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Signs of Dying: How to Know When Death Is Near

Dying · 7 min read · First published 2004 · Updated November 2026

A hospital room with an empty bed and a person in a wheelchair by the window
Photo by Annabel Podevyn on Unsplash

How to tell when death may be getting close

Many caregivers want to know what signs they can look for when someone they love is nearing the end of life. There is no exact order of stages, and every person's death is as individual as they are. Still, hospice teams often describe two broad phases before death. The first is called the pre-active phase, and the second is called the active phase. Not everyone will clearly go through both, so please treat this as a general guide and not a schedule. What you see will depend a great deal on the person's illness and overall health.

The pre-active phase is the longer one and can last weeks. The active phase is much shorter. MedlinePlus describes the body's final shutting down as lasting a few days to a couple of weeks, and the Hospice Foundation of America notes that for some people it may be only a few days or hours.

Some of these changes, such as pain, breathing trouble, nausea or anxiety, can often be eased with treatment. If you notice something new, please tell the doctor or hospice nurse.

Signs in the Pre-Active Phase

  • A person may pull back from social activities and spend more time alone or at home.
  • They may look back over their lives, and some people start to think about funeral plans.
  • They may want to talk with family and friends, make amends, or catch up.
  • Anxiety can show up as restlessness, trouble getting comfortable, confusion, agitation or nervousness.
  • Daily activities may matter less.
  • Some people have swelling in the arms or legs.
  • Interest in eating and drinking often fades.
  • They may be inactive, tired or asleep more of the time.
  • They may talk about dying, say they are going to die, or ask questions about death.
  • They may say they see or talk with people who have already died.
  • Breathing may pause for several seconds before starting again. This can happen awake or asleep.
  • Some people ask to speak with a spiritual or religious leader, such as a chaplain, priest, minister, rabbi, imam, monk or elder, or want to pray or reflect more. Others find their comfort in quiet, music, nature or time with the people they love.

Signs in the Active Phase

  • Breathing changes a lot. There may be fluid sounds or congestion, longer pauses in breathing, and cycles of slow then fast breathing. Noisy breathing is common, and in most cases it does not upset the person. Raising their head or slowly turning them onto one side may help.
  • The person may say they are going to die soon.
  • Swallowing becomes difficult, or they refuse most or all food and drink.
  • Their personality may seem to change. They may be very restless or agitated, or see and hear things that others do not.
  • It becomes harder to wake them. They may not wake at all, or seem to be in a coma-like state.
  • They may be unresponsive or unable to speak, and may not move for long periods.
  • Hands, feet, arms and legs may feel cool to the touch. The person may say they feel numb.
  • The skin on the arms, legs, hands and feet may look blotchy, purple, blue or gray (called mottling).
  • They may urinate less, and may lose control of the bladder or bowels.
  • Body temperature, blood pressure and heart rate may rise and fall or drop. The hospice nurse will watch these for you, so there is no number you need to keep track of at home.
  • Sight and other senses may fade. Hearing and touch are often the last senses to go, and many people can still hear after they can no longer speak.

Comfort for the Person, and for You

Many people believe those who are dying can sense who is in the room and may hear your voice right up to the end. Even if you get no answer, talking to them can comfort them, and your presence can help them feel less afraid or alone. Be loving and supportive. Say what you need to say, such as "I love you," "thank you," "I forgive you," or "it's okay to go when you're ready."

A calm room can help. You might dim the lights, play their favorite music softly, hold their hand, and use soft touch and a soothing voice. A cool, damp cloth on the forehead can help if they feel warm, and a soft blanket if they feel cold. Avoid heating pads and electric blankets, which can burn fragile skin. Ice chips (if they are awake), a moist swab for the mouth and lip balm can ease dryness. Don't push food or drink.

Tears are natural. For many families, loving words, memories and a few tears are all part of saying goodbye. If the emotion becomes too much, it's okay to step out for a moment and let someone else sit with your loved one.

If a much-loved pet is part of the household, ask the hospice team whether the pet can be nearby. For many people, a familiar animal is a comfort.

If possible, have someone by the person's side. Friends and family can take turns so that no one gets too worn out.

Not everyone will have all of these signs. Death can come slowly, or quite suddenly. Some people show few signs and die within minutes of a change being noticed. If your loved one wants someone with them at the end, it's best not to delay a visit.

When to Call Hospice or the Doctor

  • If your loved one is already receiving hospice care, call the hospice team any time you have a question, a worry, or you see new or worsening symptoms. Hospice teams can adjust medicines and show you how to keep your loved one comfortable. Under Medicare's hospice benefit, a hospice nurse and doctor are on call 24 hours a day, 7 days a week.
  • Call right away for signs of pain, anxiety or distress, breathing that seems hard or distressing, new agitation, a wound or sore, or a fever or shivering.
  • If your loved one is enrolled in hospice, call the hospice team before calling 911 or going to the emergency room, unless your care plan says otherwise. When death comes at home under hospice care, call the hospice's 24-hour line, not 911.
  • If they are not yet receiving hospice care, call their doctor and ask about it. The doctor can refer them, and in many cases you can contact a hospice yourself to ask for an evaluation. Hospice isn't only for the final days. People can receive it for weeks or months if they are eligible.
  • If someone is in immediate danger or you are unsure what to do, call 911.

Sources

Written by Words to Comfort

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