End-of-Life Stages Timeline

The dying process usually begins well before death takes place. There are often signs 40 days (or more) before death where people move through end-of-life stages that follow a general timeline.

Being tuned in to the physical, mental, and emotional changes of your loved one can help you recognize the signs that they're dying. Knowing more about the end-of-life process may help you better prepare for what's to come.

This article explains a typical end-of-life timeline and what happens to someone mentally, behaviorally, and physically. While some people may follow this closely, not everyone experiences all stages and some may cycle through the stages far faster (even within days) or for months.

Signs: 40 to 90 Days Before Death

The dying process often comes into view about 40 to 90 days before death. Many of the experiences that take place at this first end-of-life stage are broadly common but the specifics can differ for each individual. A healthcare provider may be able to give you a sense of your loved one's expected timeline as they move through these stages.

Physical Changes

As the body starts to slow down, a dying person may have the following physical signs:

• Reduced appetite
• Reduced thirst
• Increased sleeping
• Weight loss
• Mild sense of happiness and well-being (euphoria) due to natural changes in body chemistry

The reduced appetite and weight loss can be alarming, but it helps to know your loved one isn't suffering in any way by not eating. Their energy needs decrease when they stop regular activities and start sleeping more.

As the body slows down to prepare for death, the metabolism slows down and requires less food. The digestive tract is also less active, which means a dying person won't feel hungry or thirsty.

Mental and Behavioral Changes

Social and cultural factors help shape a person's dying experience. For example, gender roles can be a factor.

Talking Openly About Death

Research suggests men are less likely than women to talk openly about their mortality and end-of-life wishes. One reason might be that men find it more difficult to ask for help and don't want to come across as "needy."

These differences aren't necessarily unique to one gender identity, though. Plenty of women struggle to talk about their deaths and don't want anyone to feel "burdened" by caring for them.

Religious and cultural backgrounds can influence how someone feels about the dying process. Depending on their beliefs, certain practices, rituals, and customs can be steps along the end-of-life timeline.

Withdrawal and Reflection

As they start to accept their mortality and realize death is approaching, they may start to withdraw. They're beginning the process of separating from the world and the people in it.

During this stage, your loved one may say no to visits from friends, neighbors, and even family. When they do accept visitors, it might be hard for them to interact. That may make you feel rejected, which is especially hard when you know your time with the person is limited.

This stage is also one of reflection. The dying person often thinks back over their life and revisits old memories. They might also be going over the things they regret.

Signs: 1 to 2 Weeks Before Death

The dying process starts to move faster in the last week or two of life. The acceleration can be frightening for loved ones.

As death approaches, you may want to "correct" them if they say things that don't make sense—but it's better not to. At this stage, it's better to listen to and support your loved one rather than to risk upsetting them or starting an argument.

For example, your loved one might say that they see or hear a person who died before them. In those moments, just let your loved one tell you about it.

You might feel frustrated because you can't know for sure whether they're hallucinating, having a spiritual experience, or just getting confused. The uncertainty can be unsettling, but it's part of the process.

Physical Changes

At this point in the end-of-life timeline, a dying person's body has a hard time maintaining itself. Your loved one may need help with just about any form of activity.

For example, they may have trouble swallowing medications or refuse to take them. If they have been taking pain medications, they may need liquid morphine now to manage pain.

During this end-of-life stage, signs that death is near include:

• Body temperature that's one or more degrees lower than normal
• Cold hands and feet 
• Lower blood pressure
• An irregular pulse that may slow down or speed up
• Increased sweating
• Skin color changes, with lips and nail beds that are pale, bluish, or, in people of color, purplish
• Breathing changes (e.g., a rattling sound and cough)
• Less or no talking
• Sudden arm or leg motions
• Constipation
• Incontinence
• Nausea
• Pain

Mental and Behavioral Changes

During this stage of the end-of-life timeline, people tend to:

• Sleep most of the time
• Become confused
• Have altered senses
• Experience delusions (fearing hidden enemies, feeling invincible)
• Continue or begin having hallucinations (seeing or speaking to people who aren't present or who have died)
• Become restless (pick at bedsheets or clothing, have aimless or senseless movements)

It can be hard for you to witness these changes, but it's important that you remain supportive.

Signs: Days to Hours Before Death

In their last days or hours, the dying person may go through several possible stages.

Surge of Energy

The last few days before death can surprise family members. At this stage, your loved one may have a sudden surge of energy. They may want to get out of bed, talk to loved ones, or eat after having no appetite for days or weeks.

You may take these actions as signs that a dying person is getting better, but the energy will soon go away. It can be painful to watch this happen but know that this is a common step within the end-of-life timeline. These energy bursts are a dying person's final physical acts before moving on.

The surges of activity are usually short. The previous signs of being close to death return more strongly once the energy has been spent.

Breathing Changes

At this stage, a dying person's breathing becomes slower and less regular. Rapid breaths followed by periods of no breathing at all (Cheyne-Stokes breathing) may occur. You may also hear a "rattling" sound when they breathe.

These changes can be unpleasant to witness but you should try to remember that these are not signs your loved one is uncomfortable.

Change in Appearance

Your loved one's hands and feet may start looking blotchy, purplish, or mottled. The changes in skin appearance may slowly move up their arms and legs.

Also, their lips and nail beds may turn bluish or purple, and their lips may droop.

Unresponsiveness

At this end-of-life stage, a dying person usually becomes unresponsive. They may have their eyes open but not be able to see their surroundings.

It's widely believed that hearing is the last sense to stop working. Knowing this can remind you that it's still valuable to sit with and talk to your dying loved one during this time.

Reaching the End

When your loved one stops breathing and their heart stops beating, death has occurred. Other signs of death include:

• No muscle tension
• Eyes remain fixed
• Bowel or bladder releasing

Coping

Supporting a loved one at the end of their life can be difficult, but you don't have to go through it alone. Reach out to a hospice, social worker, or clergy member to help you navigate the process. They can help you recognize and understand some of the changes that are happening as your loved one moves through the process of death.

People deal with grief in different ways. After your loved one has died, bereavement support groups may be useful. There are some common feelings and experiences that some people may want to share with others.

Summary

Signs can be evident one to three months before someone's death. Physical, mental, and behavioral changes are common.

In the week or two before death, the dying process speeds up. They may become more confused and periodically not make sense. Their bodily process may slow down or become erratic, but the person may also appear restless.

In the final days or hours of life, many people have a brief surge of energy and seem like they're doing better. However, once the surge passes, they may appear worse. You may notice breathing changes and skin discoloration.

Knowing these signs may help you prepare for the end of a loved one's life and bring you comfort as you face the physical and mental changes that happen along the end-of-life timeline.