What happens when someone is dying

When a person is expected to die, there are some common changes that can happen in the days or weeks before their death.

People die in different ways. But understanding what may happen can help you or your family to prepare and get any support you need. Your GP, hospital doctor or palliative care team can help.

This information is for natural and expected deaths. For example, when someone dies of a recent serious illness, a long-term condition or old age.

Weeks before death

It can be hard to know if someone is dying. The process may last hours, days or sometimes weeks.

Some people know themselves when they are getting closer to death. They may notice this before they talk about it with anyone.

Your GP or hospital doctor may tell you or your family when it is time to prepare for someone's death. They can explain what can happen and how they can support you.

Common signs in the weeks before death include:

• feeling more tired and drowsy
• spending more time sleeping
• eating less or not wanting to eat or drink
• needing more help with everyday things such as washing, eating or going to the toilet
• shortness of breath
• feeling restless or agitated
• being confused

Care in the weeks before death

You and your healthcare team can discuss what you want and need. They can answer any questions you have.

They may:

• explain what is happening and what will likely happen in the future
• ask you about your wishes for your care - for example, the types or place
• ask if you have recorded wishes for your care in an advance healthcare directive
• ask if there are any important things you want to do before you become too weak to do them
• ask you if you want to stop any medicines
• prescribe new medicines to help with any symptoms that bother you
• prescribe medicines in case you need them (anticipatory medicines)
• give medicine in another way - for example, as an injection if you cannot swallow tablets
• ask you what emotional or spiritual support you want
• recommend support for your family or carers
• refer you to other services depending on your needs - for example, a public health nurse, home carers or specialist palliative care services
• prescribe incontinence products if you cannot use a toilet
• insert a catheter into your bladder if you have problems peeing or cannot use a toilet

You can get as much information as you need. You and your family can think about and discuss your care options.

Supporting someone who is dying

If you are caring for someone in the weeks before they die, it can help to:

• find out who to contact if you need help - this may be a GP, public health nurse, carer or specialist palliative care team
• note the phone numbers you may need - include out-of-hours services
• keep important documents where you can find them quickly
• ask the person if there is anything they need or want to do - for example, call someone, organise a visit or go outside
• keep soft blankets nearby in case the person gets cold
• offer soft foods or drinks if the person does not want to eat - for example, yogurt, custard or smoothies
• gently wet their mouth and lips or apply lip balm if the person does not want to eat or drink

It is also important to look after yourself. Try to eat well, drink enough water and get enough sleep or rest. Talk to your GP if you find it hard to cope.

Communicating when someone is dying

Some people may spend a lot of time sleeping during the last weeks before death. They may also become confused or have strong emotions.

When you are with the person, it can help to:

• listen to them if they want to share their thoughts or feelings
• assume they can hear and understand everything you say
• say who you are before you speak
• tell them what is happening around them
• continue to talk about everyday things
• offer to sit with them quietly or hold their hand if they do not want to talk
• ask them about what they see if you think they are hallucinating
• play familiar sounds - for example music, the radio or TV shows that they like

Days and hours before death

As the person gets closer to death, their body will slow down a lot. They may not need to eat or drink.

They may have:

• longer periods of unconsciousness
• changes to breathing patterns - such as shallow breathing followed by deep and rapid breathing
• pauses in breathing
• noisy breathing - you may find the sound difficult but it is often not uncomfortable or distressing for the person dying
• cold feet or hands
• confusion
• hallucinations - when you see, hear or feel things that are not there

Some people can die without these signs.

The final moments of life are usually calm. The person may have very slow breathing. Their tummy may move with each breath.

The person may have long pauses between breaths. This means it can be difficult to know the exact moment someone dies. After they stop breathing, the muscles in their body will relax. They may look very peaceful.

What to do if someone dies at home

If the person was expected to die at home, you do not need to do anything quickly.

You may want to spend time with the person or call someone else for support. You can do what feels right for you.

When you are ready, you can call the person's GP or an out-of-hours GP service. This is to tell them that the person has died. You could also call a funeral home. If the person dies during the night, you can wait until the morning to call if you want.

If someone dies in hospital

When you know the person has died, you can take the time you need with the person.

When you are ready, tell the hospital staff. They may ask you to leave the person for a few minutes so they can verify the death. But you can stay with the person again if you want to.

The hospital staff can support you and explain what will happen next. They may offer to contact the pastoral care team for you.

When someone dies - citizensinformation.ie