Hospice End of Life Guideposts

One of the questions that loved ones often ask as their loved one approaches the end of life is how to know when the end is near. Of course, every person is different and so their progress toward death will be unique. However, based on the experience of folks providing hospice care, here are some of the guideposts to help families know the condition of their loved one:

One to Three Months Before Death

  • Withdrawal from the world and people
  • Decreased food intake
  • Increase in sleep
  • Less communication

One to Two Weeks Before Death

  • Mental Changes
    • Disorientation
    • Agitation
    • Talking with the unseen
    • Confusion
    • Picking at clothes
  • Physical Changes
    • Decreased blood pressure
    • Pulse increase or decrease
    • Skin color changes: pale, bluish
    • Increased perspiration
    • Respiration irregularities
    • Congestion
    • Sleeping but responding
    • Complaints of body tired and heavy
    • Not eating and taking little fluids
    • Body temperature: hot or cold

Days or Hours Before Death

  • Intensification of previous signs
  • Surge of energy
  • Decrease in blood pressure
  • Eyes glassy, tearing, half open
  • Irregular breathing: stop, start
  • Restlessness or no activity
  • Purplish, blotchy knees, feet, hands
  • Pulse weak and hard to find
  • Decreased urine output
  • May wet or stool the bed

Hours to Minutes Before Death

  • “Fish out of water” breathing
  • Cannot be awakened
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