When someone we love enters the final stage of life, the body gradually slows down. Knowing in advance about the physical changes that appear during this time can ease some of the fear and surprise. These changes are usually part of the body's natural process of winding down, and they do not necessarily mean great suffering.
As circulation slows, the hands and feet may become cool, and the knees, feet, or arms may show blotchy, bruise-like discoloration (skin mottling). This is not a bruise from injury but a common change caused by reduced blood flow to the body's edges. As the kidneys slow, urine output often decreases and the color may become darker.
Fluid may collect in the body, causing swelling (edema) of the face, arms, and legs. Breathing may become shallow or irregular, sometimes with pauses between breaths (Cheyne–Stokes breathing). A rattling sound from secretions in the throat may be heard; although it can be hard for family to listen to, the patient often does not appear distressed by it.
Awareness also changes. The person may sleep for longer periods and be difficult to wake, and even with open eyes may stare at one spot or respond less. Hearing is believed to remain relatively late, so calling their name and speaking gently by their side is meaningful. Eating and drinking less is also a natural part of this process, and there is no need to force large amounts of food.
What family can offer at this time is closer to "comfort" than "treatment." Moistening the lips with a damp cloth or sponge so the mouth does not dry out, changing position often, and quietly holding a hand can themselves be great care. If worrying changes such as black stool or dark urine appear, it helps to ask the care team what they mean for the person's comfort.
If circumstances such as an intensive care unit keep you from staying at the bedside, please do not blame yourself. Love reaches a person in many ways—a brief visit, a letter left behind, a quiet prayer. Because the timing and order of these changes differ from person to person, asking the care team is the most reliable way to understand what you are seeing.
This article is for general information only and does not replace the diagnosis or treatment of an individual patient. Please always consult your care team about changes in condition and about how to provide care.