Getting familiar with end-of-life symptoms in older adults can help you understand what your loved one may be experiencing and promote a smooth transition for everyone.

Caring for a loved one through the final stage of life is never easy. Whether you carry all the responsibility or just want to be there for them, you’re probably wondering what to expect.

Some diseases, like end stage cancer, for example, may cause an increase in pain. This can be managed with pain medication to make your loved one more comfortable in their last days.

Outside of the effect of specific conditions, the are some general changes you might see as your loved one nears the end of life.

The list below outlines these changes. Just keep in mind that everyone is different, so you shouldn’t expect to see all these end-of-life signs. Also, your loved one will progress at their own pace, which could be significantly faster or slower.

1. Appetite and digestive changes

As one nears the end of life, metabolism and digestion gradually slow. Fewer calories are needed, so loss of appetite and decreased thirst are typical

Trouble swallowing, nausea, and constipation can also interfere with appetite. Weight loss and signs of dehydration might also occur.

2. Sleeping more

Generalized weakness and fatigue are common. Energy levels wane, and time spent sleeping increases.

This means your loved one will likely sleep more than they’re awake. They’ll move and talk less and may not respond to conversation or commotion.

3. Withdrawal from the world

Some of the earliest signs involve a sense of resignation, which may include low mood, lack of motivation, and withdrawal.

The person may create a protective bubble of fewer people and less curiosity about events outside the bubble. They might spend more time talking about the past than the present.

4. Anxiety and depression

As the end of life becomes apparent, some people experience a growing fear or worry for themselves or for those who will be left behind. End-of-life anxiety and depression aren’t uncommon.

5. Urinary and bladder incontinence

As the kidneys begin to fail, urine can become more concentrated and darker in color. Both bladder and bowel functions get harder to control.

6. Changing vital signs

Heart rate, body temperature, and blood pressure begin dropping. With reduced circulation, the hands, arms, feet, and legs may start to feel cool to the touch. The skin may turn dark blue, purple, or appear mottled.

7. Confusion

Your loved one may be periodically confused. Time, place, and even close loved ones may be difficult to identify. You might note a limited attention span or repetitive motions like pulling at sheets or tugging at clothing.

8. Sensory changes

Eyesight can weaken. Someone nearing death may see, hear, or feel things that you don’t, even speaking to others who have died. Sensory changes can also lead to illusions, hallucinations, and delusions.

9. Saying goodbye

If alert to what’s happening, some people want to participate in funeral planning, putting affairs in order, or distributing possessions. They may feel a sense of urgency in clearing up loose ends, expressing feelings, and saying goodbye.

10. Breathing changes

Breathing grows increasingly slow and shallow with periods of shortness of breath. Fluid can collect in the throat as the throat muscles relax. The person may be too weak to clear it by coughing, which can lead to noisy breathing known as a “death rattle.”

11. Loss of consciousness

Waking your loved one can become difficult. Eventually, they’ll be uncommunicative and unresponsive, losing consciousness or falling into delirium. Eyes may develop a glassy appearance.

Death is generally defined as the permanent stopping of circulation and breathing or an irreversible end of brain function.

Generally speaking, if your loved one is in the hospital, a long-term care facility, hospice, or a nursing home, there is often equipment that can identify when vital signs have ceased.

Medicare and hospice

Original Medicare (parts A and B) covers hospice once a medical doctor certifies that a Medicare beneficiary has an illness that makes it unlikely they will live longer than 6 months.

Medicare coverage for hospice includes two initial 90-day benefit periods, followed by an unlimited number of 60-day benefit periods. You should be able to get equivalent coverage under a Medicare Advantage (Part C) plan.

Alternatively, a healthcare professional should be on hand to recognize the signs. If your loved one is being cared for at home, you may have an end-of-life caretaker to help you recognize when it happens.

That said, because it can be so hard to accept the loss of someone you love, it may be a good idea to familiarize yourself with the signs of death ahead of time.

At the moment of death, breathing stops, and there is no pulse or measurable blood pressure. If your loved one’s eyes remain open, their pupils will dilate.

As their body’s muscles relax, the bowels and bladder will empty. As their blood settles, their skin starts to look pale and waxy.

Be prepared that even after death, you may still see tears falling from their eyes or small movements of their arms, legs, or voice box.

Your doctor will advise you on how to provide physical comfort based on your patient’s medical conditions. This may include administering medications for pain, digestive issues, or anxiety.

Providing physical comfort

Whether you have professional caregivers or hospice care, there are some basic ways you can provide physical comfort:

  • Use a humidifier to aid breathing.
  • Apply lip balm and alcohol-free lotion to soothe dry skin.
  • Help them stay hydrated with ice chips or by applying a wet washcloth to the lips.
  • Change positioning every few hours to prevent bedsores.
  • Provide comfy bedding and refresh as necessary.
  • Prepare soft foods, but don’t force a person to eat.
  • Use low lighting and block out loud or distracting sounds.
  • Let them sleep when they want to.

Proving emotional comfort

To help provide emotional and spiritual support:

  • Encourage conversation if they’re up for it. Let them lead, be a good listener, and avoid initiating potentially stressful topics.
  • Even if they don’t respond, assume they hear you. Speak directly to them rather than about them. Identify yourself when you enter or leave the room.
  • Provide light physical contact by holding their hand or placing a hand on their shoulder.
  • Play their favorite music at low volume.
  • Don’t ignore, interrupt, or dismiss their thought process. Remain calm if they’re confused. If they’re talking with or seeing someone who isn’t there, let them be.
  • Express your love.
  • Don’t deny reality. If they want to say goodbye, let them. It can provide you both with peace of mind.

Think about your loved one’s spiritual needs. Consider bringing in an appropriate spiritual advisor, social worker, or end-of-life doula.

Medicare’s advance care planning

If you are enrolled in Medicare, you have the option to set up advance care planning, also known as end-of-life planning. This is covered by Medicare Part B as part of your annual wellness visit.

Letting go is not easy. Learning about the end-of-life symptoms in older adults can help you provide the physical and emotional support your loved one needs as they transition.

Once your loved one has passed, allow yourself time to grieve, take care of yourself, and reach out for help if you need it.