August 26, 2018

Body Changes in the Last Hours and Days of Life (Advice for Patients, Families, Carers)

This is the third article in 'The Last Hours of Living' series for people who are approaching the end of their life, for their families and for their carers. Some parts of it may also be useful for professionals who are caring for someone who is dying, or people who want to plan in advance for their own end of life care.

It covers what to expect, thinking about your wishes for your future care, and looking after your emotional and psychological wellbeing. You may want to read the first 2 articles: Introduction to the Last Hours of Living and thereafter, Preparing for the Last Hours of Life. This third article describes changes in the body which may occur in the last hours and days, and looks at how to manage them.

Changes in the last hours and days

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

1). Becoming drowsy

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

man in bed sleeping

2). 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 medicine.

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 don't eat, especially if they see you losing weight, but they don't need to force or make you eat.

As you get closer to dying, your body won't be able to digest food properly and you won't need to eat.
If you can't swallow to drink, your carers can wet your lips with water.

3). Changes in breathing

Your breathing may become less regular. You may develop Cheyne-Stokes breathing, 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 as a result of the build-up of mucus.

The body naturally produces mucus in your breathing system, including the lungs and nasal passages. When you're healthy, this mucus is removed through coughing.

When you're dying and no longer moving around, the mucus can build up and cause a rattling sound when you breathe.

4). Confusion and hallucinations

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

Some people may experience restlessness or seem to be in distress. For example, they may want to move about, even though they aren't 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 medicines that can be used.

5). Cold hands and feet

Your feet and hands may feel cold as a result of changes in your circulation. Extra blankets over your hands and feet can keep you warm.

Your skin may look slightly blue because of 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, a guide for carers, families and friends of people who are dying.

Healthcare professional?

You may also want to read this article on the last hours of living - Physiologic Changes and Symptom Management.

1). World Health Organization: End-of-life care in low- and middle-income countries - WHO Bulletin. Accessed 18.08.18. Available here:
2). NHS UK: End of life care. Accessed 21.08.18. Available here:
3). Field MJ, Cassel CK, eds. Approaching Death: Improving Care at the End of Life. Washington, DC: National Academy Press; 1997:28-30
4). Wikipedia, the Free Encyclopedia: End-of-life care. Accessed 18.08.18. Available here:

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