Physical support

The dying person has less energy, and often they may spend most of the day sleeping or resting. They may still be conscious and able to hear, but have their eyes closed and not be moving.

As the body slows down, it uses less energy and the person doesn’t need to eat or drink as much. They may resist or refuse food or drink. Giving the person fluids at this time does not help them, but you can offer slivers of ice or sips of water.

The dying person may gradually lose interest in people nearby. They may find it hard to concentrate and they may stop talking. Withdrawing is part of letting go. Near the end, some people have a sudden burst of alertness.

Breathing may become irregular, laboured, noisy and rattly. You may hear an irregular breathing pattern known as Cheyne-Stokes. This is a loud, deep breath followed by a long pause (which may last from 5 seconds to as long as a minute), before a loud, deep breath starts again.

If mucus builds up in the throat, it can create loud, gurgling sounds, which some people call a “death rattle”. Medicines can help dry up any mucus or you can try changing the person’s position in the bed, or playing music softly to distract from the sound. Listening to this change in breathing pattern can be upsetting, but many health professionals believe this is not painful for the person.

As a person eats and drinks less, they produce less urine and faeces (pee and poo). As the body’s systems slow down, the person may have trouble weeing. A catheter may be inserted into the bladder to drain urine. Medicines may be prescribed for constipation, a common side effect of some pain medicines. Loss of bladder and bowel control sometimes happens in the last stages of the dying process, but does not always happen. Speak with your healthcare or palliative care team to help you manage any incontinence.

Carers are often unprepared for the person becoming disoriented and confused. This is known as delirium. It can involve:

• a lower level of consciousness
• memory loss
• hallucinations (seeing or hearing things and people that aren’t actually there)
• delusions (false beliefs or ideas)
• mood swings
• sleep disturbances. 

A person who is dying may not be aware of where they are or who else is in the room, may speak or reply less often, or may respond to people who can’t be seen by others. The person may drift in and out of consciousness and eventually become unresponsive.

Speak to the palliative care team if you notice any of these changes, so they can advise you on managing delirium.

Delirium may occur when waste chemicals (toxins) build up in the brain as vital organs begin to shut down. It can also have a range of other causes, such as fever or constipation, and these can be treated.

These symptoms are part of delirium and may include agitation, anxiety, anguish and anger, all of which can be very distressing for carers to see. These symptoms (sometimes called terminal restlessness) are common and not necessarily uncomfortable for the dying person.

This can happen if the person is dehydrated or has been breathing through their mouth, or it may be due to some medicines. You can prevent this with regular mouth care, which your healthcare or palliative care team can teach you.

As circulation slows, the hands, feet, fingers and toes (extremities) become cooler and may turn a bluish colour. It’s thought that the person will be unaware of feeling cold.

Apply lip balm and keep the mouth moist with ice cubes or swabs. Use a vaporiser in the room to help with breathing. Put incontinence sheets or pads under the bedsheets. Keep the person warm with a blanket and use cushions so they are comfortable. Help them change positions often. A nurse or occupational therapist can show you suitable positions. 

Sit with the person and talk or hold their hand. Often just being there is all that is needed so that they don’t feel alone. Gently massage their hands or feet with a non-alcohol-based lotion. Speak gently, and occasionally remind the person of the time, place and who is with them. Don’t force-feed them even though you may be distressed by their loss of interest in eating.

Use soft lighting. Have their favourite music playing in the background to create a gentle and peaceful atmosphere. Quietly read a favourite poem, passage fUse soft lighting. Have their favourite music playing in the background to create a gentle and peaceful atmosphere. Quietly read a favourite poem, passage from a book, or spiritual or religious textrom a book, or spiritual or religious text.