appear to withdraw, even from the people they love and care about. This doesn’t mean that they don’t care anymore. These events are all very normal and a natural part of dying.

Even if the physical body is ready to shut down, some people may resist death. They may still have certain issues they want to resolve or relationships they want to put right. It is important to understand these things. Let your loved one know you are there and will help him or her with any of these issues. Allow the person to share any memories or feelings he or she has.

You may want to reassure them that it is all right to let go and die whenever they are ready. Some people will hold on until they have heard these words from the people they love, so letting them go can be one of the most important and loving things you can do for them.

Try not to worry that you are going to do the wrong thing. Just being with your loved one and letting them know you love and care for them is the most important thing.

Resources

Cancer Research UK, What happens in the final days of life

National Cancer Institute, End of life care: questions and answers

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