What to expect the last few weeks of life?

Nearing the end of life Everyone's experiences are different, but there are changes that sometimes happen shortly before a person dies. These include loss of consciousness, changes to skin colour, and changes to breathing.

mariecurie.org.uk - End of life signs | Last weeks and days - Marie Curie

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Learning about these changes can make the future seem less frightening and make you feel more prepared. It may be reassuring to know that most problems can be managed with good palliative care. Palliative care doctors and nurses are experts in looking after people who have a terminal illness (an illness that they will die from). Read more about palliative care. If you're caring for someone with a terminal illness at home, it is important to know where you can get support. Read more about caring for someone dying at home. Your loved one’s doctors and nurses should be able to give you information about what changes might happen at the end of life. Don’t be afraid to ask them if you’d like more information - palliative care doctors and nurses are there to support you, as well as the person who is ill.

Why do changes happen at the end of life?

When someone’s dying, the body slows down and shows signs that the person is approaching the end of their life. Not everyone will have these symptoms. And they can also be caused by other things, particularly if someone has just one or two changes. As someone approaches the end of life and is in the last hours of life, they might experience other changes. Read more about the final moments of life. The symptoms that someone has might depend on their illnesses, their general health and wellbeing, and treatments they’ve had or are having. It’s difficult to predict what will happen, but knowing some of the possibilities provides a chance to think ahead and prepare.

Losing weight

It’s common for people to lose weight and muscle and look thin or frail. This can be caused by their illness, treatments or loss of appetite. Some people gain weight or have swelling or puffiness, sometimes called oedema (fluid build-up). This can be caused by their illness or by certain medicines. Read more about oedema (fluid build up). Changes in appearance can be upsetting for people who are ill as well as the people around them. Speak to the person’s doctor or nurse if you are worried or would like more information about what to expect.

Feeling weak and sleeping more

Some people need to spend more time in a chair or in bed as everyday activities become too tiring. Needing to sleep more than usual is normal. Read more ways to manage weakness and fatigue when someone has a terminal illness. At this stage, lots of help is needed with things like washing, eating and going to the toilet. Find out more about caring for someone under the heading 'helping with practical tasks'.

Feeling hot or cold

Feeling hot or cold happens because the body isn’t regulating temperature as well as it used to. People can be kept comfortable by making practical changes like using blankets or opening a window.

Eating and drinking less

Wanting to eat or drink less is natural as the body uses less energy. Tastes can change and people won’t always need to eat at the same times every day. Some people have difficulty swallowing, a sore or dry mouth, or feel sick. The people around the person can help them to eat and drink if they want to and feel able to. Smaller portions may help. If the person feels thirsty and has problems swallowing, taking small sips, trying different cups, sucking on ice chips or swabbing their mouth might help. People who have problems chewing might prefer to eat soft, high-calorie foods such as ice cream and yoghurt. Some people don’t want to eat or drink or aren’t able to at the end of their life. This is normal and they shouldn’t be forced. People sometimes ask about having food or drink through a tube if someone is unable to swallow. If someone is expected to die within hours or days, this is unlikely to help them live longer or make them feel better, and it can cause other problems. Their doctor or nurse can look at whether extra nutrition or fluids are needed and talk about the advantages and disadvantages of giving these.

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Bladder and bowel problems

Near the end of life, some people lose control of their bladder or bowels as their muscles relax. There are ways to make sure comfort and dignity are maintained as much as possible. Ask the doctor or nurse what they would suggest to help with this. If someone is able to move around, they may be able to use a commode (portable toilet). If they’re less mobile, they might use pads and wipes. Some people use a catheter (a small tube that drains urine into a bag). It can help to talk to the doctor, nurse, and your loved one about what is needed and who should provide this care. Constipation can be caused by medicines, moving less, and eating and drinking less . Some medicines can also cause trouble passing urine. Speak to the doctor or nurse about what can help.

Breathlessness

Some people feel breathless or short of breath. You might hear this called dyspnoea. Some people experience this throughout their illness while others experience it in the last weeks, days and hours of life. It can be worse if the person is anxious, so helping them feel relaxed and reassured may help. The doctor or nurse may give medicine for breathlessness or advise practical steps to help, like having a fan in the room or opening a window.

Find out more about what can help with breathlessness.

Noisy breathing

Some people’s breathing may become loud if mucous has built up in their throat and airways. This may be because they aren’t coughing or clearing their airways. Some people call this the death rattle. It usually happens in the last days or hours of life. Changing the position that your family member or friend is sitting or lying in can help with this. You can ask the doctor or nurse what else might help – they might suggest medicines or gentle suction. It can be upsetting or worrying for family and friends to hear these noises. But it’s unlikely to be painful or distressing for the person themselves.

Find out more about other breathing changes towards the end of life.

Pain

Pain at the end of life is something that many people worry about. With the right treatment and support, pain can usually be managed. Tell the doctor or nurse about any pain. They’ll look at medicines or other ways to help manage the pain.

Nausea and vomiting

The doctor or nurse will look at what is causing the person to feel sick or be sick, and what can help with this. For example, they might adjust medicines if they think they are the cause. And they may offer medicines to help with it. Lots of other things might help if the person is feeling sick, including trying different foods or drinks, eating small portions, and doing activities that are distracting or relaxing.

Talking less

Many people will talk or communicate less with other people. They might not seem to notice what’s going on around them. Even if the person isn’t responding, it might help to talk calmly to them or hold their hand. They may still be able to hear what’s being said or feel your touch. If you’re not sure what to say, you could read to them or talk to them about family, friends, or what’s happening on the news.

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Restlessness or agitation

Some people feel restless or agitated and find it difficult to feel comfortable and relaxed. This can be caused by different things including emotional worries, medication, or symptoms like pain, nausea, constipation or having a full bladder. The doctor or nurse can look at what might be causing the problem and what might help. They might suggest medicines and will talk about any side effects, like sleeping more. Providing a calm, safe environment or trying to distract them from any discomfort may also help.

Delirium (sudden confusion)

Delirium is confusion that comes on suddenly, over a period of hours or days. The person might feel confused, disorientated and agitated, and they may see or hear things that aren’t there (hallucinations). Delirium is often caused by things that are treatable, like medication, dehydration, infections or constipation. The doctor or nurse can look at what might be causing the problem and what might help. They might suggest medicines and will talk about any side effects, like sleeping more. Providing a calm, safe environment and supporting them with any activities they need to do may also help.

Medicines

The doctor or nurse should look at the person’s medicines and talk to them about what they should be taking. They might see if any can be stopped if they aren’t helping any more. And they might see if other medicines can help with any symptoms they are having. It’s important to understand about any side effects of medicines that the person needs. For example, some medicines may help with symptoms and make the person more comfortable. But they may make the person sleep more and be less able to communicate. If you’re not sure about anything, ask the person’s doctor or nurse. If someone is in a care home or at home, the doctor may talk about “just in case” medicines. This is when medicines are prescribed in advance for symptoms that the person may be likely to experience in the future. This means that they can be given quickly and easily if the person develops more symptoms and needs them. If someone is unable to swallow medicines or their medicines aren’t working properly, they may be able to have their medication given by injections or through a syringe driver. A syringe driver is a small battery-powered pump that delivers medication at a constant rate through a small plastic tube under the skin.

Nearing the end of life

Everyone's experiences are different, but there are changes that sometimes happen shortly before a person dies. These include loss of consciousness, changes to skin colour, and changes to breathing. Read more on our page, final moments of life.

Planning ahead

If you’re caring for someone, you may be thinking about how and where they’d like to be looked after in their final days – this is called advance care planning. And you may have talked about whether there are any treatments or interventions they don’t want to receive in the future – this is called an advance decision to refuse treatment (ADRT), a living will or an advance directive. You could have a conversation with them and their healthcare professionals about this to understand their wishes. This can be helpful if there is a time in the future when they aren’t able to tell people what they want.

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mariecurie.org.uk - End of life signs | Last weeks and days - Marie Curie

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