Signs that someone is in their last days or hours of life
Please be aware - this information is for healthcare professionals. You can use our My Learning form to reflect on how this page has helped with your continuing professional development.
We also have information for the public on Signs that your loved one might be dying.
Everyone's experience of dying is different and it can be difficult to know when a person is reaching the last few days of their life. It's important to be able to recognise the common signs of dying, so the person you're caring for can receive the best possible care in their last days of life, and those around them can be prepared.
On this page:
Last days and hours of life
The last days or hours of a person's life are sometimes called the terminal phase. This is when someone is "actively dying".
Everyone's experience of dying is different, and some people will die suddenly or unexpectedly. But there are often signs that can help you to recognise when someone is entering the terminal phase. These include:
- getting worse day by day or hour by hour
- becoming bed-bound for most of the day
- extreme tiredness and weakness
- needing help with all personal care
- little interest in food or drink
- difficulty swallowing oral medication
- being less responsive and less able to communicate
- sleepiness and drowsiness
- reduced urine output
- new urinary or faecal incontinence
- delirium, with increased restlessness, confusion and agitation
- changes in their normal breathing pattern
- noisy chest secretions
- the person telling you they feel like they're dying.
You might also notice a change in their skin. People with lighter skin tones may look slightly blue or their skin can become mottled (have different coloured blotches or patches).
On people with darker skin tones, blue can be hard to see. It may be easier to see on their lips, nose, cheeks, ears, tongue or the inside of their mouth. Mottling is also harder to see on darker skin tones – it may look darker, purple or brownish in colour.
If you think someone is in their last days of life
It can be difficult to know whether someone is entering the last days of their life. If you're unsure, ask a more experienced colleague for advice.
Inform the person’s care team
If a patient shows signs that they're entering the terminal phase, speak to the district nurse, GP or palliative care team. They will speak to colleagues, the patient and the people around them to decide whether the patient is entering the last days of life and what care they need.
Read more about caring for patients in the last days and hours of life.
Consider reversible causes of decline
Some conditions can cause the signs and symptoms of dying but can be treated. Be aware of reversible causes of decline, which may include:
- hypercalcaemia (high level of calcium in the blood)
- renal (kidney) failure
- infection
- side effects of medicines such as strong painkillers.
If you think the patient may have any of these conditions, tell their GP or specialist nurse, who will arrange assessment and treatment.
Keep monitoring the person regularly (at least every 24 hours) to make sure they're settled. Talk to the GP or district nurse if there are any changes in their symptoms.
Communicate with the patient and those involved in their care
Even when someone has been living with a terminal illness for a while, it can be a shock for the patient and the people around them when they reach the last days of their life. It's important to be honest and reassuring when you're speaking to the patient and those important to them.
The best person to speak to the patient and the people close to them is a health and social care professional who is confident and experienced. It can help if they have had time to build a relationship with the patient. If you do not feel comfortable doing this, ask a colleague to help. You can learn the communication skills needed to speak to patients at the end of life through training, experience and feedback from colleagues.
Check whether the patient has recorded their wishes in a care plan or other document. If they haven't discussed their wishes with anyone, offer them the chance to do this as soon as possible.
Read more about advance care planning.
Some family members and friends may experience grief before the patient dies. This is called anticipatory grief.
Find out how you can help support family and friends.
Useful resources
You may find our guides on specific conditions, which include targeted information about signs of dying, useful:
- Dementia towards the end of life.
- Diabetes towards the end of life.
- Heart failure towards the end of life.
- Long-term lung conditions towards the end of life.
- Motor neurone disease (MND) towards the end of life.
- Multiple sclerosis (MS) towards the end of life.
- Parkinson's towards the end of life.
- Kidney failure towards the end of life.
Here are some useful resources from other organisations:
Key points
- Everyone’s experience of dying is different but there are some common signs that suggest a patient is entering their last days of life.
- Be aware of reversible causes of decline in a person living with a terminal illness.
- Communicate with the health and social care team to ensure the patient gets the best care in their last days of life.
- Talk to the patient and those close to them about what is happening and encourage them to express any concerns.
Marie Curie Nurse Maria describes the common changes that you might notice in someone’s last weeks, days and hours of life. Peter, Shital and Tracey also talk about their personal experiences of looking after their loved ones during this time. Not everyone experiences these changes and they might happen at different times – everyone’s experience is different.
This film was made for family and friends of people with a terminal illness, but it may also be useful for health and social care professionals.
Update: In this video, we talk about skin changes (4:26). Our information has since been updated as follows: People with lighter skin tones might look slightly blue, or their skin can become mottled (have different coloured blotches or patches). On people with darker skin tones, blue can be hard to see. It may be easier to see on their lips, nose, cheeks, ears, tongue, or the inside of their mouth. Mottling is also harder to see on darker skin tones – it might look darker than normal, purple or brownish in colour.
Let us know what you think
Email your feedback to knowledgezone@mariecurie.org.uk
Disclaimer
This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals.
The Palliative Care Knowledge Zone is not intended for use by people living with a terminal illness or their family and friends, who should access our information for the public.
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