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Caring for a loved one through the final stage of life is never easy. Whether you carry all the responsibility or just want to be there for them, you probably wonder what to expect.

Getting familiar with end-of-life symptoms in older adults can help you understand what your loved one may be experiencing, and promote a smooth transition for everyone.

Everyone is different, so you shouldn’t expect to see all these end-of-life signs. Also, your loved one will progress at their own pace, which could be significantly fast or slow.

Weeks before end of life

Some of the earliest signs have to do with a sense of resignation. That may involve low mood, lack of motivation, and withdrawal. The person may spend more time reminiscing about their childhood and earlier life experiences.

Loss of appetite, general weakness, and increasing fatigue become noticeable.

Days before end of life

Your loved one will likely sleep more than they’re awake. They’ll move and talk less and may not respond to conversation or commotion. Their sense of hearing is most likely unchanged, but vision may be impaired.

Other signs in the final days may include:

  • drop in blood pressure, heart rate, and body temperature
  • labored breathing
  • difficulty swallowing
  • refusing food
  • no more bowel movements or urination
  • hallucinations, illusions, or delusions

Some people experience a certain amount of restlessness or have a burst of energy.

Hours before end of life

Signs that the body is actively shutting down are:

  • abnormal breathing and longer space between breaths (Cheyne-Stokes breathing)
  • noisy breathing
  • glassy eyes
  • cold extremities
  • purple, gray, pale, or blotchy skin on knees, feet, and hands
  • weak pulse
  • changes in consciousness, sudden outbursts, unresponsiveness

It’s thought that hearing is the last sense to fade. Even when unconscious, your loved one can probably still hear you.

At death

At the moment of death, breathing stops and there’s no pulse or measurable blood pressure. If the eyes remain open, pupils will be dilated.

As the muscles of the body relax, the bowels and bladder empty. As blood settles, the skin starts to look pale and waxy.

After death, you may still see tears falling from the eyes or small movements of the arms, legs, or voice box.

1. Appetite and digestive changes

As one nears the end of life, metabolism and digestion gradually slow down. Fewer calories are needed, so loss of appetite and decreased thirst are normal.

Trouble swallowing, nausea, and constipation can also interfere with appetite. There might be weight loss and signs of dehydration.

2. Sleeping more

Generalized weakness and fatigue are common. Energy levels wane and time spent sleeping increases.

3. Withdrawal from the world

You might notice a sense of resignation and withdrawal from the larger world. The person may create a protective bubble of fewer people and less curiosity about events outside the bubble. They might spend more time talking about the past than the present.

4. Anxiety and depression

As the end of life becomes apparent, some people experience a growing fear or worry for themselves or for those who will be left behind. End-of-life anxiety and depression aren’t uncommon.

5. Urinary and bladder incontinence

As the kidneys begin to fail, urine can become more concentrated and darker in color. Both bladder and bowel functions get harder to control.

6. Changing vital signs

Heart rate, body temperature, and blood pressure begin dropping. With reduced circulation, the hands, arms, feet, and legs start to feel cool to the touch. The skin may turn dark blue, purple, or appear mottled.

7. Confusion

Your loved one may be periodically confused. Time, place, and even close loved ones may be difficult to identify. You might note a limited attention span or repetitive motions like pulling at sheets or tugging at clothing.

8. Sensory changes

Eyesight is weakening. Someone nearing death may see, hear, or feel things that you don’t, even speaking to others who have died. Sensory changes can also lead to illusions, hallucinations, and delusions.

9. Saying goodbye

If alert to what’s happening, some people want to participate in funeral planning, putting affairs in order, or distributing possessions. They may feel a sense of urgency in clearing up loose ends, expressing feelings, and saying goodbye.

10. Breathing changes

Breathing grows increasingly slow and shallow with periods of shortness of breath. Fluid can collect in the throat as throat muscles relax. The person may be too weak to clear it by coughing, which can lead to noisy breathing known as a “death rattle.”

11. Loss of consciousness

Waking your loved one can become difficult. Eventually, they’ll be uncommunicative and unresponsive, losing consciousness or falling into delirium. Eyes may develop a glassy appearance.

Your doctor will advise you on how to provide physical comfort based on their medical conditions. This may include administering medications for such things as pain, digestive issues, or anxiety.

Providing physical comfort

Whether or not you have professional caregivers or hospice care, there are some basic ways you can provide physical comfort:

  • Use a humidifier to aid breathing.
  • Apply lip balm and alcohol-free lotion to soothe dry skin.
  • Help them stay hydrated with ice chips or applying a wet washcloth to the lips.
  • Change positioning every few hours to prevent bedsores.
  • Provide comfy bedding and refresh as necessary.
  • Prepare soft foods, but don’t force a person to eat.
  • Use low lighting and block out loud or distracting sounds.
  • Let them sleep when they want to.

Proving emotional comfort

To help provide emotional and spiritual support:

  • Encourage conversation if they’re up for it. Let them lead, be a good listener, and avoid initiating potentially stressful topics.
  • Even if they don’t respond, assume they hear you. Speak directly to them rather than about them. Identify yourself when you enter or leave the room.
  • Provide light physical contact by holding their hand or placing a hand on their shoulder.
  • Play their favorite music at low volume.
  • Don’t ignore, interrupt, or dismiss their thought process. Remain calm if they’re confused. If they’re talking to or seeing someone who isn’t there, let them be.
  • Express your love.
  • Don’t deny reality. If they want to say goodbye, let them. It can provide you both with peace of mind.

Think about your loved one’s spiritual needs. Consider bringing in an appropriate spiritual advisor, social worker, or end-of-life doula.

Letting go is not easy. Learning about elderly end-of-life symptoms can help you provide the physical and emotional support your loved one needs as they transition.

Once your loved one has passed, allow yourself time to grieve, take care of yourself, and reach out for help if you need it.