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End-of-Life Stages & Recognizing the Signs of a Loved One’s Final Days

By: Leigh Morgan • Edited by: Tracey Rosenblath • Subject Matter Expert Reviewed by: Brindusa Vanta, MD • 3 cited sources • Updated Oct 14, 2024

Dying isn’t a single event but a series of stages. For some people, this process may last for weeks; for others, it may be much shorter or longer^[1]. As an individual transitions from one stage to the next, their body begins to slow down, making it more difficult to have in-depth conversations and carry out everyday activities.

Watching your loved one progress through these stages can be emotionally exhausting. For caregivers, it’s also physically taxing, as a dying individual needs more assistance with eating, drinking, and other activities of daily living. Losing a loved one is never easy, but learning more about the three end-of-life stages can help you understand what to expect.

Key Takeaways

• The dying process occurs in three stages.
• Every stage causes a unique combination of physical and psychological symptoms.
• It’s important to respect the patient’s wishes during the dying process.
• Hospice and palliative care professionals can provide additional recommendations regarding end-of-life care.

What Are End-of-Life Stages?

The end-of-life timeline occurs in three stages: the early stage, the middle stage, and the late stage. Understanding these stages is essential for helping a loved one make the transition between life and death. Caregivers also need to understand the end-of-life stages, as a dying individual has different needs during each stage.

The Early Stage of Dying

During the early stage of dying, the human body begins to shut down. One of the first end-of-life signs is a reduced need for food and liquids. The body needs less energy, so a dying individual doesn’t need to consume as many calories. Family caregivers should avoid forcing their loved one to eat or drink. It may also be necessary to provide foods that are easy to eat and digest, such as soup, gelatin, pudding, and ice cream. The first stage of dying may last up to several weeks^[2].

Early Stage Signs & Symptoms to Expect

Initially, family members and friends should expect their loved one to eat and drink less. As this stage progresses, a dying individual may find it more difficult to drink liquids without choking. Eventually, your loved one may stop eating food and start sucking on ice chips or lozenges to keep their mouth moist. Someone in the early stage of dying may also express frustration over their lack of appetite or inability to eat without difficulty.

The Middle Stage of Dying

During the middle stage of dying, the body slows down even more, reserving blood and oxygen for the kidneys, liver, and other major organs. This causes an individual to become less responsive to the people and events around them.

Middle Stage Signs & Symptoms to Expect

Family members and friends may notice that their loved one seems detached from what’s happening. This is a completely natural response to the dying process. During this stage, the body focuses on circulating blood to the organs, so you may notice that your loved one’s hands and feet feel cold to the touch. They may also have difficulty answering questions or having complex conversations.

The Late Stage of Dying

The late stage of dying causes pronounced physical and psychological changes. As the body prepares for death, a person’s metabolism changes significantly. Circulation slows down even more, making it difficult for the organs to carry out their normal functions.

Late Stage Signs & Symptoms to Expect

In this late stage of dying, it’s common for urination and bowel movements to decrease or even stop. The individual may also become incontinent, creating a need for adult diapers, catheters, or other incontinence supplies.

In the final days or hours of life, they may also develop terminal restlessness. Physical symptoms include fidgeting, twitching, picking at bed linens, moaning, and tossing and turning in bed. Someone with terminal agitation may also become paranoid, have hallucinations, or become extremely irritable^[3]. These changes occur for many possible reasons:

• Organ failure
• Medication side effects
• Lack of pain control
• Infection
• Fear of death
• Constipation associated with dehydration and electrolyte imbalances
• Urinary retention

How to Support a Loved One on an End-of-Life Timeline

It’s not easy to watch a loved one go through the end-of-life stages, but there are several things you can do to make the process a little easier. During the first stage, friends and family members should follow these tips:

• Avoid forcing food and liquids on a loved one.
• Accommodate as many requests as possible for special foods. For example, if your loved one expresses a desire for ice cream, you should stock up on a few favorite flavors.
• Provide ice chips, flavored ice pops, and other cold treats as requested.
• Ask the individual if they prefer warm or cold beverages. 

During the middle stage of dying, it’s common for an individual to feel cold. Caregivers should provide warm blankets, fuzzy socks, and other items designed to promote warmth. However, it’s important to avoid electric blankets and heating pads. At the end of life, skin becomes more fragile, making it more susceptible to burns.

Caring for a loved one at the end of their life requires a special skill: the skill of tuning into their needs. Observe and listen closely to your loved one, and respond with kindness. Trust your instincts to offer comfort when it’s needed most.

Dr.Brindusa Vanta, MD

Even if your loved one doesn’t talk much, they may be able to hear what’s going on around them. You should avoid discussing distressing topics within earshot. It’s also helpful to whisper words of comfort and reassurance. Not everyone is comfortable with touch, so family caregivers should ask for permission before holding a loved one’s hand or patting them on the arm or shoulder.

Quality end-of-life care should include emotional and spiritual support, as the dying process brings up many emotions. It’s common for an individual to experience fear, anxiety, anger, and other feelings. Listen carefully to your loved one’s concerns and provide regular reassurance. If necessary, family caregivers should arrange for their loved one to speak with a therapist or a social worker. Finally, it’s important to respect the person’s wishes regarding last rites and other spiritual traditions.

Supporting a loved one during the dying phase can be emotionally and physically overwhelming. Make self-care a priority and recognize your limits and feelings of burnout. Seek support from other caregivers and professionals. By taking care of yourself, you can recharge and continue to support and comfort your loved one and family throughout this process.

Dr. Brindusa Vanta, MD

Finding Support During the Dying Process

The dying process occurs in three stages, all of which have unique physical and psychological symptoms. As the body shuts down, it’s common for an individual to experience reduced circulation, poor appetite, organ failure, and other complications. Caregivers should consult hospice and palliative care professionals for more information on the physical aspects of dying.

Although the end-of-life process is challenging, understanding what to expect can help ease the journey for patients and their loved ones. Learning more about the three end-of-life stages also ensures family members and friends know how to provide appropriate support.

Written by Leigh Morgan

Leigh Morris has 15 years of experience developing high-converting content for the Web. She enjoys writing about health, law, finance, marketing and careers. Hope has a bachelor's degree in business administration (human resource management) and a master's degree in management and leadership.

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Edited by Tracey Rosenblath

A writer and editor with a strong passion for editing, Tracey authored the Project 2000 Black Book for Coriolis Technology Press and, alongside Michael Meyers, co-authored the first edition of the A+ Certification Passport for Osborne/McGraw-Hill. She now focuses her expertise on editing just about anything, from technical pieces to fiction. A strong generalist, she believes there's nothing more satisfying than taking words on a page and manipulating them into something better than they were before.

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Subject Matter Expert Brindusa Vanta, MD

Dr. Brindusa Vanta is a healthcare professional, researcher, and medical subject matter expert . She earned her MD degree from "Iuliu Hatieganu" University of Medicine, Romania. She has a special interest in mental health and has collaborated with psychologists and other mental health practitioners on various research projects focused on therapies to manage depression, age-related cognitive decline, trauma and stressor- related conditions.