Family members look to the physician and nurse to help them know what to expect when a loved one is dying. Indicate your desire to help by asking the family if they would like to know what to expect. If they say yes, the following list may be helpful.
1. Social withdrawal is normal for the dying patient as they become less concerned about their surroundings. Separation begins first from world affairs, then from people generally, and finally from the patient's most-loved family members and friends. There is less need to communicate with others.
2. The patient will have a decreased need for food and drink as the body is preparing to die. This is one of the hardest things for some family to accept. There decrease in interest in eating and appetite is gradual; it may come and go. Liquids are preferred to solid food.
3. The patient will spend more and more time sleeping; it may be difficult for them to keep their eyes open. One consequence of disease may be a change in the body’s metabolism.
4. The patient may become confused about time, place, and the identity of people around them. They may see people who are not there, such as family members who have already died. Sometimes they describe welcoming or beckoning. The patient may not be distressed, and there is no need to correct them.
5. The patient may become restless and pull at the bed linens; these symptoms are also due to a change in the body’s metabolism.
6. Clarity of hearing and vision may decrease. Soft lights in the room may prevent visual misinterpretations. Never assume that the patient cannot hear, as hearing is the last sense to be lost.
7. Incontinence of urine and bowel movements is often not a problem until death is very near. The amount of urine will decrease and the urine become darker as death approaches.
8. Physical changes as death approaches.
- Blood pressure decreases; the pulse may increase or decrease.
- Body temperature can fluctuate; fever is common.
- The skin color changes: it may become flushed with fever, or bluish with cold. A pale yellowish pallor often accompanies approaching death.
- Respirations may increase, decrease, or become irregular. Periods of no breathing (apnea) are common.
- Congestion may present as a rattling sound in the lungs and/or upper throat. This occurs because the patient is too weak to cough or clear the throat.
- Arms and legs may become cool to the touch; the hands and feet may become purplish; the knees, ankles, and elbows may be blotchy. These symptoms are a result of decreased circulation.
- The patient will enter a coma before death and not respond to verbal or tactile stimuli.

How to know that death has occurred
- No breathing or heartbeat.
- Loss of control of bowel or bladder.
- No response to verbal commands or gentle shaking.
- Eyelids slightly open; eyes fixed on a certain spot.
- Jaw relaxed and mouth slightly open.

See reference for more information.

Adapted from von Gunten CF. Teaching the family what to expect when the patient is dying. Palliative Care Network of Wisconsin. Fast facts and concepts #149. Internet. Accessed on December 27, 2019.