When someone you love is approaching the end of their life, not knowing what may happen can make an already difficult time more frightening. This guide explains some of the changes families may notice in the final weeks, days and hours before death, what the final moments can look like, and what usually happens afterwards.
There is no exact timetable for dying. Every person is different, and not everyone will experience the same changes. Some of the signs described here can also have other causes, so if you are worried about a new symptom, pain, breathlessness, agitation or distress, speak to the person’s GP, district nurse, palliative care team, care home staff or hospital team.
If a collapse or death is sudden or unexpected, or you are not sure whether the person may still be alive, call 999. This article is mainly about an expected death where the person is already receiving end-of-life or palliative care.
What to expect when someone is dying
People often search for phrases such as what to expect when someone is dying, signs someone is dying, what happens in the last days of life or what happens when someone dies. The difficult part is that there is no single pattern.
According to NHS and palliative-care guidance, changes can develop gradually over weeks or more quickly over days or hours. The important thing is to look at the whole picture rather than one sign on its own.
The last weeks of life
In the final weeks, someone may gradually have less energy and need more help with everyday tasks. They may spend more time sleeping, be less interested in food and drink, lose weight, become less mobile or seem to withdraw from things happening around them.
Other symptoms can include breathlessness, pain, nausea, changes in bladder or bowel function, difficulty swallowing, confusion or feeling unusually hot or cold.
These changes do not automatically mean that death is imminent. Some symptoms may be treatable, and good palliative care can often make a significant difference to comfort. If something is new, getting worse or causing distress, ask the healthcare team for advice.
Signs someone may be in the last days or hours of life
As the body slows down, families may notice a combination of the following:
- sleeping much more or becoming very drowsy
- being less responsive or communicating less
- eating and drinking very little
- difficulty swallowing
- reduced urine output
- changes in breathing pattern
- pauses between breaths
- noisy breathing caused by secretions
- restlessness, confusion or agitation
- cold hands and feet
- changes in skin colour or mottling
Not everyone will experience all of these signs, and they do not always occur in a particular order.
Eating and drinking less
One of the changes families often find hardest is seeing someone lose interest in food or drink.
As a person approaches the end of life, their body usually needs less food and may no longer be able to process it in the same way. Swallowing can also become difficult. Trying to make someone eat when they do not want to can be uncomfortable.
If swallowing is becoming difficult, ask the healthcare team for advice. Medicines can sometimes be given in a different way, and simple mouth care can help keep the person comfortable.
Changes in breathing
Breathing can become noticeably different in the last days or hours. It may become shallow, irregular, faster or slower. There can be pauses between breaths, sometimes followed by deeper breathing.
You may also hear a rattling or bubbling sound. This can happen because the person is no longer able to cough or clear normal secretions effectively. The sound can be upsetting for relatives, but it does not necessarily mean that the person is in pain or distress.
If breathing appears uncomfortable, or you are concerned, tell the doctor or nurse. There may be medication or practical measures that can help.
Confusion, restlessness or agitation
Some people become confused, restless or agitated towards the end of life. They may not recognise where they are, may appear unsettled, or may say or do things that seem out of character.
There can be several causes, including medication, pain, infection or changes within the body. Do not assume that agitation is simply part of dying. Let the healthcare team know, because they may be able to identify and treat the cause or provide medication to reduce distress.
Changes in skin and circulation
Hands and feet may become colder as circulation changes. Skin can look paler, blue, grey or mottled. On darker skin tones, changes may be easier to see around the lips, mouth, nose, cheeks, ears or tongue.
These changes are often part of the natural process as the body slows down.
Can they still hear you?
Someone may become unable to respond even though you are still beside them. It is reasonable to continue speaking calmly, holding their hand if that is something they would normally welcome, playing familiar music, or simply sitting quietly with them.
You do not need to find the perfect words. Presence can be enough.
What happens in the final moments of life?
The exact moment of death is not always obvious. Breathing usually becomes slower and eventually stops. The face and body may relax. There may be a final breath or small movement.
There is no “correct” way for family members to react. Even when a death has been expected for a long time, the moment itself can still feel shocking or unreal.
What to do when someone dies at home and the death was expected
If the person dies at home and the death was expected, a healthcare professional will need to confirm that they have died. This is often called verification of death.
During normal surgery hours, contact the person’s GP practice or the healthcare team that has been caring for them. Outside normal hours, NHS 111 can advise and arrange an appropriate healthcare professional where necessary.
If the death was not expected, or there is any doubt about what has happened, call 999 and follow the instructions you are given.
Do not remove medical equipment such as syringe drivers unless the healthcare professional responsible for the person’s care tells you to do so.
You do not have to rush
After an expected death has been verified, families often worry that everything must happen immediately. In many circumstances there is time to sit with the person, contact close family members and gather yourselves before making the next arrangements.
The next steps can vary depending on where the person died and the circumstances of the death. A funeral provider can explain when the person can be brought into their care.
What happens after the death has been confirmed?
In England, the medical certification process now involves a medical examiner. After a doctor has confirmed the death and provided the relevant medical information, the medical examiner independently reviews the proposed cause of death.
The medical examiner’s office will contact the family when the death can be registered. Once you have been told that registration can proceed, the death normally needs to be registered within five days in England and Wales.
After registration, the necessary paperwork for burial or cremation can be issued.
When can a funeral service collect your loved one?
For an expected death at home, the person normally needs to have been formally verified as having died before a funeral service transfers them into its care.
If you are considering direct cremation, you do not need to understand the whole process before making contact. We can explain what information is needed, when a transfer can take place and what happens afterwards.
Read our guide: What to do when someone dies →
Planning ahead when someone is expected to die
If a relative is approaching the end of life, it can help to discuss practical arrangements before the death if you feel able to do so. This does not mean giving up or caring less. It can simply reduce the number of decisions that have to be made immediately afterwards.
You may want to know:
- who to call if the person dies during the day
- who to call overnight or at the weekend
- whether the GP, district nurse or palliative care team has documented that the death is expected
- who can verify the death
- whether there are religious or cultural wishes that need to be followed promptly
- which funeral provider you would like to contact
If the person has specific wishes about their care, these should be discussed with their healthcare team while they are still able to express them.
If you are worried, ask the healthcare team
Articles like this can help you understand some common changes, but they cannot tell you exactly what is happening to one individual person.
If your loved one has new symptoms, appears uncomfortable, is struggling to breathe, is in pain, becomes very agitated, or you are simply unsure what you are seeing, contact the professionals caring for them.
Sources and further help
This guide has been checked against current guidance from the NHS, GOV.UK and Marie Curie. Useful further reading includes:
- NHS: Changes in the last hours and days of life
- NHS: What to expect from end of life care
- Marie Curie: End of life stages timeline
- GOV.UK: What to do after someone dies
BM Funeral Service is not providing medical advice in this article. For medical concerns, speak to the person’s healthcare team, NHS 111 or 999 where appropriate.
Need help with what happens after an expected death?
BM Funeral Service provides direct cremation and professional deceased care from our base in Charing, Kent. If someone is approaching the end of life and you want to understand what happens after death, you are welcome to speak to us before you need our service.