There are several signs that can indicate that someone is nearing death:

• physical condition;
• eating;
• breathing;
• mental condition.

Physical condition

Deterioration in physical condition is usually the first sign that someone is near the end of life. The deterioration may be gradual or quick, and is reflected in the person’s level of energy and range of activity. There are four stages that a person usually passes through as death approaches:

Stage 1    performs regular activities;
Stage 2    tires quickly with exertion;
Stage 3    spends most of the time sitting or in bed;
Stage 4    doesn’t get out of bed at all.
 

Eating and drinking

People who are approaching death usually lose appetite and thirst and, as a result, lose a lot of weight. When someone is no longer eating or drinking, he or she usually has a few days to live, but may live as long as a few weeks if the person has reserves of energy.

Breathing

Changes in breathing are common. Some people develop long pauses in their breathing known as apnea. If a person is unconscious and unable to cough, there may be a pooling of secretions at the back of the throat. These secretions can make a rattling sound when the person breathes. The secretions aren’t distressing to the person because they are unconscious.

Mental condition

Closer to death many people become confused or restless. Eventually they may become unconscious or unresponsive to things around them. Most people become quiet near the end of life. It may be that because they have less energy and are too tired to participate in conversations. Commonly, people become reflective as death approaches and they spend more time thinking than in interacting with others. The final hours of life may bring signs of delirium, which is a sign of changing brain function that makes people confused and restless or lethargic and withdrawn.

One approach to estimating how long someone has to live is referred to as the momentum of change. If someone’s condition is changing from week to week, it’s a good indication that there are only weeks of life left. If there are changes from one day to another, there are likely days of life left. When changes happen from one hour to another, there are usually hours left. This is a general guideline. Sometimes a health crisis develops and someone dies sooner than expected. Families need to prepare for this possibility.