How Long Does Transitioning to Death Take?

Families and patients often ask us about the timeline for the end of life. While each experience is unique, understanding the stages of dying can provide clarity, prepare loved ones, and bring some peace during this challenging time. In this guide, Los Angeles and Orange County’s local hospice team at Agape Hospice & Palliative Care will explain the stages of dying and how long the transition to death takes.

Common Stages of Dying

No two individuals experience death in exactly the same way, and the timeline for transitioning can vary greatly. However, there are some common stages that patients may go through. These stages often include physical, emotional, and mental changes. Knowing these clinical signs may help families provide care and identify where they are along the dying timeline.

Months Before Death

Months before death, subtle but significant changes begin to occur, signaling that the body is gradually starting to slow down and prepare for its final stages. These changes can vary from person to person, but some common clinical signs may include shifts in energy levels, changes in appetite, and alterations in sleep patterns. Loved ones might notice the individual becoming more fatigued or withdrawing socially as the body conserves energy. These signs often serve as early indicators of the natural processes that accompany the end of life, such as:

Reduced Appetite: Eating less or favoring smaller portions as their body requires less energy
Sleepiness: Needing more rest and showing less interest in their daily activities
Being Disinterested in People or Otherwise Important Things: Pulling away from social interactions or hobbies they previously enjoyed
Increased Pain or Nausea: Experiencing discomfort or persistent symptoms as the illness progresses
Infection: Becoming more susceptible to infections due to their decreased immunity
Weight Loss: Gradual weight reduction as their appetite decreases and metabolism shifts

Weeks Before Death

Typically, physical and emotional changes become more pronounced in the weeks leading up to death. These changes can include increased fatigue, reduced appetite, and noticeable shifts in breathing patterns. Emotional responses may also vary, ranging from withdrawal and reflection to moments of clarity or heightened communication. Look for the following signs:

More Intense Sleepiness: Spending extended periods sleeping or resting as their fatigue deepens
Stopping Eating: Ceasing to consume food or liquids as their body prepares to shut down
Restlessness: Showing agitation or involuntary movements due to discomfort or confusion
Congestion: A buildup of mucus that can cause noisy or labored breathing
More Confusion: Forgetfulness or difficulty recognizing family members or surroundings
Hallucinations or Visions: Seeing or speaking about things that others cannot perceive
Changes in Vital Signs: Irregular heartbeat, lower blood pressure, or varied breathing patterns

Four to Six Days Before Death

During this stage, the body begins to exhibit more focused and noticeable signs of nearing the end of life. These may include a significant decline in energy levels, changes in breathing patterns, reduced appetite, and increased periods of rest or unresponsiveness as the body starts to conserve its remaining strength. Common symptoms include:

Atypical Vitals: Further fluctuations in blood pressure, temperature, and heartbeat
Lower Levels of Consciousness: Severely reduced alertness, and patients may hardly respond
Dysphagia of Liquids: Difficulty swallowing even small amounts of liquids

Two to Three Days Before Death

The final days may involve a deeper shutdown of the body’s systems, as vital functions such as heart rate, breathing, and circulation gradually slow down. This process is a natural part of the body’s transition and often signifies the final stages of life. Signs include:

PPS 20% or Less: The Palliative Performance Scale (PPS) indicates levels of functionality
Peripheral Cyanosis: A bluish tint to the fingers, toes, or lips due to poor circulation
Less Response to Visual Stimuli: Reduced ability to visually follow or respond to light
Drooping of the Nasolabial Fold: Relaxation and sagging facial muscles
Hyperextension of the Neck: The head tilts back due to decreased muscle control
Cheyne-Stokes Breathing: Irregular breathing with periods of rapid breaths followed by pauses
Nonreactive Pupils: Eyes no longer respond to light stimulation
Decreased Response to Verbal Stimuli: Limited or no reaction to spoken words

Less Than Two Days Before Death

The final hours bring about profound physical signals, often marking the body’s transition towards the end of life. These signals can include changes in breathing patterns, a noticeable drop in energy, and shifts in skin coloration, all reflecting the body’s gradual slowing down. Be attentive to these signs:

Death Rattle: A distinct sound caused by secretions in the throat during breathing
Apnea: Extended pauses between breaths
Respiration With Mandibular Movement: Jaw motion accompanying labored breaths
Decreased Urine Output: A significant reduction or cessation of urination
Pulselessness of Radial Artery: Difficulty detecting a pulse in the wrist
Inability to Close Eyelids: Eyelids remain partially or fully open
Grunting: Vocal noises during breathing
Fever: A sudden rise in body temperature

Why It’s Important to Understand the Clinical Signs

While it’s impossible to predict exactly when a life will end, the clinical signs above can help give patients and families a rough roadmap. For instance, those with two or more clinical signs had a 40% chance of passing within the next three days, while those with eight clinical signs had an 80% chance of dying in the next three days. Recognizing the stages of dying allows families and caregivers to organize end-of-life planning for care needs and support their loved ones with compassion.

What Is the Active Stage of Dying?

The active stage of dying is the final phase before passing. This can last from a few hours to a few days. During this time, significant physical changes, such as irregular breathing, nonresponsiveness, and minimal vital signs, occur. It’s important for families to remain close, providing emotional and physical presence to the patient.

Transitioning vs. Active Dying

Transitioning to death is a gradual process that encompasses weeks or months, with the body progressively slowing down. Active dying, on the other hand, is a shorter phase that typically happens within two days of death. Understanding the difference allows caregivers to provide appropriate support during both phases.

Death Has Emotional Signs Too

Beyond physical changes, emotional shifts are part of the process. Patients may withdraw from loved ones, find peace in their faith, or experience lucid moments when they express deeply personal thoughts. These emotional aspects are just as key as the physical signs in helping families honor the dying process.

How Our Hospice Team Can Help

With in-home hospice care, our team at Agape Hospice & Palliative Care provides comprehensive support, from medical assistance to emotional comfort. A nurse can quickly respond through our two-way communicator to address distress. Whether managing symptoms or communicating clearly about what to expect, we strive to go above and beyond for our patients and their families, offering personalized care and unmatched compassion.

Why Families Choose Agape Hospice & Palliative Care

Families in Los Angeles and Orange County trust us for our highly skilled, locally-owned care team. Unlike large corporations, we deliver personalized attention and a human touch. Our philosophy of teamwork and communication ensures every patient and family receives timely, attentive support.

Get a Free Hospice Care Consultation Now

Transitioning to death is an emotional time, but no one has to face it alone. If you’re in Los Angeles or Orange County, our team can provide the in-home hospice care you need. Whether you need immediate support or want to learn more about the stages of dying hospice care, our team is here to help. Contact us today for a free consultation.

How Long Does Transitioning to Death Take?