Patient Referral

Active dying is the final stage of the dying process that lasts roughly three days. Active dying occurs after the pre-active stage of death, which lasts for about three weeks. By definition, actively dying patients are very close to death, and exhibit many signs and symptoms of near-death. Actively dying patients are often unresponsive and their blood pressure often drops significantly.

Below is a list of some of the typical signs of active dying that can occur as close as 48 hours to 3 minutes before death. While a patient may not experience all these symptoms, this list will help the patient’s family members and loved ones in recognizing and defining active dying. Additionally, if you have more questions about "what is active dying" and how to identify and help your loved one through this natural process, you can talk to a hospice care expert by calling 855-327-4677 for 24/7 support or contact us online.

What are the symptoms of active dying?

The signs and symptoms of active dying include:

  • Long pauses in breathing; patient’s breathing patterns may also be very irregular
  • Blood pressure drops significantly
  • Patient’s skin changes color (mottling) and their extremities may feel cold to the touch
  • Patient is in a coma, or semi-coma, or cannot be awoken
  • Urinary and bowel incontinence and/or decrease in urine; urine may also be discolored
  • Hallucinations, delirium, and agitation
  • Build-up of fluid in the lungs, which may cause unusual gurgling sounds

Predicting active dying.

Understanding what to expect by learning the signs and symptoms of active dying can be helpful. However, predicting active dying is still difficult. A patient may not exhibit all the signs above.

One of the clearest signs that active dying is occurring is when a patient verbally states that they believe they are dying. Another sign can include the patient’s position becoming rigid, indicating the time of death has approached.

As a loved one and/or caregiver of the patient, it’s important that you talk with a hospice nurse regarding their condition. They can identify when someone is actively dying and help you and your loved one during this time.

If you haven’t done so already, we recommend contacting a hospice provider who can help your loved one by addressing their physical, emotional, and spiritual needs at the end-of-life.

How does hospice help during the active dying stage?

During the active dying stage, hospice care becomes particularly important to ensure the patient’s physical, emotional, and spiritual needs are met. A hospice team assists patients who are actively dying and their families by providing:

  • Pain and symptom management: Hospice professionals are skilled in alleviating any pain and other distressing symptoms that occur in the active dying stage.
  • Comfort and dignity: Hospice staff are trained to prioritize the patient’s comfort and dignity with tasks like bed repositioning, bathing, and maintaining personal hygiene.
  • Emotional support: Hospice offers emotional and psychological support to both patients and their family members via social workers, counselors, and spiritual care providers.
  • Decision-making: Hospice teams facilitate open and honest communication between the patient, family, and medical professionals and help guide them in making informed decisions about care options.
  • Grief support: Hospice programs offer grief support to family members and loved ones after the person’s passing. This includes counseling, support groups, and other resources to help individuals cope with their loss.

End-of-Life signs by disease.

Learn about the specific end-of-life signs of common diseases and terminal illnesses:

More end-of-life resources.