What Should I Expect as a Loved One Approaches the End of Life? A Compassionate Guide

End of life is one of the most profound and challenging experiences a family can face. When someone you love is approaching death, it is natural to want to know what is happening, what to expect, and how you can help.

At Authentic Living London, we often hear questions such as, “What should I expect as my loved one approaches the end of life?” Understanding some of the physical, emotional, and practical changes that may occur can make this unfamiliar territory feel a little less frightening.

Every person's dying process is different. The underlying illness, overall health, medications, care setting, and individual circumstances can all influence what happens. Recent research suggests that certain physical changes become more common as death approaches, but no single symptom can predict exactly when someone will die. Clinical judgment and communication with the person's medical team remain essential (Rocha-Baião & Reis-Pina, 2026; Simões et al., 2025).

This guide is intended to help families understand some of the changes they may encounter while also recognizing the importance of individualized medical guidance.

Common Physical Changes Near the End of Life

As the body begins to slow down, changes in eating, drinking, alertness, movement, and breathing may occur. A person may sleep more, have less interest in food, become weaker, or spend increasing amounts of time resting in bed.

These changes can be difficult for families to witness, particularly when eating and drinking have always been associated with health and strength. Near the end of life, however, reduced appetite and food intake can be part of the natural dying process rather than a sign that someone is simply not receiving enough nourishment.

Changes in consciousness can also occur. Someone who was previously alert may become increasingly sleepy or less responsive. Breathing patterns may change as death approaches, sometimes becoming irregular or developing periods of pauses. Research examining signs of imminent death has found that certain respiratory and neurological changes become more likely during the final days, although their presence or absence cannot determine the exact timing of death (Rocha-Baião & Reis-Pina, 2026; Simões et al., 2025).

Families may also notice changes in circulation, such as cooler hands and feet or changes in skin colour. Again, these signs can occur as the body's systems gradually change, but they should always be discussed with the person's healthcare providers when there is uncertainty.

Perhaps the most important thing to remember is that a physical change does not automatically mean that the person is suffering. Some changes can look alarming to family members while being less distressing to the person who is dying. The medical and palliative care team can help determine whether a particular symptom requires treatment and explain what the family is seeing.

The Emotional and Psychological Experience

The end of life involves much more than physical changes. It can bring emotional, psychological, relational, and spiritual experiences for both the person who is dying and the people who love them.

Someone nearing death may want to talk about their life, relationships, memories, regrets, hopes, or wishes. At other times, conversation may become less important than simply having someone nearby. There is no single emotional pattern that every person follows.

For family members, the emotional experience can be equally complicated. Love, sadness, fear, anger, exhaustion, relief, guilt, and anticipatory grief may exist side by side.

Research on grief before death has found that this experience is more complex than simply “grieving in advance.” A recent systematic review distinguished between anticipatory grief, which is focused on the feared or anticipated losses that will follow death, and illness-related grief, which involves grieving losses that are already occurring during the illness itself (Singer et al., 2022).

For example, a family member may be grieving the future they expected to share with their loved one while simultaneously grieving changes that have already happened. A parent may no longer be able to care for their children in the same way. A spouse may become a caregiver rather than an equal partner. A person's personality, independence, communication, or ability to participate in familiar activities may change.

These losses are real, even though the person is still physically present.

Research also suggests that pre-loss grief can be associated with significant psychological distress. A systematic review involving caregivers of people with terminal cancer found that higher levels of pre-loss grief and lower preparedness for death were associated with poorer adjustment after the death (Treml et al., 2021). Another meta-analysis found that anticipatory grief is relatively common among caregivers of people with life-threatening illnesses, reinforcing the importance of recognizing caregiver grief before the death occurs (Nielsen et al., 2022).

Preparing Without Trying to Control Everything

Preparation can provide a sense of stability during an uncertain time. It does not mean that you have to know exactly what will happen or that you need to have every detail figured out.

One helpful place to begin is with conversations about what matters most to the person who is dying. Their wishes about medical treatment, comfort, location of care, important relationships, and other end-of-life decisions can provide valuable guidance for family members and healthcare providers.

Advance care planning can also help people communicate their preferences before they become unable to speak for themselves. Research has found that advance care planning interventions can improve communication and increase completion of advance care planning and advance directives (Kim & Lee, 2020). Research specifically examining caregiver outcomes suggests that advance care planning may also provide benefits for family members, although the evidence remains mixed and additional research is needed (Malhotra et al., 2022).

Practical preparation can include organizing important documents, identifying who should be contacted when decisions need to be made, discussing funeral or memorial preferences, and determining who can help with caregiving responsibilities.

There is also value in preparing emotionally.

That might mean recording a family story.

It could involve looking through photographs together.

Sometimes it is simply sitting beside someone while their favourite music plays.

A meaningful conversation does not have to be profound. A quiet “I love you” can be enough.

Making Space for Connection

When someone is approaching the end of life, families sometimes feel pressure to make every remaining moment meaningful. That pressure can actually make an already difficult situation more stressful.

There does not need to be a perfect final conversation or profound goodbye. Being present can be meaningful in itself.

Families and patients can support one another in surprisingly ordinary ways. Research examining mutual support in palliative care found that patients and family caregivers can help one another by acknowledging the challenges they are facing, adapting to changing roles, and finding ways to remain connected through difficult circumstances (McCaughan et al., 2021).

If conversation becomes difficult, companionship can take many forms. Sitting quietly, holding a hand, watching television together, looking through photographs, sharing familiar music, or simply being nearby can all communicate love and presence.

Caring for Yourself While Caring for Someone Else

One of the hardest parts of end-of-life caregiving is remembering that your wellbeing matters too.

Family caregivers can experience substantial emotional and psychological strain. Research involving caregivers of people with advanced cancer has identified significant unmet needs and risks for anxiety, depression, caregiver burden, and difficult bereavement outcomes (Alam et al., 2020).

You may feel guilty for needing a break. Feeling frustrated with your loved one and then feel guilty for feeling frustrated is also very common. Plus, exhaustion may make even small decisions feel overwhelming. None of these experiences automatically mean that you love the person any less.

Caregiving is demanding, particularly when you are simultaneously trying to process the possibility of losing someone you love. Accepting help from family, friends, healthcare providers, respite services, or other community resources can make the experience more sustainable.

Psychosocial interventions for family caregivers have also shown potential benefits, including improvements in psychological distress, coping, self-efficacy, and quality of life (Gabriel et al., 2020).

When Should You Reach Out for Support?

You do not have to wait until you are completely overwhelmed before asking for help.

Professional support may be helpful if anxiety about the future is becoming difficult to manage, sleep is consistently disrupted, family relationships are becoming strained, or caregiving is leaving you emotionally depleted.

Support can also be valuable when you are experiencing anticipatory grief and do not know what to do with everything you are feeling.

You might feel sadness one moment and relief the next. Love can exist alongside frustration.

Gratitude can sit beside anger. Anticipating someone's death can bring both profound sorrow and a desire for their suffering to end. These emotional contradictions can be difficult to carry alone. They do not make you a bad person or a less loving family member.

You Do Not Have to Navigate This Alone

At Authentic Living London, we understand that end-of-life experiences affect the entire family. Grief does not necessarily begin when someone dies. For many people, it begins much earlier, as illness changes relationships, routines, roles, expectations, and the future they once imagined.

Our goal is not to tell you how you should feel. It is to offer a compassionate place where you can talk honestly about what is happening without judgment.

Whether you are supporting a parent, partner, friend, or another loved one, counselling can provide space to process anticipatory grief, caregiver stress, fear, uncertainty, and the many emotions that accompany an approaching loss.

You do not have to have everything figured out, or be strong every moment.

You simply need somewhere safe to put some of what you are carrying.

At Authentic Living London, we offer compassionate grief counselling and psychotherapy in London, Ontario, including support during end-of-life and life-transition experiences. If you would like to explore whether counselling might be helpful for you, we invite you to contact us to arrange a consultation.

This article is intended for educational purposes only and is not a substitute for individualized medical or palliative care advice. If you have questions about changes in your loved one's physical condition, speak with their physician, nurse, palliative care team, or other healthcare professional.

References

Alam, S., Hannon, B., & Zimmermann, C. (2020). Palliative care for family caregivers. Journal of Clinical Oncology, 38(9), 926–936. https://doi.org/10.1200/JCO.19.00018 

Gabriel, I., Creedy, D., & Coyne, E. (2020). A systematic review of psychosocial interventions to improve quality of life of people with cancer and their family caregivers. Nursing Open, 7, 1299–1312. https://doi.org/10.1002/nop2.543 

Kim, M., & Lee, J. (2020). Effects of advance care planning on end-of-life decision making: A systematic review and meta-analysis. Korean Journal of Hospice and Palliative Care, 23(2), 71–84. https://doi.org/10.14475/kjhpc.2020.23.2.71 

Malhotra, C., Huynh, V. A., Shafiq, M., & Batcagan-Abueg, A. P. M. (2022). Advance care planning and caregiver outcomes: Intervention efficacy: Systematic review. BMJ Supportive & Palliative Care, 13(e3), e537–e546. https://doi.org/10.1136/spcare-2021-003488 

McCaughan, D., Roman, E., Smith, M., & others. (2021). Mutual support between patients and family caregivers in palliative care: A systematic review and narrative synthesis. Palliative Medicine, 35(7), 1326–1341.

Rocha-Baião, B., & Reis-Pina, P. (2026). Recognizing and predicting the syndrome of imminent death (≤14 days): A systematic review. Journal of Pain and Symptom Management, 71(6), e671–e695. https://doi.org/10.1016/j.jpainsymman.2026.01.019 

Simões, C., Carneiro, R., & CardosoTeixeira, A. (2025). High specificity clinical signs of impending death: A scoping review. International Journal of Nursing Studies, 164, 105015. https://doi.org/10.1016/j.ijnurstu.2025.105015 

Singer, J., Roberts, K. E., McLean, E., Fadalla, C., Coats, T., Rogers, M., Wilson, M. K., Godwin, K., & Lichtenthal, W. G. (2022). An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review. Palliative Medicine, 36(4), 581–608. https://doi.org/10.1177/02692163221074540 

Treml, J., Schmidt, V., Nagl, M., & Kersting, A. (2021). Pre-loss grief and preparedness for death among caregivers of terminally ill cancer patients: A systematic review. Social Science & Medicine, 284, 114240. https://doi.org/10.1016/j.socscimed.2021.114240