The 3 Stages of Dying in Palliative Care

The early stage | The middle stage | The late stage

Posted 6th December 2023 |  3 minute read

Written by Jesse Gramenz Reviewed by Julie Dymock  

Rarely does anyone consider preparing for the end of a loved one's life. But without an understanding of what to expect during that time, it can things seem scarier and more uncertain than they need to be. Arm yourself with the facts about what to expect when someone is dying in Palliative Care and give yourself a little extra peace in a time where peace can be hard to come by. If that sounds ok, let's get started.

Managing Pain at End-of-Life

Many people (but not all) may experience pain at the end-of-life and to varying degrees. Pain can be due to a variety of reasons, and there are a number of medications available which can be prescribed, depending on the nature of the pain. The required dosage of pain medication varies from person to person, and it is sometimes necessary to make adjustments to these medications. We will provide the best of medical care in assessing and providing pain management and pain relief.

Understanding the Stages of Dying

As we are alongside somebody who is at the end of their life, it’s natural for us to be concerned and emotional about what to expect and how to make it as comfortable as possible for our loved ones and others around us. While death can often be a difficult and unfamiliar process, having a better understanding of the three main stages of dying can help to better prepare us for what may occur, how we manage it, and what we can all do.

Stage One: The Early Stage of Dying

The early stage of dying is marked by changes in appetite and drinking habits. Residents may eat and drink less frequently, consume smaller quantities, and with less enthusiasm. Even though it can be quite troubling to see our loved one losing interest in food and drink, it’s important to understand that this is normal - the body is conserving energy and does not require as much nourishment as it did before.

To provide comfort, we may wish to offer small amounts of food, sips of fluids, or ice chips. However, we believe that it is important that we respect the patient’s wishes when it comes to eating and drinking. Contrary to what some people may think, artificial or forced feeding during this time does not prevent death and can even lead to physical distress for the person.

Typically, this early stage of dying may last from a few days up to several weeks.

Stage Two: The Middle Stage of Dying

The middle stage of dying is when we will begin to see more changes in the person’s physical appearance and behaviour.

As the body’s circulation slows down, blood is reserved for helping major internal organs function. Residents may feel cold in their hands and feet, with their extremities possibly also becoming darker in appearance. During this stage, we can offer blankets to increase comfort as the person’s circulation changes. But heating pads and electric blankets are not recommended because the resident may be unable to judge if they’re becoming too hot.

The person may become increasingly less responsive to their surroundings and those around them, to the point where they may eventually become unable to speak or move at all and drift in and out of consciousness. The detachment from surroundings and relationships is the body’s physical and spiritual response to the process of dying and is perfectly natural. You should assume the person can hear everything they say. Speaking softly and touching gently, if the resident likes it, can help provide comfort.

This is also a good time for reflection, prayer, or meditation. It’s not recommended to ask the person questions that require answers.

Stage Three: The Last Stage of Dying

The final stage of dying is marked by significant changes in breathing, as well as disorientation and restlessness. Some people may have uncontrolled bowel movements or they may stop having them altogether. Their breathing may become shallow and irregular, with long pauses that grow more frequent as death approaches. There may also be sounds of chest congestion and ‘rattling’ in the throat in the final hours.

When a person enters the final stage of dying, it’s helpful to talk to them reassuringly. The person may seem disoriented and confused about the time, place, and identity of people including those close and familiar to them. This is due in part to the changes in their metabolism. It’s helpful to identify yourself by name before you speak. Speak softly and clearly when you need to communicate something important for their comfort, such as when it’s time for their medication or when a new person enters the room.

Gentle touch, if they like it, can also be comforting. Even if they’re not responsive, the person may still be able to hear others around them, which is why it’s important to speak gently. Even during this sad and distressing time, the best thing is to remain calm and present for your loved one as they make their final transition.

Some people may need medication for restlessness, continence aids like a pad, a catheter, or underbody pads. At this point, administering oxygen will not help.