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​​This aims to guide you through the physical symptoms to expect during the final hours as you prepare to say goodbye to your loved one.

The ‘final hours’ refer to the period just before death occurs, which may range from hours to short days.

Physical symp​​toms when death approaches.

  • ​Spending more time sleeping
  • ​May be difficult to arouse or respond to you
  • Not eating
  • ​​​​​​​Reduced interest in food or drinks as body begins to conserve energy naturally
  • However if still alert, may feed small teaspoons of their favourite drinks or food to allow pleasure tasting
  • Confusion
  • ​Reduced conscious level
  • Sometimes may appear restless in bed, gesture with hands, or speak incoherently
  • Lowered body temperature
  • ​Fingers and toes become cool to touch as body redirects blood circulation to vital organs
  • Purplish blue discolouration appear at the palms and soles of feet
  • Reduced urine output
  • ​A result of reduced intake
  • Change in breathing pattern
  • Tends to breathe with mouth open as muscles become more relaxed
  • ​May develop deep, rapid breathing alternating with periods of shallower breathing or cessation of breathing
  • Gurgling
  • ​Collection of saliva and mucus at back of throat
  • A result of loss of coughing or swallowing reflexes

Preparing to say goodbye...​
​Communicate when your loved one is most alert. Hold his/ her hand and speak gently into the ear using short, simple sentences. If drowsy, continue to talk calmly and reassuringly as hearing is the last sense to be lost.

Four important things you may want to say to express your feelings:

  • ​​​​Please forgive me
  • I forgive you
  • Thank you
  • I love you

You may also play your loved one’s favourite music softly in the room, or to recite prayers to provide spiritual reassurance.


  1. Dover Park Hospice
  2. Singapore Hospice Coun​cil​

​- Article contributed by Palliative & Supportive Care, Department of Integrated Care - 

Senior Health; Caregiving

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