Signs of Approaching Death

Most people with a life-threatening chronic disease want to know how much time they have left to live. Family members often want to be present at the time of death and may need to make arrangements to ensure their availability. Predicting the timing of death is imperfect. For a variety of reasons, doctors almost always overestimate the amount of time that their patients have to live. More experienced doctors seem somewhat better at making this prediction, although the longer a doctor has known a patient, the less objective and accurate the prediction seems to be.

Despite the difficulties involved in predicting when death will occur, some signs indicate that death is approaching or imminent.

• Change in level of alertness: When near death, people typically spend increasingly more time sleeping. When awake, they may be less alert or interactive. Confusion or disorientation is common.
• Decreased interest in eating or drinking: People near death typically refuse most food, although they may still request or accept sips of fluid.
• Absence of urination: Once a person stops urinating, death typically follows within days to a few weeks.
• Changes in the skin: The hands and feet often become cool and bluish or develop a lacy pattern. These changes are expected and are markers that death is likely in hours to days.
• Changes in breathing: The breathing pattern changes as death approaches. Breathing may become rapid and shallow or may alternate between periods of slow and rapid breathing. The person may stop breathing for increasingly prolonged periods, only to resume breathing again. A rattling noise may be heard when the person breathes (the death rattle). This noise is caused by accumulation of secretions, such as saliva, that the dying person cannot swallow or spit out and by relaxation of muscles in the throat. The dying person is usually unaware of this noise, but family members may be very distressed by it, fearing that their loved one is choking.