What to Expect in the Final Days

Psychological Changes

Month-Weeks Before Passing: While some individuals may be hesitant to discuss death with loved ones, others may show more of a desire to participate in end-of-life communications. They may also desire to complete unfinished business, begin to withdraw from the world, struggle with fluctuations between hope and despair, seek to make amends so they can pass in peace, talk about the many losses that come with terminal illness, feel uncertain and vulnerable about the future, or seek support and understanding. Weeks-Days Before Passing: As an individual’s end of life draws nearer, their responses to questions may be increasingly minimal or they may be unable to finish sentences altogether. They may talk with the unseen, experience more confusion, and perhaps have very little interaction or initiation. Your loved one might be harder to understand and have long periods of restlessness and agitation that give way to calm. Rather than being surrounded by a large group of people, it may put them more at ease to only be around one or a few. Days-Hours Before Passing: In their final days, individuals may often feel most comfortable being asleep and spend very little time awake. At this point, they may also be non-responsive or only able to communicate their needs nonverbally. To help your loved one through these psychological changes, you can continue showing support and talking to them, expressing your love while letting them know it is okay to let go, and saying your final goodbyes.  

Spiritual Changes

Month-Weeks Before Passing: Receiving the news of a terminal illness is understandably met with a great deal of shock and disbelief. This also comes with a variety of progressive responses from a spiritual standpoint. A patient may start to express their fear of death and what comes after and therefore, be more receptive or more active in sustaining religious practice. They may also want to take an active role in planning their funeral. As their abilities wane, they could start seeking a new purpose in life. Weeks-Days Before Passing: Individuals with a terminal illness tend to do a lot of self-reflection, thinking back on their life, relationships, triumphs, and regrets. Many will begin to accept their diagnosis and start to detach from this life as they begin to prepare for the next. Days-Hours Before Passing: Your loved one has spent the last few months, weeks, or days, reflecting and reconnecting with God. They may feel more at peace and at this stage and be mostly unresponsive and withdrawn. To help your loved one through these spiritual changes, you can comfort your loved one through physical touch such as holding their hand, forgive them for any past estrangement, and pray out loud for or with them.

Physical Changes

Month-Weeks Before Passing: The physical changes that someone with a terminal illness experiences are often the most noticeable. Your loved one may feel frustrated being unable to do normal activities or hobbies as they become weaker. You might notice that they are sleeping much longer and finding more solace in rest. They may also begin to have trouble swallowing. Weeks-Days Before Passing: Changes can happen quickly and you will sometimes see drastic differences from day-to-day. Your loved one may become completely bed-bound and require assistance around the clock. While they will nearly always be resting or sleeping, they may restlessly move their arms or legs or pick at bed linens and clothes. You may notice a decrease in liquid intake and output, a wet cough, cold hands and feet, or a warm forehead and cheeks. Days-Hours Before Passing: The physical changes your loved one goes through can be difficult to see. Death, especially from a terminal illness, is hard on the body, but this does not take away from the beautiful life your loved one lived. In the final days before passing your loved one may have very minimal or no urine output, reach a point of unresponsive sleep, have eyes semi-open with a glassy look to them, or have a slacken mouth. You may also see a drop in blood pressure, an increase in heart rate, blotchy skin, irregular breathing patterns, and louder congestion. To help your loved one through these physical changes, you can adjust any care or routines as needed, continue providing any necessary medications, and, if needed, reposition often to increase comfort.