What Are the Different Stages of Dying?

Death is an unfamiliar process for many people. Although it is an inevitable part of life, few people know how to find the support needed as a loved one enters the final stages of life, and many are unsure what the stages of dying look like.

People who are terminally ill and their caregivers want to know what to expect during this time to know how to make end-of-life more comfortable. Hospice care provides comfort through pain and symptom management. Hospice also provides support for caregivers throughout this unfamiliar and difficult time. 

The stages of dying can look different for each person. Read on to learn how to be better prepared for this transition and the kind of care available to make your loved one more comfortable. 

The Three Stages of Dying 

Generally, the stages of dying are determined based on early, middle, and last stage symptoms. These stages are marked by changes in responsiveness and body function. There are many signs for each stage, and each person’s experience will be different depending on factors like diagnosis, medications, health history and more. Some signs that death may be near include: ¹

• Decreased activity and communication
• Decreased appetite
• Increase in pain and other symptoms
• Changes in bowel and bladder function
• Body temperature decreases or increases
• Skin color changes and more frequent wounds
• Changes in breathing pattern or rate
• Confusion, agitation or restlessness
• Decreased responsiveness

For some people, the dying process lasts weeks. In these cases, early-stage symptoms might rapidly become last-stage symptoms. In other cases, the process is more gradual. For every stage for eligible patients, personalized, tailored care is available to improve quality of life through pain and symptom management and other services based on individual needs. 

Below you will learn which common symptoms are often seen in each stage. 

1. The Early Stage 

The early stage can last anywhere from a few months to a few days depending on the individual. The signs during this stage can include:

• Decreased appetite, showing a lack of interest in eating with noticeable weight loss.
• Increased sleepiness.
• Increased pain and nausea.
• Increased risk of infections.
• A person may become more withdrawn, less active, less communicative, and possibly even more introspective during this time.

In this stage, the body is conserving energy and does not require as much nourishment. Although a decreased intake of food and water can be upsetting for families and caregivers, it is important to remember that it is not a sign that someone is in pain or suffering. 

To comfort your loved one, you can offer assistance with eating or drinking, however, the body shutting down hunger is a natural response. Avoid over-encouraging more food or drink. This may not necessarily improve their quality of life and can actually lead to physical distress. 

2. The Middle Stage

Depending on the person, the middle stage can last from a few hours to several days. Signs of this stage include:

• Changes to physical appearance.
• Greater desire to sleep.
• Slower responsiveness to surroundings.
• Increased restlessness and confusion.
• Decreased intake or the patient may stop eating.
• Struggling to speak or move.

During this stage, they might still be experiencing symptoms listed in the first stage. As they develop into the middle stage, circulation in the body is slowing down, reserving blood to help major internal organs function. 

To help during this period, offer your loved one blankets for comfort and warmth. Even if they are responding less, continue to communicate with them, but try to avoid questions that require a great deal of effort an answer. 

3. The Last Stage 

In the final stage, which can last anywhere from several days to a few hours, your loved one might experience: 

• Increased disorientation, restlessness, or unresponsiveness.
• Increased sleeping/change in sleep patterns.
• Not wanting to eat or drink.
• Loss of control of their bodily functions.
• Shallow, irregular breathing.
• Chest congestion.
• Fluids accumulate in throat causing “death rattle.”
• Increased hallucinations or visions that may involve loved ones who have passed.
• Drop in body temperature and blood pressure.
• Cold feet and/or hands that are darker in appearance.

Many of these symptoms are due to the body preparing for death. Decreased blood circulation can affect kidney and bowel functions and cause major organs, such as the lungs, to lose the power to clear out fluids. Relaxed muscles can lead to incontinence.

During this stage, your loved one might need medication and other interventions to help manage symptoms. The goal is always to keep your loved one as comfortable as possible.

Although they may no longer be able to communicate, they may still be able to hear, so continue to speak with them reassuringly.

Emotional and Psychological Aspects of Death

We’ve touched on the physical symptoms and stages of dying, but the end-of-life journey also impacts a person’s emotional and psychological state of being. It’s one reason hospice care focuses on a person’s holistic care needs, providing spiritual and emotional support in addition to medical care.

There are some common emotional and psychological experiences at the end of life:

• Grief and loss— individuals may grieve the loss of future experiences, relationships, or identity. Loved ones also begin anticipatory grief before death occurs.
• Fear and anxiety— common fears include pain, loss of control, being a burden and the unknown. Anxiety may stem from existential concerns or unresolved life issues.
• Denial and acceptance— Elisabeth Kubler Ross’s Five Stages of Grief are often used to describe the process of denial, anger, bargaining, depression and acceptance that can happen with loss. ²
• Depression and sadness— feelings of hopelessness or sadness may emerge as a person confronts mortality.
• Hope and meaning-making— many individuals seek purpose or spiritual understanding in their final days. Legacy-building and reconciliation are common coping strategies.

How Hospice Can Help

Hospice care can provide quality of life and dignity when dealing with a life-limiting illness. Although it is available to individuals whom a doctor has certified have six months or less to live if their disease runs its normal course, as many as 50% of hospice recipients are only enrolled for 18 days before they pass away. ³

Having a conversation with your loved ones and healthcare providers early in the end-of-life journey can help you make a decision about enrolling in care sooner. By receiving hospice care before entering the stages of dying, you can live with fewer symptoms and more comprehensive support throughout the final chapter of life.

Hospice care teams are comprised of nurses, hospice aids, medical directors, bereavement counselors, chaplains, and social workers who contribute to the following services:

• A plan to provide treatment specific to the patient and caregiver
• Pain and symptom management 
• Emotional and spiritual support for patients and family members

With staff available 24 hours a day, seven days a week, all year long, patients receive the care they need, opening up more quality time to spend with their loved ones.

Hospice Care From Amedisys

If you’re navigating the end of your loved one’s life, working with a hospice care provider can help provide your loved one with care and support through this unfamiliar and difficult time.

Hospice care from Amedisys creates a personalized care program for eligible people facing a life-limiting illness. Through our services, patients live their remaining days with as much comfort, dignity, and quality of life as possible.

If you’re still unsure if hospice care is the right solution for you, take our hospice quiz to see if your loved one is eligible for hospice care.

Deb Gallaher, MBA, MSN, RN, NE-BC, CHPN, is a Senior Hospice Clinical Education Specialist for Amedisys. She has 10 years of experience in hospice and is passionate about sharing her insights on high-quality care.