What to expect when someone close to you is in their final days

In the last days of life the person’s appetite and thirst is likely to be much reduced. Families and carers may be concerned about the effects of reduced food intake or dehydration but this is a natural and expected part of the dying process. The body is slowing down, and if someone eats or drinks more than they really need it can cause them discomfort. More care is needed with swallowing and soft food is a little safer.  

Things that may help:

• Let the person choose if and when they want to eat or drink  
• Offer small amounts of soft food, especially the person’s favourite flavours
• Offer crushed ice or small ice lollies instead of drinks
• Use a small spray bottle to mist the mouth with small amounts of water
• Frequent mouth care can prevent the person feeling thirsty     
• NHS Herts Valleys have produced a helpful leaflet (see downloads) with suggested food and drinks 

As a person’s body shuts down, it is normal that their breathing becomes shallower often with long pauses between breaths. Sometimes this alternates with rapid breathing. Both are normal and not a sign of distress or suffocation. 

Sometimes the person’s breathing may become irregular and noisy. This is likely to be because they are not able to swallow their saliva, which can cause a rattling sound. Whilst the sound may be unsettling it does not usually cause distress. If there is distress then small doses of medicines to dry the secretions, or to deepen sleep may help.

As time goes by the person will spend more time sleeping, often very deeply. Some people become completely unconscious for a period of time - this could be short, or as long as several days.

The person’s skin may feel cold and change colour. Their hands, feet, ears and nose may feel cold to the touch due to reduced circulation in the final hours. Occasionally, a person’s hands or other parts of the body may swell and their skin may also become mottled or uneven in colour as their circulation slows down.

In the last few days some people become more restless and agitated. They may hallucinate, and see or hear people or things that are not actually there which can be distressing to watch.

The person may lose control of their bladder or bowels. This happens because the muscles in these areas relax and don’t work as well as they did. They may also have fewer bowel movements as they eat less, and their urine may get darker as they drink less. There are many practical ways that nurses can advise on how to manage this to help retain dignity.