Signs that death is near, by timeframe

The timeline at a glance

Not every person shows every change, and the order can differ.

Weeks to months before death

For many people with a long illness, the first changes are slow and easy to miss. The body is using less energy, and the person begins to turn inward. Hospice guides often describe this as one to three months before death, but it can be shorter or longer. People who search for "signs 40 days before death" are usually asking about this stretch. There is no medical sign tied to 40 days.

• Sleeping more and resting through much of the day.
• Eating less. Appetite can fall over weeks or months, and weight loss follows. Offer favorite foods in small amounts, and do not force meals.
• Less interest in the outside world: the news, visitors, hobbies. The person may talk less and want fewer people around.
• More weakness, and needing more help to walk, bathe and dress.

One to two weeks before death

Hospice nurses often call the last days to a week or two transitioning. The changes become easier to see.

• Sleeping most of the time and hard to wake. In one study of people with advanced cancer, lower alertness and very low activity often began more than three days before death.
• Eating and drinking very little, with trouble swallowing liquids. In the same study, trouble swallowing liquids began about a week before death on average. Read how long someone can live after they stop eating and drinking.
• Confusion or restlessness, picking at the sheets or trying to get up. Sometimes it has a cause the nurse can treat. Read terminal agitation.
• Dreams or visions of people who have died, which many people find comforting. Read dreams and visions near death.
• Changes in the body's rhythms: blood pressure and heart rate may drift lower, and temperature may rise or fall a little.

Days before death

As the body slows further, the signs below often appear. Many of them are among the last changes, but not every person shows them.

• Breathing changes: faster, then slower, with pauses. Raising the head of the bed and a fan in the room can help.
• Cool hands and feet, and skin that looks pale, gray, blue or blotchy. A light blanket is enough.
• Much less urine, and urine that is dark.
• No longer able to swallow pills or food. The nurse can change comfort medicines to forms that do not need swallowing, such as a liquid placed in the mouth, a skin patch or a suppository.
• A short burst of energy or clarity: the person may talk, ask for food or seem like themselves. The National Institute on Aging advises families to take these moments, and to understand that they are likely temporary and not a sign of getting better.

Hours before death: the last 24 to 48 hours

In the last day or two, the changes the nurse goes by are mostly in breathing, skin and response. People who search for "last 24 hours before death" or "48 hours before death" are usually seeing these.

• Breathing with long pauses, or deep breaths that alternate with shallow ones or none at all. The jaw may move with each breath.
• Noisy, wet breathing from saliva the person can no longer swallow. It usually does not upset the person. Read the death rattle.
• Mottled skin: purple or blotchy patches on the knees, feet and hands. It often means death may come within days or hours.
• Little or no response, with the eyes half open. The pulse at the wrist may become hard to feel, and there may be almost no urine.
• Hearing may remain. Most people can still hear after they can no longer speak. Talk to the person, not about them, and say what you want to say.

What are the "7 stages of dying"?

There is no standard medical list of seven stages of dying. Lists with that name online differ from each other, and some mix up the changes of the body with the well-known stages of grief, which describe feelings, not physical signs. Hospice nurses and doctors usually speak in time windows like the ones on this page, and they always add that the windows are rough.

Can anyone tell how much time is left?

Not exactly. A nurse or doctor can often say whether they think the time is weeks, days or hours, based on the changes they see, and they will say it more confidently as the signs build. They cannot give a date. If you want to know, ask the nurse directly what they see today. It is also fine to ask the nurse to tell you when family should come.

Common questions

Read more

This page is part of signs that death is near. The other pages in the series: the death rattle, terminal agitation, how long someone can live after they stop eating and drinking, transitioning and active dying and dreams and visions near death. For the family's own feelings in these weeks, see anticipatory grief.