Peterson Hospice and Palliative Care created guidelines to help caregivers better understand the physical changes of the end-of-life process, as well as the emotional and spiritual changes taking place.

The following describes the physical symptoms you may observe: End-of-life signs and helpful tips:

1. Coolness. Hands, arms, feet, and legs may be increasingly cool to the touch. The color of the skin may change and become mottled. How you can help: Keep the person warm with comfortable, soft blankets.
2. Confusion. They may not know time or place and may not be able to identify people around them. How you can help: Identify yourself by name before you speak. Speak normally, clearly and truthfully. Explain things such as, “It’s time to take your medicine now.” Explain the reason for things, such as, “So you won’t start to hurt.”
3. Sleeping. An increasing amount of time may be spent sleeping. The person may become uncommunicative, unresponsive, and difficult to arouse. How you can help: Sit quietly with them. Speak in a normal voice. Hold their hand. Assume they can hear everything you say. They probably can.
4. Incontinence. They may lose control of urinary/bowel functions. This is a common change that occurs during the end of life process. How you can help: Keep your loved one clean and comfortable, Ask your hospice nurse for advice.
5. Restlessness. The person may make repetitive motions such as pulling at the bed linen or clothing. This is due in part to decrease in oxygen. How you can help: Do not interfere with these movements or try to restrain them. Speak in a quiet, natural way. Lightly massage their forehead. Read to them Play soothing music.
6. Congestion. There may be gurgling sounds inside the chest. These may be loud. This end-of-life symptom does not indicate the onset of severe pain. How you can help: Gently turn their head to the side to drain secretions. Gently wipe their mouth with a moist cloth.
7. Urine decrease. Output may decrease and become tea colored. How you can help: Consult your hospice nurse.
8. Fluid and food decrease. Your loved one may want little or no food or fluid. The body will naturally conserve energy required for the task ahead. Food is no longer needed. How you can help: Do not force them to eat or drink if they don’t want to. It only makes them more uncomfortable. Small chips of ice or frozen juice chips might be refreshing. A cool, moist cloth on their forehead might help.
9. Change in breathing. The person may take shallow breaths with periods of no breathing for a few seconds to a minute. They may experience periods of rapid, shallow panting. These patterns are common and indicate decrease in circulation. How you can help: Elevating their head or turning them on their side may bring comfort. Hold their hand. Speak gently.
10. Fever. Increase in temperature is common. How you can help: Consult your hospice nurse. A cool, moist cloth on their forehead may bring comfort.

As end-of-life physical changes occur, your loved one is completing important work on another level. Emotional and spiritual changes may be manifested.