So what are the signs to watch for? According to Kelleen Brown, a nurse practitioner with Utah Valley Hospital who specializes in palliative care, “There are some common signs that someone is nearing the end, although not every person will display all the signs. When caregivers observe these changes, they know death will occur within a few hours to a few days. Having an advanced directive in place will help ensure the dying person’s wishes are respected. ”

Here are some of the changes you may observe:

1. Loss of appetite and thirst. As the body shuts down, the person shows a decreased interest in food and drink, and he or she may have difficulty swallowing. Allow the person to eat and drink when desired, and know this isn’t painful for them. It is most comforting to keep his or her mouth and lips moist using swabs or a wet cloth.
   
   
2. Sleeping more than usual. People may spend more time sleeping and may be tired more frequently. You may have more difficulty waking them up. The best thing to do is to allow the person to sleep.
   
   
3. Disorientation or confusion. As death approaches, organs, including the brain, begin to fail. The person may stop responding to conversation or have conversations with people who can’t be seen by others.
   
   
4. Breathing will change. Breathing becomes more labored and irregular. You may hear gurgling sounds as secretions pool in the back of the throat. When death is near the person may lapse into a Cheyne-Stokes breathing pattern, which means no breaths at all for a short period followed by a gradual increase then decrease in breaths, before another period of no breaths. While observers may find the change in breathing frightening, the dying person doesn’t find it painful.
   
   
5. Change in temperature or color. During the process of death, blood moves away from the extremities toward vital organs. Though the hands or feet are cool, other areas of the body may be warm. You may also notice purplish bruised-looking skin on the legs, arms, or underside of the body where blood has collected. The skin may appear yellow or waxen as death draws nearer.

“The best thing to do is keep the person as comfortable as possible during the dying process. The person’s physician or hospice caregiver may have suggestions to help. You can also provide comfort through gentle touch and by talking to the person. Hearing and touch are the last senses to go, so talk to them, share memories, play their favorite music, hold their hand, do whatever feels right. They may not be alert or able to respond but they can still feel your love for them,” says Kelleen.

Preparing for the death of a loved one isn’t easy. Discussing death and knowing the person’s wishes ahead of time helps to ease the strain. Becoming familiar with the physical signs of death and knowing how to comfort your loved one will also help those left behind move forward.