Recognizing the signs: What to expect as a loved one nears the end of life

(Aging Untold) — Planning for the future often means avoiding conversations about death, but understanding the physical signs of end-of-life can help families navigate one of life’s most difficult moments.

A 2024 AARP study found that seven in 10 seniors generally avoid the subject of end-of-life discussions.

“Recognizing when a loved one is entering the final stage of life can be difficult,” Katherine Ambrose, an aging-well coach, said.

Physical changes signal the body’s final stage

Dr. Rhea Rogers, a board-certified physician, said the body conserves energy as it nears death.

“The energy is gone,” Rogers said. “So you start to see different signs of energy conservation.”

Those signs include fatigue, withdrawal, decreased appetite and mental changes, Rogers said.

Sam Cradduck, a gerontologist, has been present at more than 100 deaths through hospice care work.

Families, she said, often mistake normal end-of-life signs for medical emergencies.

“The hardest part really isn’t that death is coming, is it?” Cradduck said. “Nobody is taking the time to teach the family what death is going to look like.”

Ambrose said everyone who is working with the patient and the family should do their best to explain what is going on.

Common end-of-life symptoms

Families should expect their loved one to sleep more and stop eating, she said, and forcing nutrition is unnecessary because the body no longer needs it at that stage.

But she urged family members to use a swab to keep the person’s mouth moist.

Fluid buildup in the lungs can cause what is known as a death rattle, but hospice agencies manage that symptom and dry secretions, Cradduck said.

Mottling, a discoloration of the skin on the extremities, can disturb families, she warned.

It happens as the cardiovascular system slows and sends blood to vital organs instead of limbs.

“Those things are hard to see because your flesh is literally turning a color,” Cradduck said.

Rogers said the blood flow redirects to vital organs as a last resort.

Communication remains important

Amy O’Rourke, an aging expert, addressed how the family communicates with the person who is dying.

She said families should continue talking to their loved one, even without expecting a response.

“I go on the assumption that they can hear you,” O’Rourke said. “And anything that you want to say, any comforting.”

Rogers said hearing is the last sense to go, so talk to your loved one and let them know it’s OK.

O’Rourke recalled one person who did not know what to say, and he was shocked when she suggested saying goodbye.

“Don’t say foolish things in the room because they’re not conscious because they are able to still hear most of the time,” Cradduck said.

Understanding rallying and terminal agitation

Cradduck said families can be disturbed when a dying person rallies, showing a sudden burst of energy during active dying.

“The family finds hope in that,” Cradduck said. “And that is really just that last big energy burst.”

Terminal agitation, when a person appears unsettled, is less common but can indicate pain, constipation or urinary retention, Cradduck said.

“Work really close with your hospice nurse,” Cradduck said. “Ask all the questions. ... Don’t think that any question you have is dumb.”

O’Rourke addressed the feelings family members might have if they were not present when their loved one died.

She said families should not feel guilty if their loved one dies when they are out of the room.

“I’ve heard that said, ‘Oh my gosh, I should never have left. I should never have. But, if you’re a mom and you don’t want your daughter to be there when you die, you’ve made that decision,” O’Rourke said.

She said she likes to provide that comfort.

“Wherever you were when they died, they made that decision themselves,” O’Rourke said.

The dying person is doing inner work to prepare, she said.

“They’re preparing their soul and their inner being to leave the world. You need to let them go,” O’Rourke said.