Caring for someone nearing death

Daily Care

Just being there as a caring presence can mean a lot to the dying person and their family.

Work and communicate with your team leader and the primary health care team to provide excellent care for the dying person and their family. What matters most to people at end of life is:

Maintaining their dignity
Providing physical and spiritual comfort
Communication
Presence of loved ones

Communicate with the person, and those involved in their care.

Even when a person has been living with a life limiting illness for a while, it can be a shock for the person and their loved ones when they actually reach the last days of their life. It’s important to speak to the person and those important to them about what’s happening. The best person to speak to the person and their loved ones is a healthcare professional who is confident and experienced and has a good rapport with the person. If you don’t feel comfortable doing this, ask a colleague to help.

Support the wellbeing of relatives or carers attending the person.

How do you recognise when someone is in their last days/weeks of life?

Everyone’s experience of dying is different, and some people will die suddenly or unexpectedly. But in most cases, there are some signs that can help you to recognise when someone is in their last days/weeks of life. These include:

Getting worse day by day or hour by hour.
Reduced mobility, or becoming bed-bound.
Extreme tiredness and weakness.
Needing assistance with all personal care.
Little interest in getting out of bed.
Little interest in food or drink.
Difficulty swallowing oral medication.
Being less able to communicate.
Sleepiness and drowsiness.
Reduced urine output.
New incontinence.
Progressive weight loss.
Increased restlessness, confusion, and agitation.
Changes in their normal breathing pattern.
Respiratory secretions from mouth.
Chest noises.
Mottled skin and feeling cold to the touch.
The person may tell you that they feel as if they are dying.

A person in their last days/weeks of life may not have all of these signs but they might have a few at once.

If you think someone is entering their last days/weeks of life, speak to the GP, District Nurse or palliative care team coordinator.

Reversible causes of decline

Some conditions can cause the signs and symptoms of dying but can be actually be treated. Such reversible causes of decline include infection or side effects of medicines such as strong painkillers.

If you suspect any of these conditions, inform the person’s GP or specialist nurse so they can arrange assessment and treatment.

Find out more

Mannix K. (2019) Dying is not as bad as you think

Marie Curie: What does high quality end of life care look like?

Scottish Palliative Care Guidelines: End of Life Care

National Institute of Health and Social Care Excellence Guideline: Caring for dying adults in the last days of life

National Institute of Health and Social Care Excellence Clinical Knowledge Summary: Palliative care-general issue: The terminal phase

Macmillan Cancer Support: End of Life Guide – Available as booklet, CD and downloadable audio file

Mannix K. (2017) With the End in Mind: Dying, Death and Wisdom in an Age of Denial. William Collins, London.

Nidirect: End of life care and palliative care: resources to support palliative and end of life care.

Royal College of Nursing: Resources to Support End of Life Care

Scottish Government (2014). Caring for people in the last days and hours of life: National Statement

Welsh Government: End of Life Care