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What signs indicate death is near?

The following provides an overview of the signs and symptoms indicating death is near. Please remember each patient’s experience is unique, and these may vary.

Patients meet the medical guidelines for hospice care if they have a prognosis of six months or less. If you see these signs of decline, please contact us for more information about starting hospice services.

Three to Six Months Prior to Death

  • Recurrent infections
  • Continued weight loss
  • Swallowing difficulties
  • Shortness of breath
  • Nausea/vomiting that does not respond well to medications
  • Increased pain
  • Increased edema or ascites
  • Progressive weakness/fatigue
  • Change in level of consciousness
  • Increased confusion
  • Increased ER visits/hospitalizations
  • Decrease in ability to perform ADLs
  • Increased skin fragility


One to Three months Prior to Death

  • May withdraw from friends and family
  • Spends more time sleeping
  • Gradual decrease in eating and fluid intake


One to Two Weeks Prior to Death

  • Sleeping most of the time, but can be roused
  • Changes in skin color
  • Decrease in blood pressure
  • Changes in breathing
  • Continued decrease in food and fluids


One to Two Days Prior to Death

  • Difficulty or inability to swallow
  • Decrease in blood pressure
  • Changes in breathing
  • Congestion or respiratory secretions
  • Restlessness
  • Sleeping most of the time
  • Mottling—blotchiness to skin
  • Surge of energy or alertness
  • Fluctuating body temperature
  • May or may not have pain


Hospice care provides relief from pain and symptoms at the end of life. Learn how to refer a patient to hospice care.

We can provide answers to the common questions you might have: