Palliative care in the last few days of life

It’s normal for people to not have much of an appetite in their last few days of life. Eventually, someone who’s dying will stop eating and drinking. Although this can be distressing, it’s a normal part of the dying process. You can help to keep them comfortable by offering them small sips of water through a straw or from a teaspoon or wetting their lips with water.

In a person’s final few days or hours they’ll spend more and more time asleep. They may wake up for periods during the day and night and may be able to spend some time talking, or they may just find comfort from you being there with them. You may find they’re drifting in and out of consciousness.

They may not be able to communicate much with you, but that doesn’t mean they can’t hear what you’re saying. Spend time talking with them, play their favourite music, read to them or just sit and hold their hand.

During the dying process, a person’s breathing may become less regular. They may have periods of shallow breathing followed by periods of rapid deeper breathing. There can be long pauses between each breath. Their breathing may also become noisier and sound rattly because they can’t cough or swallow normal fluids in their chest or throat. This is usually more distressing for people hearing it than for the person dying. They may be more comfortable with a change of position onto their side (with the help of a nurse of carer) or you can use a small fan or open a window if they’re feeling breathless.

The person’s hands and feet can start to feel cold because of changes in their blood circulation, and their skin can become pale and uneven in colour. Covering them with blankets, or putting gloves or socks on for them, can help keep them warm. Gentle massaging or their hands and feet may also be comforting.

You may find the person becomes agitated and confused. Sometimes they might have hallucinations where they see or talk to people who aren’t actually there. They may shout or lash out, which can be distressing for you if this isn’t their usual behaviour.

There are some simple things you can do that may help:

• Have 1 or 2 familiar people sitting with them.
• Remind them who you are – you may need to this often.
• Have familiar things around them, such as photos and favourite items.
• Remind them of the day and time and help them have regular routines during the day and at bedtime.
• Help them wear their glasses and hearing aids if they have these.
• Reassure them that they’re safe if they say things that aren’t true.

If no underlying cause is found for the confusion and changes in behaviour, the person can be given medicines to help ease their restlessness, anxiety or confusion.