In the last weeks before death, many people eat and drink less, feel more tired and can get symptoms like pain, nausea or breathlessness. On this page, we describe what symptoms people might have in their last weeks and what can help. This page is for family and friends of people living with a terminal illness or advanced old age.
We know it can be upsetting to think about the end of someone’s life or reflect on what has happened. You might find some of the descriptions on this page upsetting or worrying. If you don’t feel ready to read this information just yet, you can come back to it at any time.
If you have any questions or need to speak to someone, you can call our free Support Line on 0800 090 2309 or email support@mariecurie.org.uk.
Watch: What to expect at the end of lifeWatch: What to expect at the end of life
Marie Curie Nurse Maria describes the common changes that you might notice in someone’s last weeks, days and hours of life. Update: In this…
Why do changes happen at the end of life?
When someone’s dying, the body slows down and shows signs and symptoms that the person is approaching the end of their life. Not everyone will have these symptoms. And these symptoms can also be caused by other things, particularly if someone has just one or two symptoms.
The symptoms that someone has might depend on their illnesses, their general health and wellbeing, and treatments they’ve had or are having.
It may be reassuring to know that most symptoms can be managed with good palliative care. If you have any questions, ask the person’s GP, district or community nurse, care home staff or hospital doctor.
It’s difficult to predict what will happen, but knowing some of the possibilities provides a chance to think ahead and prepare.
As someone approaches the end of life and is in the last days or hours of life, they might experience other changes.
When should I ask for help with end of life symptoms?
Many of the symptoms we talk about on this page are a normal part of the dying process. If the symptoms are making the person uncomfortable, they may be able to be treated with medicines or managed in other ways.
Speak to the person’s doctor or nurse if they have:
- any new symptoms
- symptoms that are getting worse
- symptoms that are causing them pain or discomfort
- anything that is making you concerned.
You do not have to manage things alone. If you do not know who to ask for help, speak to their GP, district or community nurse, care home staff, or hospital doctor or nurse.
Eating less and loss of appetite in the last weeks of life
Wanting to eat less is natural in the last weeks of life, as the body uses less energy. The person’s tastes might change and they will not always need to eat at the same times every day. They might have difficulty swallowing, a sore or dry mouth, or feel sick.
Other people can help the person to eat if they want to and feel able to. Smaller portions may help. People who have problems chewing might prefer to eat soft, high-calorie foods such as ice cream and yoghurt.
Some people don’t want to eat or are not able to at the end of their life. This is normal and they should not be pressured to eat.
Losing weight in the last weeks of life
Many people lose weight and muscle in the last weeks or days of life and look thin or frail. This can be caused by their illness, treatments or loss of appetite.
Changes in appearance can be upsetting for people who are ill as well as the people around them. Speak to the person’s doctor or nurse if you are worried or would like more information about what to expect.
Feeling weak and sleeping more in the last weeks of life
Some people need to spend more time in a chair or in bed as everyday activities become too tiring. Needing to sleep more than usual is normal in the last weeks of life. You can let the person rest and support them to do things if they want to.
The person may lose interest in doing things they enjoyed before. At this stage, they will need help with things like washing, eating and going to the toilet.
Feeling hot or cold in the last weeks of life
Feeling hot or cold happens because the body is not regulating temperature as well as it used to. You might notice that the person’s hands or feet feel cold. People can be kept comfortable by making practical changes like using blankets or opening a window.
If the person has a fever or feels shivery, this could be a sign of an infection. Speak to their doctor, nurse or care home staff for advice.
Breathlessness in the last weeks of life
Some people feel breathless or short of breath. You might hear this called dyspnoea. Some people experience this throughout their illness, while others experience it in the last weeks, days and hours of life.
It can be worse if the person is anxious, so helping them feel relaxed and reassured may help. The doctor or nurse may give medicine for breathlessness or advise practical steps to help, like having a fan in the room or opening a window.
Pain in the last weeks of life
Pain in the last weeks of life is something that many people worry about. With the right treatment and support, pain can usually be managed. Tell the doctor or nurse about any pain. They’ll look at the causes of their pain and suggest medicines or other ways to help manage the pain.
Nausea and vomiting in the last weeks of life
The doctor or nurse will look at what is causing the person to feel sick or be sick, and what can help with this. For example, they might adjust medicines if they think they are the cause. And they may offer medicines to help with it.
Lots of other things might help if the person is feeling sick, including trying different foods or drinks, eating small portions, and doing activities that are distracting or relaxing.
Restlessness or agitation in the last weeks of life
Some people feel restless or agitated and find it difficult to feel comfortable and relaxed. This can be caused by different things including emotional worries, medication, or symptoms like pain, nausea, constipation or having a full bladder.
The doctor or nurse can look at what might be causing the problem and what might help. If the person seems uncomfortable, they might suggest medicines to help. Providing a calm, safe environment or trying to distract them from any discomfort may also help.
Delirium (sudden confusion) in the last weeks of life
Delirium is confusion that comes on suddenly, over a period of hours or days. The person might feel confused, disorientated and agitated, and they may see or hear things that aren’t there (hallucinations).
Delirium is often caused by things like medication side effects, medication changes, dehydration, or infections. The doctor or nurse can look at what might be causing the problem and what might help. For example, they might be able to give antibiotics if the person has an infection.. Providing a calm, safe environment and supporting them with any activities they need to do may also help.
Depression and anxiety in the last weeks of life
Some people have feelings of sadness, hopelessness, anger, worry and fear in their last weeks of life. They might have questions or worries about their life or relationships with other people. They may feel able to talk about how they feel. Or they might show their feelings in different ways, like being angry towards or withdrawing from people around them. If they are not talking, they may look concerned or they might not engage in what is happening around them.
Ask the person how they are and listen to what they are saying. If they do not want to talk or are not able to, try to do things they enjoy like listening to music or reading to them.
If you’re worried about the person’s emotional wellbeing, speak to their doctor or nurse. It might also help to speak to someone who can provide emotional or spiritual support, such as a faith leader or counsellor.
Seeing someone close to you depressed or anxious can be hard on you too. Try to get support for yourself and take breaks if you can. You can call our free Support Line on 0800 090 2309 or email us at support@mariecurie.org.uk.
Bladder or bowel incontinence in the last weeks of life
Some people lose control of their bladder or bowels as their muscles relax. There are ways to make sure comfort and dignity are maintained as much as possible. Ask the doctor or nurse what they would suggest to help with this.
If the person is able to move around, they may be able to use a commode (portable toilet). If they’re less mobile, they might use pads and wipes. Some people use a catheter (a small tube that drains urine into a bag). It can help to talk to the doctor, nurse, and your loved one about what is needed and who should provide this care.
Constipation in the last weeks of life
Constipation can be caused by medicines, moving less, and eating and drinking less. If the person is uncomfortable, speak to the doctor or nurse about what can help. They might suggest drinking more fluids if possible, laxatives (medicines that loosen stool) or other treatments.
Hallucinations, dreams and visions in the last weeks of life
Some people who are dying have dreams or visions of family or friends who have already died. This can feel very real to them, and we do not know why it happens. If they want to talk about it, you can ask them about what they saw and talk about their memories of the person they saw.
If you’re worried that the person seems confused, speak to their doctor, nurse or care home staff.
Medicines in the last weeks of life
If someone is in their last weeks of life, their doctor or nurse may:
- stop medicines that are not helping or are causing side effects
- prescribe new medicines to help with symptoms
- prescribe ‘just in case medicines’ or ‘anticipatory medicines’ to help with symptoms they may get in the future
- look at other ways to give medicines if the person cannot swallow or their symptoms are not managed, for example in a syringe driver.
Speak to the person’s doctor or nurse if you have any questions or concerns about their medicines.