1.6 Describe the triggers that suggest individuals are nearing the end of life

This guide will help you answer 1.6 Describe the triggers that suggest individuals are nearing the end of life.

When supporting people in health and social care, recognising the signs that someone may be approaching the end of their life is very important. Noticing these triggers means you can provide comfort, dignity, and respect at a sensitive time. This section explores the main signs and triggers that can indicate a person is nearing death. Understanding these triggers guides care planning, ensures needs are met, and allows for important conversations with individuals and their families.

What Is the End of Life?

The term “end of life” can mean different things to different people. In health and social care, it typically refers to the last year, months, weeks, or days of a person’s life. Each person’s journey is unique; for some, the changes may come quickly, while for others, the decline is gradual.

Caring for someone in this time means being alert to physical, emotional, and behavioural changes. Recognising the triggers helps make sure a person’s wishes and needs come first. It can also help families prepare and find support.

Why Recognising End of Life Triggers Matters

Early recognition of end of life triggers means a more personalised and comfortable care approach. It can avoid unnecessary hospital stays and reassure the individual and their family. By spotting the signs early, you can help bring in services like palliative care, spiritual support, and practical help with legal and financial matters.

If you notice a change, it should be recorded according to organisational policy, discussed with senior staff, and shared with the multidisciplinary team. This ensures everyone works together and the person stays at the centre of their care.

Physical Triggers That May Suggest End of Life

Changes in the body are often the most obvious signs that someone is nearing the end of life. These can include:

• Weakened body
  The person may become frail and find it hard to do everyday tasks. They may spend more time in bed or in a chair.
• Loss of appetite and thirst
  They may eat and drink much less. This often comes from losing interest in food, trouble swallowing, or the body not needing as much energy.
• Weight loss
  Noticeable and often rapid weight loss, sometimes with muscle wasting.
• Changes in breathing (respiratory changes)
  Breathing can become irregular, shallow or noisy. You may notice long pauses between breaths (apnoea) or “Cheyne-Stokes” breathing, which is a pattern with rapid breaths followed by no breaths.
• Changes in skin
  Skin may become pale, cool, mottled (patchy blue or purple), or clammy. Hands and feet might feel cold.
• Reduced mobility
  Movement may become limited. The person may need help to turn in bed, sit, or stand.
• Increasing drowsiness or loss of consciousness
  The person could become sleepy, difficult to wake, or unresponsive.
• Incontinence
  Losing control over the bladder or bowels is common as muscles weaken.
• Difficulty swallowing (dysphagia)
  They may struggle to swallow food, drinks, or medicines.
• Change in vital signs
  Blood pressure may drop, pulse weakens or becomes irregular.
• Bleeding or fluid retention
  Some people experience bleeding or build-up of fluid, such as swollen legs or abdomen.

It is important to remember that one symptom on its own does not always mean someone is dying, but groups of these signs often indicate that the person is moving towards the final stage of life.

Emotional, Psychological, and Behavioural Triggers

The end of life is not just about physical changes. Emotional and behavioural signs may be just as important.

• Withdrawal
  The person may withdraw from family, friends, and activities they once enjoyed.
• Less interest in the world around them
  They may seem less responsive to conversation or surroundings.
• Restlessness or agitation
  Sometimes a person becomes confused, restless, or anxious. This is called terminal agitation and can be a sign of approaching death.
• Unusual dreams or hallucinations
  Talking about seeing people who have already died, or experiencing vivid dreams and visions.
• Mood changes
  Mood swings, low mood, depression or hostility may be more obvious.

These emotional triggers can be upsetting for the individual and those close to them. Support and reassurance are very important at this time.

Clinical Judgement and Medical Triggers

Healthcare professionals may use specific tools to help identify end of life. Clinical triggers include:

• Recognition of advanced, progressive, or incurable illness
  This might be cancer, heart failure, lung disease, dementia, or another life-limiting condition.
• A shift from curative treatment to care aimed at comfort
  The healthcare team may decide that treatment will no longer control the illness.
• Escalating symptoms
  Pain, breathlessness, and other symptoms may become hard to control with usual medication.
• Frequent hospital admissions
  The individual may have been to hospital several times recently, often for the same problems.
• The “surprise question”
  Doctors and nurses sometimes ask themselves: “Would I be surprised if this person were to die in the next year, months, weeks or days?” A “no” may signal that end of life is approaching.

Sometimes, disease-specific triggers are present. For example:

• Advanced cancer: Spreading cancer, not responding to treatment, unable to tolerate further therapy.
• Dementia: The person loses the ability to speak, walk or feed themselves, or develops repeated infections.
• Heart or lung disease: Severe breathlessness at rest, needing oxygen support, or resistant heart failure.

Nutritional Triggers

Food and drink are important signals of health and wellbeing. At end of life, many people stop eating or drinking. Signs include:

• Refusing meals or liquids
• Difficulty swallowing
• Nausea and vomiting
• Losing interest in favourite foods

Lack of nutrition points to the body shutting down, and providing food and fluids might no longer help. Artificial feeding is usually not started at this stage, as it may cause discomfort.

Social and Environmental Triggers

Sometimes changes in social behaviour or environment also indicate a person is nearing the end of life.

• Wanting to see family or resolve unfinished business
  A person may ask for certain people or wish to talk about the past or make peace.
• Expressing a wish to settle affairs
  Making a will, sorting out paperwork, or giving away personal items.
• Needing more help with personal care
  Extra support may be needed with washing, dressing, going to the bathroom, or moving.
• Reduced communication
  Speech and conversation may become slow or stop altogether.

Recognising these social triggers helps care workers support emotional, spiritual, and practical needs at the right time.

Use of End of Life Care Tools

Some care settings use specific tools to help spot when someone is reaching end of life. These include:

• Gold Standards Framework (GSF): Helps identify people in the final year of life and encourages planning.
• Liverpool Care Pathway (LCP): While no longer widely used, it was an early attempt to standardise end of life care.
• Supportive and Palliative Care Indicators Tool (SPICT): Helps identify individuals who may benefit from palliative care.

You do not need to diagnose or use these tools yourself, but being aware of them helps you understand the wider care process.

The Role of Observation and Reporting

Your eyes and ears are vital. No two people will have exactly the same end of life experience. You will often be the first to spot small changes.

Good care means:

• Recording changes clearly and accurately
• Reporting signs promptly to your manager or the medical team
• Observing without judgement; listen carefully to what the individual and their family say

Follow your organisation’s procedures. You are not expected to decide alone, but your input is valued.

Communication at End of Life

Spotting the triggers is just one part of caring for people at end of life. Communicating well is equally important.

When you see any of these signs, talk with the person if they wish to, and pass the information on. Be sensitive to their wishes and those of their family. Sometimes, talking about death is difficult for everyone involved. Use plain language, avoid jargon, and offer a listening ear.

If needed, help the person put wishes in place or support access to other professionals, such as a nurse, priest, or social worker.

Cultural, Spiritual, and Religious Triggers

Every person has their own beliefs and wishes. At this stage, some people look for meaning or want to follow special rituals or customs.

Be alert to:

• Changes in religious practices or requests for spiritual support
• New or urgent requests to see religious leaders or perform practices
• Wanting time alone for prayer or spiritual reflection
• Expressions of fear, hope, regret, or peace

Being aware of these triggers lets you provide care that respects each person’s background and wishes.

Recognising the Dying Phase

The last days or hours of life have a set of typical signs, sometimes called the “dying phase.” These may include:

• Breathing is irregular, shallow or noisy
• Loss of consciousness, or only semi-awake
• Cold, mottled skin on limbs
• Little or no response to speech or touch
• Loss of control over bladder or bowels
• No longer eating or drinking

At this point, comfort is the main aim of care. Pain and distress are managed, and families receive emotional support.

Remember, not everyone will show all the signs. The approach should always be individual. Be vigilant, gentle, and compassionate.

Supporting Families and Loved Ones

When you spot end of life triggers, relatives or close friends may feel distress, confusion, or grief. Some may already know what is happening, while others are caught off guard.

Good care includes:

• Giving clear, honest information (within your remit)
• Allowing them time to ask questions
• Supporting their emotional well-being; sometimes, just sitting with them can help
• Knowing when to involve other team members

Grief and shock are normal. Give families information about what is happening and what to expect, if they want it.

Ethical and Legal Considerations

Recognising triggers and discussing end of life can bring up ethical or legal questions. Record all care and changes clearly. Protect the individual’s wishes and confidentiality. Act in line with the Mental Capacity Act if decisions need to be made on behalf of someone who cannot decide for themselves. Always look for any Advance Decisions or care plans.

Barriers to Recognising End of Life Triggers

Noticing triggers can be complicated because:

• Chronic illnesses can cause slow changes
• Some families or individuals may not want to talk about dying
• Staff may worry about “getting it wrong”
• Some symptoms, such as tiredness or reduced eating, are common in both long-term illness and dying

Ask for advice when needed. Use team meetings and handovers to share observations.

Final Thoughts

Caring for people nearing the end of life calls for honesty, kindness, and close attention. By spotting the physical, emotional, and behavioural triggers early, you play a key role in making this difficult time more comfortable and meaningful.

No one experiences the end of life in exactly the same way. Your skills in observation, communication, and support help individuals and their families find peace and dignity. Trust what you see, share concerns with your team, and always keep the person’s wishes at the heart of care. By doing this, you bring comfort and humanity to those in your care at the time they need it most.