The Final Stages of Life

What To Expect and How To Respond

Table of Contents

Loss of Appetite

Loss of appetite is a common symptom in the final stages of life and can be caused by a variety of factors, including physical discomfort or pain, changes in metabolism, and the side effects of medications. It’s important to remember that the person’s appetite may fluctuate during this time and that it’s normal for their intake of food and fluids to decrease as they near the end of life.

If the person is experiencing a loss of appetite, it’s important to try to identify any underlying causes and address them as appropriate. This may involve adjusting medications, providing comfort measures, and addressing any physical or emotional issues that may be contributing to the loss of appetite.

It’s also important to remember that the person’s nutritional needs may change during this time, and they may require additional support to meet those needs. This may include offering small, frequent meals and snacks, providing nourishing liquids such as broth or smoothies, and using supplements as needed.

The hospice team can work with the person and their loved ones to develop a plan to manage the loss of appetite and ensure that the person is as comfortable as possible. It’s also important to respect the person’s wishes and preferences and allow them to make decisions about their care and treatment.

What can be done for the patient:

If the person is experiencing a loss of appetite, there are several steps that can be taken to manage this symptom and ensure that the person is as comfortable as possible:

  1. Identify and address any underlying causes: It’s important to try to identify any underlying causes of the person’s loss of appetite and address them as appropriate. This may involve adjusting medications, providing comfort measures, and addressing any physical or emotional issues that may be contributing to the loss of appetite.
  2. Offer small, frequent meals and snacks: It can be helpful to offer the person small, frequent meals and snacks rather than larger, less frequent meals. This can make it easier for them to eat and help maintain their nutritional status.
  3. Provide nourishing liquids: If the person is having difficulty swallowing or is unable to eat solid food, it can be helpful to offer nourishing liquids such as broth or smoothies.
  4. Use supplements as needed: If the person is unable to meet their nutritional needs through food and drink alone, the hospice team may recommend supplements to help maintain their nutritional status.
  5. Respect the person’s wishes and preferences: It’s important to respect the person’s wishes and preferences and allow them to make decisions about their care and treatment.

Withdrawal from the external world

Withdrawal from the external world is a common experience for people who are approaching the end of life. As the body begins to shut down, a person may become less interested in their surroundings and may have less energy and desire to interact with others. This process is sometimes referred to as “withdrawing” or “withdrawing from life.”

There are several reasons why people may withdraw from the external world as they approach the end of life:

  1. Physical changes: Physical changes that occur as the body begins to shut down can affect a person’s ability to engage with their surroundings. They may feel tired, weak, or uncomfortable, and may have difficulty communicating or interacting with others.
  2. Emotional and spiritual changes: As people approach the end of life, they may experience a range of emotional and spiritual changes. They may feel a sense of peace or acceptance, or they may have spiritual or existential questions or concerns. These changes may lead them to withdraw from the external world and focus inward.
  3. Changes in communication: Changes in communication can also contribute to withdrawal. A person may have difficulty speaking, writing, or understanding others, or may have changes in their level of consciousness.

What can be done for the patient:

If the person is experiencing withdrawal from the external world, there are several steps that can be taken to manage this symptom and ensure that the person is as comfortable as possible:

  1. Identify and address any underlying causes: It’s important to try to identify any underlying causes of the person’s withdrawal from the external world and address them as appropriate. This may involve adjusting medications, providing comfort measures, and addressing any physical or emotional issues that may be contributing to this symptom.
  2. Create a calm and peaceful environment: A calm and peaceful environment can help to reduce agitation and distress and may encourage the person to engage with the external world.
  3. Provide reassurance and support: It can be helpful to provide the person with reassurance and support, such as talking to them calmly and reassuring them that they are not alone.
  4. Use medications or other therapies as needed: The hospice team may recommend medications or other therapies, such as music therapy or art therapy, to help manage the person’s withdrawal from the external world.
  5. Respect the person’s wishes and preferences: It’s important to respect the person’s wishes and preferences and allow them to make decisions about their care and treatment.

Visions and Hallucinations

As people near the end of life, they may experience various physical and emotional symptoms. One of these symptoms can be visions and hallucinations, which are perceptions of things that are not actually present. These experiences can be distressing for both the person experiencing them and their loved ones, but they are also a normal part of the dying process and can often be managed with the help of a hospice team.

Visions and hallucinations can be caused by a variety of factors, including changes in brain chemistry, medications, and physical discomfort or pain. They can also result from delirium, a condition that can occur in the final stages of life and is characterized by confusion, disorientation, and changes in the person’s level of consciousness.

It’s important to remember that visions and hallucinations can have a variety of meanings and significance for the person experiencing them. They may represent unresolved issues or be a way for the person to communicate with loved ones. It can be helpful to ask the person about their visions and hallucinations and try to understand their significance to them.

If the person is experiencing visions and hallucinations that are causing distress or interfering with their quality of life, the hospice team can work with the person and their loved ones to manage these symptoms. This may include adjusting medications, providing comfort measures, and addressing any underlying physical or emotional issues.

What can be done for the patient:

If the person is experiencing visions and hallucinations, several steps can be taken to manage these symptoms and ensure that the person is as comfortable as possible:

  1. Identify and address any underlying causes: It’s important to try to identify any underlying causes of the person’s visions and hallucinations and address them as appropriate. This may involve adjusting medications, providing comfort measures, and addressing any physical or emotional issues that may be contributing to these symptoms.
  2. Ask the person about their visions and hallucinations: It can be helpful to ask the person about their visions and hallucinations and try to understand their significance to them.
  3. Create a calm and quiet environment: A calm and quiet environment can help to reduce agitation and distress, which can, in turn, help to reduce the frequency and intensity of visions and hallucinations.
  4. Use medications or other therapies as needed: The hospice team may recommend medications or other therapies, such as music therapy or art therapy, to help manage the person’s visions and hallucinations.
  5. Respect the person’s wishes and preferences: It’s important to respect the person’s wishes and preferences and allow them to make decisions about their care and treatment.

Confusion, Restlessness, and Agitation

Confusion, restlessness, and agitation are common symptoms in the final stages of life and can be caused by a variety of factors, including changes in the person’s brain chemistry, medications, physical discomfort or pain, and delirium. Delirium is a condition that can occur in the final stages of life and is characterized by confusion, disorientation, and changes in the person’s level of consciousness.

If the person is experiencing confusion, restlessness, and agitation, it’s important to try to identify any underlying causes and address them as appropriate. This may involve adjusting medications, providing comfort measures, and addressing any physical or emotional issues that may be contributing to these symptoms.

The hospice team can also work with the person and their loved ones to develop a plan to manage these symptoms and ensure that the person is as comfortable as possible. This may include creating a calm and quiet environment, providing reassurance and support, and using medications or other therapies as needed.

It’s important to remember that everyone’s experience of the end of life is unique, and confusion, restlessness, and agitation are just one potential aspect of this experience. The hospice team can provide support and guidance to help manage any symptoms and ensure that the person is comfortable and as free from distress as possible.

What can be done for the patient:

 

If the person is experiencing confusion, restlessness, and agitation, there are several steps that can be taken to manage these symptoms and ensure that the person is as comfortable as possible:

  1. Identify and address any underlying causes: It’s important to try to identify any underlying causes of the person’s confusion, restlessness, and agitation and address them as appropriate. This may involve adjusting medications, providing comfort measures, and addressing any physical or emotional issues that may be contributing to these symptoms.

  2. Create a calm and quiet environment: A calm and quiet environment can help to reduce agitation and distress. This may involve reducing noise and light levels and limiting the number of people in the room.

  3. Provide reassurance and support: It can be helpful to provide the person with reassurance and support, such as talking to them calmly and reassuring them that they are not alone.

  4. Use medications or other therapies as needed: The hospice team may recommend medications or other therapies, such as music therapy or massage, to help manage the person’s confusion, restlessness, and agitation.

  5. Respect the person’s wishes and preferences: It’s important to respect the person’s wishes and preferences and allow them to make decisions about their care and treatment.

Changes in Breathing, Congestion in Lungs or Throat

The final stages of life Changes in Breathing, Congestion in Lungs or Throat

Changes in breathing, congestion in the lungs or throat, and shortness of breath are common symptoms in the final stages of life and can be caused by a variety of factors, including changes in the person’s metabolism, medications, physical discomfort or pain, and underlying health conditions such as lung disease or heart failure. These symptoms can be distressing for both the person experiencing them and their loved ones, but they can often be managed with the help of a hospice team.

If the person is experiencing changes in breathing, congestion in the lungs or throat, or shortness of breath, it’s important to try to identify any underlying causes and address them as appropriate. This may involve adjusting medications, providing comfort measures, and addressing any physical or emotional issues that may be contributing to these symptoms.

The hospice team can also work with the person and their loved ones to develop a plan to manage these symptoms and ensure that the person is as comfortable as possible. This may include using oxygen therapy, providing medications to help with congestion or shortness of breath, and positioning the person in a way that helps them breathe more easily.

What can be done for the patient:

 

If the person is experiencing changes in breathing, congestion in the lungs or throat, or shortness of breath, there are several steps that can be taken to manage these symptoms and ensure that the person is as comfortable as possible:

  1. Identify and address any underlying causes: It’s important to try to identify any underlying causes of the person’s breathing symptoms and address them as appropriate. This may involve adjusting medications, providing comfort measures, and addressing any physical or emotional issues that may be contributing to these symptoms.
  2. Use oxygen therapy: Oxygen therapy can help to increase the amount of oxygen in the person’s bloodstream and can be administered through a variety of methods, including a nasal cannula or face mask.
  3. Use medications to help with congestion or shortness of breath: The hospice team may recommend medications such as bronchodilators or corticosteroids to help reduce congestion and improve breathing.
  4. Position the person in a way that helps them breathe more easily: Changing the person’s position or using pillows to prop them up can help to improve their breathing and reduce shortness of breath.
  5. Create a calm and quiet environment: A calm and quiet environment can help to reduce agitation and distress, which can in turn help to improve the person’s breathing.

Change in Bowel and Bladder Functions

Changes in bowel and bladder functions are common in the final stages of life and can be caused by a variety of factors, including changes in the person’s metabolism, medications, and physical discomfort or pain. These changes can be distressing for both the person experiencing them and their loved ones, but they can often be managed with the help of a hospice team.

If the person is experiencing changes in bowel and bladder functions, it’s important to try to identify any underlying causes and address them as appropriate. This may involve adjusting medications, providing comfort measures, and addressing any physical or emotional issues that may be contributing to the changes.

The hospice team can also work with the person and their loved ones to develop a plan to manage these symptoms and ensure that the person is as comfortable as possible. This may include using incontinence products, assisting with hygiene, and making sure that the person is well-hydrated.

What can be done for the patient:

 If the person is experiencing changes in bowel and bladder functions, there are several steps that can be taken to manage these symptoms and ensure that the person is as comfortable as possible:

  1. Identify and address any underlying causes: It’s important to try to identify any underlying causes of the person’s changes in bowel and bladder functions and address them as appropriate. This may involve adjusting medications, providing comfort measures, and addressing any physical or emotional issues that may be contributing to these symptoms.
  2. Use incontinence products: Incontinence products, such as pads or briefs, can help to manage incontinence and keep the person clean and dry.
  3. Assist with hygiene: It can be helpful to assist the person with hygiene, such as helping them to use the toilet or bathing them as needed.
  4. Make sure the person is well-hydrated: Ensuring that the person is well-hydrated can help to prevent constipation and maintain bladder function.
  5. Respect the person’s wishes and preferences: It’s important to respect the person’s wishes and preferences and allow them to make decisions about their care and treatment.

Change in Skin Temperature and Color

As a person approaches the end of life, their body’s natural processes begin to shut down, which can cause changes in their skin temperature and color. These changes can be a normal part of the dying process and are often a result of decreased circulation and decreased production of hormones and other substances that regulate body functions.

One common change that may occur is a decrease in skin temperature, which can cause the skin to feel cool to the touch. This can be due to a decrease in circulation and a reduction in the body’s ability to regulate its own temperature.

Another common change that may occur is a change in skin color. The skin may become pale or take on a yellowish or bluish hue due to changes in circulation and oxygen levels in the body. The skin may also become mottled, which is a patchy appearance caused by changes in blood flow.

 What can be done for the patient:

 

The Final Stages of Life Change in Skin Temperature and Color what can be done

During the final stages of life, several things can be done to provide comfort and support to a person experiencing changes in skin temperature and color:

  1. Keep the person comfortable: Make sure the person is in a comfortable position, and provide additional blankets or pillows if needed to keep them warm.
  2. Provide emotional support: Offer emotional support and reassurance to the person during this difficult time. It can be helpful to listen to their concerns and allow them to express their feelings.
  3. Keep the person hydrated: Offer the person fluids, such as water, juice, or broth, to help keep them hydrated.
  4. Administer medications as prescribed: If the person is experiencing discomfort, medications may be prescribed to help manage their symptoms. It’s important to administer these medications as directed by a healthcare professional.
  5. Consult with a healthcare professional: If you have any concerns about the person’s care or their symptoms, it’s important to consult with a healthcare professional for guidance. They can provide advice on how to manage the person’s symptoms and provide additional support as needed.

Saying Goodbye

Saying goodbye to a loved one who is in the final stages of life can be a difficult and emotional experience. It’s natural to feel a range of emotions, including sadness, grief, and fear. Here are a few suggestions for saying goodbye during this time:

  1. Spend time with the person: It’s important to spend as much time as possible with the person and to make the most of the time you have left together. This can be a time to talk, share memories, or simply be present with the person.
  2. Express your feelings: It can be helpful to express your feelings to the person, whether it’s through words or simply through your presence. You might want to tell the person how much they mean to you or express any regrets you have about things you wish you had done differently.
  3. Say goodbye in your own way: There is no right or wrong way to say goodbye. What’s most important is that you find a way to express your feelings and say goodbye in a way that feels comfortable and meaningful to you. This might be through words, a hug, a kiss, or a touch.
  4. Consider seeking support: Saying goodbye to a loved one can be a challenging experience, and it’s important to take care of yourself during this time. It can be helpful to seek support from friends, family, or a mental health professional to help you cope with your emotions.


It’s important to remember that saying goodbye is a natural and important part of the dying process and can provide closure and a sense of peace for both the person who is dying and their loved ones.

Being Present at the Moment of Death

Being present at the moment of death can be a deeply emotional and meaningful experience for many people. It can provide a sense of closure and a chance to say goodbye to a loved one. Here are a few things to consider if you are present at the moment of death:

  1. Take care of yourself: Being present at the moment of death can be a physically and emotionally draining experience. It’s important to take care of yourself and to allow yourself time to rest and process your emotions.
  2. Focus on the person: The moment of death can be a time to focus on the person who is dying and to be present with them. You might want to hold their hand, talk to them, or simply be with them in silence.
  3. Share your feelings: It can be helpful to express your feelings to the person who is dying, whether it’s through words or simply through your presence. You might want to tell them how much they mean to you or express any regrets you have about things you wish you had done differently.
  4. Seek support: Saying goodbye to a loved one can be a challenging experience, and it’s important to take care of yourself during this time. It can be helpful to seek support from friends, family, or a mental health professional to help you cope with your emotions.

     

Everyone’s experience at the moment of death is unique and that there is no right or wrong way to be present. What’s most important is that you find a way to be with the person in a way that feels comfortable and meaningful to you.