Loss and Grief - Signs of Death

Family Caregiving September 23, 2015 Print Friendly and PDF

Physical Signs of Death

People who are close to death might signal that the end is near in a variety of ways. The dying process evolves over time with some physical signs that death is near including:

  • Breathing changes. The dying person’s breath may become irregular, speeding up and then slowing down. The breath may pause before starting again, or become very faint and quiet.
  • Difficulty swallowing. If the dying person begins to have difficulty swallowing, fluids should not be forced, but the mouth may be moistened with a damp sponge.
  • Disorientation. The dying person might not recognize family and friends, or might confuse them with one another. He might be confused about time and place or make restless, repetitive motions, such as pulling at bed linens or clothing. Don’t try to prevent him from doing these things, but you may calm him with a loving touch, a gentle voice, a passage from a favorite book, or a soothing song.
  • Loss of bowel and bladder control. Urine becomes more concentrated and what little there is might appear tea colored.
  • Gurgling or rattling sounds. Sometimes mucus appears in the mouth, throat and lungs. Air flowing past the mucus might make a gurgling or rattling sound. The noise can sometimes be reduced by turning the person on her side.
  • Cold extremities. The dying person’s hands and feet, and eventually, legs and arms, often become cool to the touch. Circulation in the extremities is decreasing as blood is reserved for the most vital organs.
  • Sleepiness. As the body’s metabolism slows, dying people spend more and more time sleeping, appearing unresponsive and difficult to wake. Be gentle and speak in a normal tone of voice. Keep in mind that a dying person often continues to hear even after the other senses have stopped working.

People who are close to death might ramble or say things that seem confused or jumbled. Listen closely to what is said as the messages they are trying to convey just before dying are often of great importance. Maggie Callanan and Patricia Kelley, nurses who have written an excellent book on this topic, say that dying people might express themselves through unusual behavior, symbolic language, or words that seem out of context. Sometimes dying people talk about specific destinations, the need to prepare for travel, or reconciling with a loved one.

Advice for Caregivers

Callanan and Kelley offer this advice:

  • Pay close attention to what the dying person says and does. Discuss with other family members and friends the loved one’s comments and gestures.
  • Accept what a dying person says or does. If he says, “I see a beautiful place!” you might respond by saying: “That’s wonderful. Tell me what it’s like.”
  • Ask open-ended questions in an encouraging manner. If the person alludes to visiting his dead mother, you might say: “I’m glad you feel close to her. Can you tell me more?”
  • Remember that a dying person might recall images or use language that reflects experiences from his life. For example, a former pilot might talk about getting ready for take off. You might ask: “When will the plane leave?” Or: “Is there anything I can do to help you get ready?”
  • Don’t ask too many questions or express frustration or failure if your attempts at conversation don’t work. Helpful responses may include: “It's okay. We can try talking again later.” Or: “Let me think for awhile about what you’ve said.” Sometimes it’s best simply to touch the dying person’s hand, or smile and stroke her forehead.
  • Using soothing music or soft music that the individual likes can have a calming effect and help the person relax.

Many families involve hospice programs to help make their special person more comfortable and assist the family during the dying process. For information about hospice see http://www.americanhospice.org to connect with a hospice near you and to learn more about their services and supports.

For more information, see

  • Final Gifts: Understanding the Special Awareness, Needs and Communications of the Dying (1992) by Maggie Callanan and Patricia Kelley
  • On Death and Dying (1969) by Elisabeth Kubler-Ross

Adapted with permission from GriefWorks, Sam Quick, Professor Emeritus, Human Development and Family Relations Specialist, Kentucky Cooperative Extension Service.



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This work is supported by the USDA National Institute of Food and Agriculture, New Technologies for Ag Extension project.