Near Death – Physical Changes


Physical changes may be visible to the patient and caregiver soon after a diagnosis is made by the physician. Some changes may not occur until weeks or days before death. Some may never occur. Each person’s body is special and prepares itself in its own way for death.

The following list of changes will help you understand the journey your love one’s body is taking from the physical world to the spiritual world. You cannot take the journey with them or for them, but hospice will help you anticipate their care and comfort needs along the way.

BRIGHT HORIZON HOSPICE- Weeks or Months before Death

General changes:

  • Loss of appetite and thirst.
  • Increased sleep.
  • Emotional high and lows.
  • Decreased physical activity.
  • Spending more time away from others and talking less.
  • Gradual lowering of blood pressure.
  • Weight loss.
  • Drenching perspiration of upper body with or without fever.
  • If they are hot, place a sheet over them and/or gently wash their face, arms and legs with a cool cloth. Direct an electric fan toward them or open a window to circulate air if they continue to be hot.
  • Cooling of arms and legs. If your loved one is cool to the touch, place a warm (not electric) blanket over them.
  • Skin color becomes pale or bluish around the lips, ears and nails.
  • Use lip balm to keep their lips moist.
  • Occasional loss of control of bowel and bladder functions.
  • Pain may increase or decrease.
  • Eyes may appear not to see or become glassy.
  • Difficulty swallowing.
  • Just as every birth experience is different and special for each person, so is this death experience. As more signs of death approach, your hospice team members will visit more often to help with physical and emotional concerns.
  • This is a time to ask for support from friends and family and to allow yourself to lean on others. It is also a time to call in friends and family for last goodbyes.

The patient may be conscious until the time of death or gradually become unresponsive for days prior to death. It is very important to remember that the patient’s hearing usually continues even if the patient appears to be in a deep sleep or comatose state. They will hear all of the important words you may still need to say:

“I love you.” • “I know you are tired.” • “It’s all right for you to go.”

“I’ll miss you.” • “I will be okay.”

Patients often hold on to this life until they feel their loved ones are ready to let them go. Frequently a restless, comatose patient with noisy breathing will relax and the breathing become quieter after loved ones have released them and told them they can go.

Changes in vision and speech:

Your loved one may now be more sensitive to light. Their eyes may be open, but unfocused and unseeing. It is as if they are looking through you at something beyond. Their eyes may fill with tears. They will talk less and eventually they may say only a word or two when spoken to. Their speech may become more difficult to understand. Eventually, they may not attempt to speak at all. As they move closer to the spiritual world, they have less need for words. Words belong to this physical world. They may communicate more with nonverbal communication, such as squeezing your hand, lifting a brow or smiling. A grimace or a furrowed brow can tell you they may be in pain.

Dim the lights if they are sensitive to light.
Reassure them that even though they cannot tell you, you know that they love you.
Hold their hand and assure them that you are with them.
Continue to give comfort medications as prescribed. Observe body language for signs of pain and distress.
Talk to them even though they may not be able to respond to you verbally. Assume that they can hear you and understand what you are saying.

BRIGHT HORIZON HOSPICE- One to Three Weeks before Death

  • Your loved one will sleep much of the time.
  • Call your loved one by their name and identify yourself to them even if they seem to be asleep.
  • Always let them know what you are doing prior to providing care: “I’m going to turn you on your side.”
  • Sit by them and remind them that they are not alone.
  • Breathing is not as deep and may be irregular. (The patient may appear not to breathe for short periods of time during sleep or rest.)
  • Blood pressure continues to lower. The patient may get dizzy upon sitting or standing.
  • The patient may experience increased or decreased pulse; drenching sweats, with or without fever; cooling of the arms and legs; changes in skin color (pale, yellow or bluish around lips, ears and nails); decreased control of bowels and bladder; increasing or decreasing pain; difficulty swallowing; refusal to eat or drink.
  • Offer food and drink but do not force it.
  • Offer food that doesn’t require chewing, such as high-protein drinks to maintain your loved one’s strength.
  • Offer small amounts of food, and encourage them to eat and drink slowly.
  • If they cannot swallow, use moistened swabs or small ice chips to keep their mouth and lips comfortable.
  • Thicken liquids with a thickening agent, which can be found at the pharmacy. This can make your loved one less likely to choke on the liquid.
  • Help them to sit upright while eating or drinking to decrease choking.
  • Try using a lidded cup or a dropper. Avoid straws — they can cause your loved one to swallow air.
  • Give them permission to not eat or drink if they don’t want to. Sometimes they may force themselves to eat to satisfy loved ones, even if they don’t want to.
  • Continue to give comfort medications.
  • Skin color in arms, feet and legs may have splotches or mottled areas of reddish blue or purple.
  • May see or talk with people who have died (often relatives).

Fresno Hospice Care- One or Two Days before Death

  • Eyes may appear glassy.
  • Breathing and respiration changes.
  • Breathing may stop for 15 – 45 seconds.
  • Breathing may become loud and more irregular. Congestion may increase.
  • Turn them on their side so that secretions can drain from their mouth.
  • Remove the secretions from their mouth with a warm, wet washcloth or mouth sponge.
  • Keep their lips moist with lip balm.
  • Breathing may become very rapid or very slow.
  • Restlessness and picking at clothing or bedding may occur.
  • Reassure them that they are not alone.
  • Do not try to restrain them, except to keep them safe.
  • Try reading to them, playing soft music and talking to them about pleasant past experiences. Reassure them that it is all right for them to let go.
  • Try repositioning them in bed.
  • Change wet or soiled bedclothes and linens.
  • Agitation can be caused by pain, so continue to give pain and comfort medications.
  • Mottling or splotches moves from feet upward toward body.
  • May continue to have contact with spiritual world.
  • May speak in riddles or of events to come.
  • May ask to go “home.”

Signs of Imminent Death:

  • Their lips, hands and feet may be bluish in color.
  • Their arms, legs and feet may appear mottled.
  • Their hands and feet may be cold to the touch.
  • Their eyes may have a fixed, glassy stare.
  • They may be breathing through their mouth with long pauses between their breaths.
  • They may not respond to your voice.