End-of-life symptoms include physical and mental changes that indicate the body is shutting down. As organ systems prepare to shut down, circulation, blood pressure, and fluctuations in body temperature cause changes in the dying person's appearance. A withdrawal from previously enjoyed activities is common. It is usually during this period of withdrawal that a person mentally prepares for death.
Adopting a calm and reflective attitude is common during the last months or weeks of life. In some cases, the dying person may become depressed. End-of-life symptoms may also include a desire to contact lost friends or loved ones to repair previously damaged relationships.
Loss of appetite is also among the symptoms of the end of life. As the body prepares for death, it stops processing nutrients properly, and eating can cause discomfort. Ice chips and light fluids can be offered during this time, but the decision to eat and drink should be left to the dying person. Shortly before death, some terminally ill people have a burst of hunger and may request favorite foods that they previously lost interest in eating.
From a couple of weeks to a few days before death, the person who is dying may sleep much more than he or she had previously slept. The body is using what energy it has left to allow the person to rest. An energy burst a few days before death is a common occurrence. During this time, the dying person may become talkative and possess more physical energy than in previous weeks.
End-of-life symptoms typically include a cooling of the skin on the extremities of the dying person. Loved ones often notice this when holding the dying person's hand or stroking their arm during the last days and hours of life. Cooled skin temperature is caused by reduced blood pressure, which in turn reduces circulation to the hands and feet. Slippers can be offered to warm the feet. Hands can be kept under a sheet or blanket.
Cheyne-Stokes respiration occurs a few hours before death. This breathing involves short, rapid breaths followed by long intervals of no breathing. As fluids build up in the lungs, the terminally ill patient may cough. This is sometimes called a sonic cough because of its rattling sound. It does not mean that the dying person is uncomfortable; however, if listening is stressful for loved ones, there are several medications that will reduce its frequency.
Changes in skin color are typical symptoms of the end of life. A gray shade replaces normal skin tones. Also, mottled patches may be present on the extremities. Such symptoms do not cause discomfort.
Shortly before death, the dying person may experience pleasant sights and hallucinatory sounds. Such hallucinations are common end-of-life symptoms and real to the person who has them. In other cases, he or she hallucinates that people are trying to cause harm.
After death, breathing has ceased and the eyes are partially open. The mouth can be relaxed and open. The skin is cool to the touch.