Signs of Dying in the Elderly: What to Expect
This is one of the hardest things you may ever face. Knowing what to expect can help you be present, provide comfort, and find peace. Take breaks if you need to. This information is here when you're ready.
When a person is dying, the body goes through a natural process of shutting down. Understanding what happens can help you recognize where your parent is in this journey, know what's normal, and focus on providing comfort rather than fear.
Not everyone experiences all these signs, and the timeline varies greatly. Some people decline over weeks; others, over days or hours. If your parent is under hospice care, their team can guide you through what to expect.
Weeks to Months Before
Decreased Appetite
Eating and drinking less is natural as the body slows down. The body no longer needs as much fuel. Don't force food—it can cause discomfort. Offer small amounts of favorite foods if they want them.
Increased Sleep
Sleeping much more than usual, sometimes 20+ hours a day. The body is conserving energy. Let them rest. Speak to them during awake periods.
Withdrawal
Less interest in activities, visitors, or even close family. Turning inward is part of the process. Don't take it personally. Sit quietly with them.
Weakness
Increasing difficulty moving, sitting up, or performing basic activities. May need more help with all care. Be gentle with transfers.
Days to Weeks Before
Disorientation
Confusion about time, place, or people. May not recognize family members. May talk to people who have died. This is normal. Respond with calm reassurance.
Visions and Conversations
May see or speak with deceased loved ones, describe beautiful places, or talk about "going home" or "a trip." These are common and often comforting to the dying person.
Restlessness
Agitation, picking at bedclothes, trying to get out of bed. May be called "terminal restlessness." Speak calmly, play soft music, keep environment peaceful. Medications can help.
Fluid and Food Refusal
May refuse all food and water. This is natural and usually not uncomfortable for them. Artificial feeding often causes more distress. Keep lips moist with swabs.
Hours to Days Before
Breathing Changes
Cheyne-Stokes breathing: Cycles of deep breaths, then shallow breaths, then pauses (sometimes 10-30 seconds). Can be distressing to watch but usually not uncomfortable for them.
"Death Rattle"
Gurgling or rattling sound from throat as they can no longer clear secretions. Sounds worse than it feels to them. Repositioning may help. Medications can reduce secretions.
Skin Changes
Skin may become pale, grayish, or mottled (blotchy purple/blue). May start at feet and move up. Hands and feet may feel cold while body is warm. This is normal circulation changes.
Decreased Responsiveness
May be unconscious or in a coma-like state. May still hear you—hearing is thought to be the last sense to go. Keep talking, saying what you need to say.
Eyes
May be half-open, unfocused, or "glassy." Tears may be present even if unconscious.
The Moment of Death
Death itself is usually peaceful. You may notice:
- Breathing stops
- No pulse
- Eyes fixed and pupils dilated
- Jaw relaxes, mouth may open
- Skin becomes pale/waxy
- Bladder or bowel may release
There is no rush. You can sit with them as long as you need.
Providing Comfort
Physical Comfort
- Keep lips moist with swabs or lip balm
- Keep skin clean and dry
- Turn gently every few hours if not distressing
- Light blankets—they may feel warm
- Dim lights, quiet environment
- Pain medication as needed (even if they can't communicate pain)
Emotional Comfort
- Speak calmly and gently
- Say what you need to say—they may hear
- Give permission to go if you're able
- Hold their hand or touch them
- Play favorite music softly
- Read to them if they liked that
- Pray if that's meaningful to them
What to Say
There are no perfect words. Simple is enough: "I love you." "Thank you." "I'm here with you." "It's okay to go." "We'll be okay." Many people find peace in giving their dying parent permission to let go.
Things You Don't Need to Do
- Force food or water: It causes discomfort, not comfort
- Call 911: Unless hospice isn't involved or something unexpected happens
- Try to wake them: Sleep is protective
- Leave them alone: Take shifts with family if possible
- Hide your emotions: Crying is natural and okay
Hospice nurses are available 24/7 for questions and support. Chaplains and social workers can help with emotional and spiritual needs. Ask for help.
If Hospice Is Involved
- Call them with questions anytime—that's what they're for
- They will pronounce death and help with next steps
- They can provide comfort medications as needed
- They can guide you through what happens after death
If Hospice Is Not Involved
It may not be too late. Hospice can be started even in the final days and provides tremendous support. Ask the doctor for a referral.
If death occurs without hospice:
- Call their doctor (not 911) unless unexpected
- The doctor or medical examiner will need to pronounce death
- Contact funeral home when ready
What Happens After
There is no rush. Take time to be with your parent, make calls to family, and process what has happened. The body does not need to be moved immediately.
- If hospice: Call hospice nurse; they will come and guide you
- Notify doctor and funeral home
- Notify family and friends
- Funeral home will transport the body when you're ready
Caregiver Grief Support
Guidance for navigating grief after your caregiving journey ends.
Read the Guide