In the final phase of life, urine production may become very limited or stop altogether.
Although this can be part of the natural dying process, reduced urination is not automatically a sign that death is imminent. Dehydration, urinary retention, medication effects, kidney disease, and other treatable conditions can also cause changes in urination.
If your parent is still receiving active medical treatment, a doctor or nurse should assess a significant change. If they are receiving end-of-life care, the care team can explain what is expected and how to maintain comfort.
Families should not force a person to drink large amounts of water simply because they are worried about reduced urination. In some situations, excessive fluids may worsen swelling, breathing difficulties, or fluid accumulation.
Instead, follow the guidance of the medical team. Comfort-focused care may include regular mouth care, lip moisturizers, and small sips if the person is awake, able to swallow safely, and wants them.
7. Confusion, Restlessness, and Changes in Awareness
Changes in awareness can be particularly difficult for families to witness.
A parent who once recognized everyone immediately may begin confusing names, forgetting where they are, or speaking about people who are no longer alive. They may appear unsettled, become restless at night, or seem unable to follow a conversation.
Sometimes, they may reach toward something that family members cannot see or speak as though someone else is in the room.
These experiences can occur during the final stages of serious illness, but they are not exclusive to the dying process.
One possible explanation is delirium, a sudden change in attention, awareness, and thinking. Delirium is common among seriously ill older adults and may be caused by infection, dehydration, medication effects, organ dysfunction, pain, constipation, urinary retention, or changes in the body's chemistry.
Some causes can be treated. This is why sudden confusion should never automatically be dismissed as a normal part of aging or dying.
If your parent becomes confused unexpectedly, contact their healthcare provider. A medical assessment can help identify whether the change is related to an infection, medication, or another problem that may be relieved.
If the person is already receiving end-of-life care, tell the palliative care team about any new restlessness or distress. They can assess possible causes and recommend appropriate comfort measures.
Family members can also make the environment more reassuring:
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Speak slowly and calmly.
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Introduce yourself if your parent seems unsure who you are.
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Keep familiar objects nearby.
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Reduce unnecessary noise and bright lighting.
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Avoid arguing about things they may be seeing or believing.
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Offer gentle reassurance rather than repeatedly correcting them.
If your parent says they can see a loved one who has died, you do not necessarily need to challenge the experience. Listen calmly and ask whether they feel comfortable or frightened.
The priority is not to win an argument about what is real. It is to understand whether your parent feels safe and supported.
8. Difficulty Swallowing and Changes in the Voice
Another possible development in advanced illness is difficulty swallowing.
A parent who previously enjoyed meals may begin struggling to swallow food, water, or medication. They may cough during meals, take much longer to finish a small portion, or appear uncomfortable when trying to drink.
In the final phase of life, the muscles involved in swallowing may become weaker, and alertness may decrease. This can make eating and drinking increasingly difficult.
However, swallowing problems can also result from stroke, neurological disease, infections, medication effects, or other medical conditions. A sudden inability to swallow, especially when accompanied by facial weakness or difficulty speaking, requires urgent medical assessment.
If swallowing becomes difficult, do not force food or liquids. Doing so can cause choking or allow material to enter the lungs.
A healthcare professional may recommend a swallowing assessment and explain whether particular food textures or liquid consistencies are safer.
When someone is very close to death and no longer wants or is able to eat, the goal of care often changes from maintaining normal nutrition to preserving comfort.
Small amounts of food may be offered only when the person is awake, interested, and able to swallow safely. If they turn away, close their mouth, or appear uncomfortable, respect those signals.
Mouth care becomes especially important. Gently cleaning the mouth and applying a suitable lip moisturizer can relieve dryness even when a person is no longer drinking much.
Some families worry that allowing a loved one to eat less means they are failing to care for them. In reality, the body may no longer be able to process food and fluids in the same way. Comfort, safety, and the person's wishes should guide decisions.
9. Noisy Breathing and the Sound Sometimes Called the Death Rattle
One of the most distressing changes for relatives can be a wet, rattling sound during breathing.
This sound is sometimes called the death rattle. It may occur when a person becomes too weak or less conscious to swallow or cough effectively. Saliva and other secretions collect in the throat and upper airways, producing a bubbling or rattling noise as air passes through.
Hearing this sound can make family members fear that their loved one is suffocating.
However, the noise itself does not necessarily mean that the person is experiencing pain or feeling unable to breathe. It often occurs when awareness is significantly reduced.
The healthcare team can assess whether the person appears uncomfortable and explain what can be done.
Possible comfort measures include gently changing the person's position, keeping the head slightly elevated if appropriate, and using prescribed medication when recommended.
Deep suctioning is not routinely helpful in every situation and may cause discomfort. Family members should not attempt it themselves.