Care in the last days of life

When a person may be entering the last days of life, care becomes even more focused on comfort, dignity, communication, and coordinated support. NICE says it can be difficult to be certain that someone is dying, so care should be based on ongoing assessment, clear documentation, and honest communication about uncertainty as well as about likely prognosis.

Signs that may suggest the last days of life

• More sleeping or reduced consciousness
• Very limited intake or loss of appetite
• Changes in breathing pattern or noisy respiratory secretions
• Mottled skin, increasing weakness, or less mobility
• More withdrawal, less communication, or increasing fatigue
• Agitation or distress that may reflect pain, delirium, or other bodily needs

What good care looks like

Good care in the last days of life includes a clear individualised plan, regular review, comfort-focused care, mouth care, careful hydration decisions, symptom management review, and knowing who to call day or night. NICE also emphasises that current medicines should be reviewed and that medicines causing no symptomatic benefit may need stopping, while symptom-control medicines need clear review and communication.

Frontline care staff are not expected to manage the whole clinical picture alone, but they are central to comfort, observation, timely escalation, and helping families understand what they are seeing.

A practical team reminder

Care in the last days of life should be individualised, regularly reviewed, and openly communicated. The aim is comfort, dignity, and proportionate care, not automatic escalation by default.