14 Top Signs That Death Is Near

14 Top Signs That Death Is Near

14 Top Signs That Death Is Near; Death is a subject many people do not like to discuss, but it’s a part of life that we will all have to face. Sometimes the more you know about a certain subject, the less frightening it becomes.


Each person’s journey to death is unique. Some people have a very gradual decline; others will fade quickly.

As death approaches, your role is to be present, provide comfort, and reassure your loved one with soothing words and actions that help maintain their comfort and dignity.

There are numerous causes of death, many of which are instant. For people who know death is approaching — whether from sickness or old age — there are certain signs. These signs range from different categories of ailments. But before going into the categories of signs that death is near, let us talk of Hospice Care which is a place of care for people of life terminal stage when pronounced by health care experts.



14 Top Signs That Death Is Near

Hospice Care

When your loved one’s health care team recognizes that he or she is likely within 6 months of dying, they may recommend switching to hospice, a more specialized care for people with a terminal illness who are expected to die.

Your loved one will still get treatment for pain relief and comfort, but hospice also offers emotional and spiritual support for them as well as you and close family.


Signs That Death Is Near

There are changes you can expect to see as an adult body stops working. These are a normal part of dying.

Children and teens have a similar process, but it can be harder to predict. They often stay fairly active and continue to ask a lot of tough-to-answer questions.



14 Top Signs That Death Is Near

The categories of signs that death is near include:

  1. Cardiovascular and Circulation Changes
  2. Function of the Urinary
  3. Foods and Fluids
  4. Skin
  5. Respiratory
  6. General Changes


Please note that it doesn’t necessarily mean that the person is dying when these symptoms are experienced. It is best to consult the doctor to get advice and to know what to expect when these signs and symptoms are present.


Signs That Death is Near

Physiological Changes

Signs and Symptoms


Cardiovascular and Circulation Changes

Decreased blood perfusion Skin may become mottled and discolored. Mottling and cyanosis of the upper extremities appear to indicate impending death versus such changes in the lower extremities. Provide good skin care. Turn patient every 2-3 hours if this does not cause discomfort. Lotion to back and extremities. Support extremities with soft pillows.
Decreased cerebral perfusion Decreased level of consciousness or terminal delirium.
Orient patient gently if tolerated and this is not upsetting. Allow pt. to rest.
Decrease in cardiac output and intravascular volume Tachycardia
Central and peripheral cyanosis and peripheral cooling.
Comfort measures. Space out activities.

Urinary output

Decreased urinary output Possible urinary incontinence.
Concentrated urine.
Keep patient clean and dry. Place a Foley if skin starts to break down or if patient is large and difficult to change diapers or if caregiver unable to provide diaper and linen changes.

Foods and Fluids

Decreased interest in food and fluid. Weight loss/dehydration Do not force fluid or foods.
Provide excellent mouth care.
Swallowing difficulties Food pocketed in cheeks or mouth/choking with eating/coughing after eating Soft foods and thickened fluids (e.g. nectar) as tolerated. Stop feeding patient if choking or pocketing food.


Skin may become mottled or discolored. Patches of purplish or dark pinkish color can be noted on back and posterior arms/legs. Keep sheets clean and dry-avoid paper chux directly to skin. Apply lotion as tolerated.
Decubitus ulcers may develop from pressure of being bedbound, decreased nutritional status. Red spots to bony prominences are first signs of Stage I decubiti and open sores may develop. Relieve pressure to bony prominences or other areas of breakdown with turning and positioning Q2 hrs if tolerated. If patient has increased pain or discomfort with position changes, decrease the frequency.
Special mattress as needed.
Duoderm or specialized skin patch to Stage I-II ulcers. Change Q5-7 days or as needed. Goals of wound care for Stage III and IV decubiti should be to promote comfort and prevent worsening rather than healing since healing most likely will not occur.Consider application of specialized products such as charcoal or metronidazole paste (compounded) if odors are present.

Respiratory tract

Retention of secretions in the pharynx and the upper respiratory tract. Noisy respirations – usually no cough or weak cough. Head of bed up at 45 degrees. Can fold small soft pillow or towel behind neck for extra support.


Shortness of breath Oxygen at 2-3 liters may help for some patients and often helps families to feel better.
Cheyne-Stokes respirations



Notable changes in breathing. A gentle fan blowing toward the patient may provide relief.
Educate families that this is normal as the patient is dying.

General changes

Profound weakness and fatigue. Drowsy for extended periods. Sleeping more. This is normal. Educate family.
Disoriented with respect to time and a severely limited attention span. More withdrawn and detached from surroundings. May appear to be in a comatose-like state. This is normal. Educate family.
Patient may speak to persons who have already died or see places others cannot see. Family may think these are hallucinations or a drug reaction. If patient appears frightened may need to treat with medication. Otherwise, educate family that this is normal and common.




14 Top Signs That Death Is Near

Help and Support

Caregivers, families, and friends of someone who is dying can turn to any caregiver organization in the country or Hospice.

In America, the following are available to run to:

  • Family Caregiver Alliance
  • Hospice Foundation of America
  • National Caregivers Library
  • National Hospice and Palliative Care Organization





Sources and References:

, I. Dying Well, Riverside Books, 1997.

Hospice Foundation of America. The Dying Process: A Guide for Caregivers, revised, 2007.

Karnes, B. Gone From My Sight: The Dying Experience, Barbara Karnes Books Inc., 1986.

Lynn, J. Handbook for Mortals, Oxford University Press, 1999.

Hallenbeck, J. Journal of the American Medical Association, May 11, 2005.

Lynn, J. Annals of Internal Medicine, Jan. 15, 1997.

Morrison, S.R. New England Journal of Medicine, June 17, 2004.

Ohio Hospice and Palliative Care Organization. Choices: Living Well at the End of Life, 4th ed., 2004.



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