Not all end-of-life experiences are alike. Death can come suddenly, or a person may linger in a near-death state for days. For some older adults at the end of life, the body weakens while the mind stays clear. Others remain physically strong while cognitive function declines. It’s common to wonder what happens when someone is dying. You may want to know how to provide comfort, what to say, or what to do.

In this article, you will read about ways to help provide care and comfort to someone who is dying. Such care often involves a team: Always remember to check with the person’s health care team to make sure these suggestions are appropriate for the situation.

What is end-of-life care?

End-of-life care is the term used to describe the support and medical care given during the time surrounding death. This type of care does not happen only in the moments before breathing ceases and the heart stops beating. Older people often live with one or more chronic illness and need significant care for days, weeks, and even months before death.

The end of life may look different depending on the person’s preferences, needs, or choices. Some people may want to be at home when they die, while others may prefer to seek treatment in a hospital or facility until the very end. Many want to be surrounded by family and friends, but it’s common for some to slip away while their loved ones aren’t in the room. When possible, there are steps you can take to increase the likelihood of a peaceful death for your loved one, follow their end-of-life wishes, and treat them with respect while they are dying.

Generally speaking, people who are dying need care in four areas: physical comfort, mental and emotional needs, spiritual needs, and practical tasks. Of course, the family of the dying person needs support as well, with practical tasks and emotional distress.

End of life: Providing physical comfort

Discomfort during the dying process can come from a variety of sources. Depending on the cause of the discomfort, there are things you or a health care provider can do to help make the dying person more comfortable. For example, the person may be uncomfortable because of:

• Pain
• Breathing problems
• Skin irritation, including itching
• Digestive problems
• Temperature sensitivity
• Fatigue

Pain. Not everyone who is dying experiences pain. For those who do, experts believe that care should focus on relieving pain without worrying about possible long-term problems of drug dependence or abuse.

Struggling with severe pain can be draining and make the dying person understandably angry or short-tempered. This can make it even harder for families and other loved ones to communicate with the person in a meaningful way.

Caregivers and other family members can play significant roles in managing a dying person’s pain. But knowing how much pain someone is in can be difficult. Watch for clues, such as trouble sleeping, showing increased agitation, or crying. Don’t be afraid of giving as much pain medicine as is prescribed by the doctor.

Pain is easier to prevent than to relieve, and severe pain is hard to manage. Try to make sure that the level of pain does not get ahead of pain-relieving medicines. Tell the health care professionals if the pain is not controlled because medicines can be increased or changed. Palliative medical specialists are experienced in pain management for seriously ill patients; consider consulting with one if they’re not already involved (see What Are Palliative Care and Hospice Care?).

Breathing problems. Shortness of breath or the feeling that breathing is difficult is a common experience at the end of life. The doctor might call this dyspnea. To help ease breathing for your loved one, try raising the head of the bed, opening a window, using a humidifier, or using a fan to circulate air in the room. Sometimes, morphine or other pain medications can help relieve the sense of breathlessness.

There may be times when a dying person has an abnormal breathing pattern, known as Cheyne-Stokes breathing. The person’s breathing may alternate between deep, heavy breaths and shallow or even no breaths. Some people very near death might have noisy breathing, sometimes called a death rattle. In most cases, this noisy breathing does not upset the dying person, though it may be alarming to family and friends. You may try turning the person to rest on one side or elevating their head. Prescription medicine may also help.

Skin irritation. Skin problems can be very uncomfortable for someone when they are dying. Keep the person’s skin clean and moisturized. Gently apply alcohol-free lotion to relieve itching and dryness.

Dryness on parts of the face, such as the lips and eyes, can be a common cause of discomfort near death. These tips may help:

• Keep their lips moist with lip balm and their mouth clean with a soft, damp cloth.
• Gently dab an eye cream or gel around the eyes.
• Try placing a damp cloth over the person’s closed eyes.
• If the inside of the mouth seems dry, giving ice chips (if the person is conscious) or wiping the inside of the person’s mouth with a damp cloth, cotton ball, or specially treated swab might help.

Sitting or lying in one position can put constant pressure on sensitive skin, which can lead to painful bed sores (sometimes called pressure ulcers). When a bed sore first forms, the skin gets discolored or darker. Watch carefully for these discolored spots, especially on the heels, hips, lower back, and back of the head.

Turning the person in bed every few hours may help prevent bed sores and stiffness. Try putting a foam pad under the person’s heel or elbow to raise it off the bed and reduce pressure. Ask a member of your health care team if a special mattress or chair cushion might also help.

Digestive problems. Nausea, vomiting, constipation, and loss of appetite are common issues at the end of life. Swallowing may also be a problem. The causes and treatments for these symptoms vary, so talk to a doctor or nurse about what you’re seeing. Medicines can control nausea or vomiting or relieve constipation, all of which are common side effects of strong pain medications.

If the person loses their appetite, try gently offering favorite foods in small amounts. Serve frequent, smaller meals rather than three larger ones. Help with feeding if the person wants to eat but is too tired or weak.

But don’t force a dying person to eat. Losing one’s appetite is a common and normal part of dying. Going without food and/or water is generally not painful, and eating and drinking can add to a dying person’s discomfort. A conscious decision to give up food can be part of a person’s acceptance that death is near.

Temperature sensitivity. When a person is closer to death, their hands, arms, feet, or legs may be cool to the touch. Some parts of the body may become darker or blueish. People who are dying may not be able to tell you that they are too hot or too cold, so watch for clues. For example, someone who is too warm might repeatedly try to remove a blanket. You can remove the blanket and place a cool cloth on the person’s head.

Hunching their shoulders, pulling the covers up, and shivering can be signs the person is cold. Make sure there is no draft, raise the heat, and add another blanket. Avoid electric blankets because they can get too hot.

Fatigue. It is common for people nearing the end of life to feel tired and have little or no energy. Keep things simple. For example, a bedside commode can be used instead of walking to the bathroom. Providing a stool so the person can sit in the shower, or sponge baths in bed can also help.

End of life: Managing mental and emotional needs

End-of-life care can also include helping the dying person manage mental and emotional distress. Someone who is alert near the end of life might understandably feel depressed or anxious. It is important to treat emotional pain and suffering. You might want to contact a counselor, possibly one familiar with end-of-life issues, to encourage conversations about feelings. Medicine may help if the depression or anxiety is severe.

The dying person may also have some specific fears and concerns. He or she may fear the unknown, or worry about those left behind. Some people are afraid of being alone at the very end. These feelings can be made worse by the reactions of family, friends, and even the medical team. For example, family and friends may not know how to help or what to say, so they stop visiting, or they may withdraw because they are already grieving. Doctors may feel helpless and avoid dying patients because they cannot help them further.

And some people may experience mental confusion and may have strange or unusual behavior, making it harder to connect with their loved ones. This can add to a dying person’s sense of isolation.

Here are a few tips that may help manage mental and emotional needs:

• Provide physical contact. Try holding hands or a gentle massage.
• Set a comforting mood. Some people prefer quiet moments with fewer people. Use soft lighting in the room.
• Play music at a low volume. This can help with relaxation and lessen pain.
• Involve the dying person. If the person can still communicate, ask them what they need.
• Be present. Visit with the person. Talk or read to them, even if they can’t talk back. If they can talk, listen attentively to what they have to say without worrying about what you will say next. Your presence can be the greatest gift you can give to a dying person.

Spiritual needs at the end of life

For people nearing the end of life, spiritual needs may be as important as their physical concerns. Spiritual needs may include finding meaning in one’s life, ending disagreements with others, or making peace with life circumstances. The dying person might find comfort in resolving unsettled issues with friends or family. Visits from a social worker or a counselor may help.

Many people find solace in their faith. Others may struggle with their faith or spiritual beliefs. Praying, reading religious texts, or listening to religious music may help. The person can also talk with someone from their religious community, such as a minister, priest, rabbi, or imam.

Family and friends can talk to the dying person about the importance of their relationship. For example, adult children may share how their father has influenced the course of their lives. Grandchildren can let their grandfather know how much he has meant to them. Friends can share how they value years of support and companionship. Family and friends who can’t be present in person can send a video or audio recording of what they would like to say, or a letter to be read out loud.

Sharing memories of good times is another way some people find peace near death. This can be comforting for everyone. Some doctors think that dying people can still hear even if they are not conscious. Always talk to, not about, the person who is dying. When you come into the room, identify yourself to the person. You may want to ask someone to write down some of the things said at this time — both by and to the person who is dying. In time, these words might serve as a source of comfort to family and friends.

There may come a time when a dying person who has been confused suddenly seems to be thinking clearly. Take advantage of these moments but understand that they are likely temporary and not necessarily a sign of getting better. Sometimes, a dying person may appear to see or talk to someone who is not there. Resist temptation to interrupt or correct them, or say they are imagining things. Give the dying person the space to experience their own reality. Sometimes dying people will report having dreams of meeting deceased relatives, friends, or religious figures. The dying person may have various reactions to such dreams, but often, they are quite comforting to them.

Providing support for practical tasks

Many practical jobs need to be done at the end of life — both to relieve the person who is dying and to support the caregiver. A person who is dying might be worried about who will take care of things when they are gone. A family member or friend can offer reassurance — “I’ll make sure your African violets are watered,” “Jessica has promised to take care of Bandit,” “Dad, we want Mom to live with us from now on” — which may help provide a measure of peace. You also may remind the dying person that their personal affairs are in good hands.

Everyday tasks can also be a source of worry for someone who is dying and can overwhelm a caregiver. A family member or friend can provide the caregiver with a much-needed break by helping with small daily chores around the house such as picking up the mail, writing down phone messages, doing a load of laundry, feeding the family pet, or picking up medicine from the pharmacy.

Caregivers may also feel overwhelmed keeping close friends and family informed. A family member or friend can help set up an outgoing voicemail message, a blog, an email list, a private Facebook page, or even a phone tree to help reduce the number of calls the caregiver must make. Listed at the end of this article are some organizations that make setting up such resources easy and secure.

Providing comfort and care for someone at the end of life can be physically and emotionally exhausting. If you are a primary caregiver, ask for help when you need it and accept help when it’s offered. Don’t hesitate to suggest a specific task to someone who offers to help. Friends and family are usually eager to do something for you and the person who is dying, but they may not know what to do.

In the end, consider that there may be no “perfect” death so just do the best you can for your loved one. The deep pain of losing someone close to you may be softened a little by knowing that, when you were needed, you did what you could.

To learn more, please visit https://www.nia.nih.gov/health/end-life/providing-care-and-comfort-end-life.

Osteoarthritis is the most common form of arthritis among older adults. It is also one of the most common causes of physical disability among adults.

Osteoarthritis is a degenerative joint disease that happens when the tissues that cushion the ends of the bones within the joints break down over time. These changes usually develop slowly and worsen gradually, causing pain, stiffness, and swelling. In some cases, people living with this disease are no longer able to work or perform daily tasks.

There is no way to reverse osteoarthritis, but the symptoms of osteoarthritis can usually be managed with lifestyle changes and medications.

Who is at risk for osteoarthritis?

Anyone can get osteoarthritis, but it is more common as people age. Women are more likely than men to have osteoarthritis, especially after age 50. Other factors that may make it more likely to develop osteoarthritis include:

• Overweight or obesity
• History of injury or surgery to a joint
• Overuse from repetitive movements of the joint
• Joints that do not form correctly
• Family history of osteoarthritis

Each of these risk factors can cause tissues within the joints to break down and lead to osteoarthritis. You can decrease your chances of developing osteoarthritis by changing the risk factors you can control.

Symptoms of osteoarthritis

Osteoarthritis symptoms range from stiffness and mild pain to persistent, severe joint pain. Common signs include swelling and tenderness, stiffness after getting out of bed, and a crunching feeling or sound of bone rubbing on bone. However, not everyone with osteoarthritis feels pain.

Osteoarthritis most commonly affects the hands, lower back, neck, and weight-bearing joints such as knees, hips, and feet. Osteoarthritis in any of these joints can lead to physical disability.

Hands. Osteoarthritis of the hands seems to run in families. If you have family members who have had osteoarthritis in their hands, you’re at greater-than-average risk of having it, too. Women are more likely than men to have osteoarthritis in the hands. For most women, it develops after menopause. When osteoarthritis involves the hands, small, bony knobs may appear on the end and middle joints (those closest to the nails) of the fingers. Fingers can become enlarged and gnarled, and they may ache or be stiff and numb. The base of the thumb joint also is commonly affected by osteoarthritis.

Knees. The knees are among the joints most commonly affected by osteoarthritis. Symptoms of knee osteoarthritis include stiffness, swelling, and pain, which make it hard to walk, climb, and get in and out of chairs and bathtubs. You may hear a grinding or scraping noise when walking or moving. Over time, the knee may start to buckle.

Hips. The hips are also a common site for osteoarthritis. As with knee osteoarthritis, symptoms of hip osteoarthritis include pain and stiffness of the joint. But sometimes pain is felt in the groin, inner thigh, buttocks, or knees. Osteoarthritis of the hip may limit the ability to move and bend, making daily activities such as dressing and putting on shoes a challenge.

Spine. Osteoarthritis of the spine may show up as stiffness and pain in the neck or lower back. In some cases, arthritis-related changes in the spine can cause pressure on the nerves where they exit the spinal column, resulting in weakness, tingling, or numbness of the arms and legs. In severe cases, these changes can even affect bladder and bowel function.

Regardless of how osteoarthritis affects an individual, over time, their daily activities may become difficult, such as going up stairs, getting on or off the toilet or in and out of a chair, gripping a pen, or walking across a parking lot. Pain and other symptoms of osteoarthritis may lead a person to feel depressed, get tired easily, or have trouble sleeping. Fortunately, there are treatments to help manage the symptoms.

How is osteoarthritis diagnosed?

To make a diagnosis of osteoarthritis, most health care providers use a combination of methods and tests. Your doctor may:

• Ask about your symptoms and medical history
• Perform a physical examination
• Use X-rays and other imaging tests to look at your joints
• Order laboratory tests to rule out other problems that could be causing your symptoms

If you have questions about your diagnosis, talk to your doctor. Your primary care provider may refer you to a rheumatologist, a doctor who specializes in arthritis and other related conditions.

Osteoarthritis treatment and pain management

There is no cure for osteoarthritis, therefore, doctors focus on treatments to ease your pain, help you move better, and stop the disease from getting worse. Treatment plans often include:

Exercise. A safe, well-rounded exercise program can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance. Try stretching and balance exercises as well as low-impact activities such as walking, cycling, swimming, or tai chi. Always talk with your doctor before starting a new exercise program. Remember to start slowly and take the time to adjust to a new level of activity.

Weight control. If you are affected by overweight or obesity, managing your weight can reduce stress on the joints, which may reduce pain, prevent more injury, and increase mobility.

Medication. Over-the-counter medications, including oral pain relievers and arthritis creams, can be helpful. Your doctor may also give you a prescription for a pill or inject a medication directly into the joint to reduce inflammation and pain.

Surgery. If other treatments are not helping and the joint damage is extensive, your doctor may suggest surgery. Surgeries that help treat osteoarthritis include osteotomy, which removes a small piece of bone to relieve pressure on the affected joint, and joint-replacement surgery, which removes a part or all of the damaged joint and replaces it with a plastic, metal, or ceramic joint.

Complementary therapy. Some research shows that complementary approaches, such as massage and acupuncture, may help relieve osteoarthritis pain. Before using other therapies, talk with your doctor about the best options for your treatment.

Take steps to help manage your pain and work toward a better quality of life:

• Try heat and cold treatments to help reduce pain.
• Use a cane or walker to help move around safely. Your doctor or therapist may suggest other devices to help with other daily activities, such as jar openers.
• Practice good posture to reduce pressure on joints.
• Make several trips and keep loads small when bringing in groceries and other purchases.
• Avoid repetitive activities, such as bending at the waist, when possible.
• Reach out online and in your community for support groups.

To learn more, please visit https://www.nia.nih.gov/health/osteoarthritis/osteoarthritis.

Diabetes is a serious disease that affects many older adults. Diabetes occurs when a person’s blood glucose, also called blood sugar, is too high. The good news is that you can take steps to delay or prevent type 2 diabetes, which is the most common form of the disease to develop in older adults. If you already have diabetes, there are ways to manage the condition and help prevent diabetes-related health problems.

What is diabetes?

Glucose is the body’s main source of energy. Our bodies can make glucose, and glucose also comes from the food we eat. To use glucose as energy, the body needs insulin, a hormone that helps glucose get into cells. If you have diabetes, your body may not make enough insulin, use insulin in the right way, or both. That can cause too much glucose to stay in the blood, which can cause health problems over time.

Types of diabetes

The main types of diabetes in older adults are type 1 and type 2:

• Type 1 diabetes: In this form of diabetes, the body makes little or no insulin. Although older adults can develop type 1 diabetes, it begins most often in children and young adults, who then have diabetes for life. People with type 1 diabetes need to take insulin every day.
• Type 2 diabetes: In this condition, the most common form of diabetes, the body’s cells don’t use insulin properly. It occurs most often in middle-aged and older adults, but it can also affect children. Your chance of developing type 2 diabetes is higher if you have risk factors such as overweight or obesity, an inactive lifestyle, a family history of diabetes, or a history of gestational diabetes (a type of diabetes that develops during pregnancy). People who are African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander also have a higher risk of developing type 2 diabetes than people from other backgrounds.

Prediabetes is a condition that occurs when glucose levels are higher than normal but not high enough to be diagnosed as diabetes. Millions of older Americans have prediabetes. Although people with prediabetes have a greater chance of developing type 2 diabetes, there are ways to help prevent or delay the disease. These include maintaining a healthy weight, exercising, having your glucose level checked regularly, and talking with your doctor about medications and lifestyle changes that may help reduce your risk.

Symptoms of diabetes

Symptoms of diabetes may include feeling tired, increased hunger or thirst, losing weight without trying, urinating often, and numbness or tingling in hands or feet. You may also get blurred vision and skin infections, and your body may heal more slowly from cuts and bruises.

In people with type 2 diabetes, symptoms often develop slowly and may go unnoticed for a long time. Some people with type 2 diabetes have no symptoms, and they only find out that they have the condition when other diabetes-related health problems develop.

Sometimes older adults dismiss the symptoms of diabetes as just part of “getting old,” but they can be signs of a serious problem. Talk with your doctor if you have any symptoms or are concerned about developing diabetes.

Tests for diabetes

If you have symptoms or risk factors for diabetes, it’s important to get tested. Getting an early diagnosis can help you manage your diabetes and may prevent health problems. Doctors use several blood tests to help diagnose diabetes:

• The fasting plasma glucose test measures your blood glucose at a single point in time. Most of the time, your doctor will give you the test in the morning after you have fasted (had nothing to eat or drink except water) for at least eight hours.
• The A1C test shows your average blood glucose level over the past three months. You can eat and drink before this test. The A1C test may not be accurate in people with certain other diseases and conditions, so your doctor may use other tests in addition to A1C to diagnose diabetes.
• The random plasma glucose test also measures your blood glucose at a single point in time. It is given at any time during the day and does not require fasting.
• The oral glucose tolerance test has two steps: first, your blood glucose level is tested after you have fasted overnight. Then you drink a sugary drink and have your blood glucose level tested again two hours later. if your glucose level is high, you may have diabetes.

If a blood test suggests you have diabetes, your doctor may do a second blood test to confirm the diagnosis.

Managing type 2 diabetes

A person with diabetes may need to manage the disease with lifestyle changes, medication, or both. Many people with type 2 diabetes can manage their blood glucose levels with diet and exercise alone. Others may need diabetes pills or insulin injections, along with medicines to manage other conditions like high blood pressure and high cholesterol. Ask your health care provider questions about your medications to make sure you understand how they work, how to take them, and what side effects may occur.

Managing your diabetes involves taking care of yourself each day. Your daily self-care plan to control your blood glucose may include:

• Tracking your glucose levels. Very high blood glucose levels (called hyperglycemia) or very low blood glucose levels (called hypoglycemia) can put your health at risk. Your plan will show how often you should check your glucose and how often to get the A1C test. If you are managing your diabetes without taking insulin, you may not need to check your glucose as often.
• Making healthy food choices. The food you eat affects blood glucose levels, so it’s important to learn what’s best for you to eat, how much, and when. Work with your health care team to manage your weight and to lose weight if necessary.
• Being active. Walking and other forms of daily exercise can help improve glucose levels in older people with diabetes. Set a goal to be active most days of the week and create a fitness plan that fits your schedule and abilities. Your health care team can help.
• Taking your medicines. You should take medicines as prescribed even when you feel good. Tell your doctor if you have any side effects or cannot afford your medicines. Also, let your doctor know if you have trouble taking your medicines or keeping track of your medication schedule.

Diabetes can affect many parts of your body. If diabetes is untreated or poorly managed, it can cause serious health problems over time, such as damage to the eyes, kidneys, nerves, feet, and heart. People with type 2 diabetes may also be at greater risk for cancer, depression, and dementia. Here are more strategies to stay as healthy as possible with diabetes:

• Manage your blood pressure. Get your blood pressure checked often. High blood pressure increases the risk for heart disease and can damage the eyes and kidneys.
• Manage your cholesterol. At least once a year, get a blood test to check your cholesterol and triglyceride levels. High levels may increase your risk for heart problems.
• Stop smoking. Smoking raises your risk for many health problems, including heart attack and stroke. If you smoke, take steps to quit.
• Have yearly eye exams. Finding and treating eye problems early can help keep your eyes healthy.
• Check your kidneys yearly. Because diabetes can affect your kidneys, getting recommended urine and blood tests will show if your kidneys are healthy.
• Get flu shots every year and the pneumonia vaccine. A yearly flu shot will help keep you healthy. If you’re over 65, make sure you have had the pneumonia vaccine. If you were younger than 65 when you had the pneumonia vaccine, you may need another one. Ask your doctor.
• Care for your teeth and gums. Brush your teeth and floss daily. Have your teeth and gums checked twice a year by a dentist to avoid serious problems.
• Protect your skin. Keep your skin clean and use skin moisturizers for dryness. Take care of minor cuts and bruises to prevent infections.
• Check your feet. Keep your feet clean by washing them every day and help protect your feet from damage by wearing shoes and socks at all times. Take time to look at your feet every day for any red patches. Ask someone else to check your feet if you can’t. If you have sores, blisters, breaks in the skin, infections, or calluses, see a foot doctor, called a podiatrist.
• Keep up with cancer screenings. Ask your doctor which screenings to get based on your age, sex, and other risk factors.
• Be prepared. Ensure you always have several days’ worth of supplies on hand for testing and treating your diabetes in case of an emergency.
• Talk with your doctor about your concerns. If you think you might need help with your management plan, are depressed, are worried about your memory, or have any other concerns, talk with your doctor. There may be ways to help.

When you visit your health care team, your providers will assess how well you are managing your diabetes. Your care plan may change, or you may need more information and support. A change in health, such as a new diagnosis or complication, or a change in care, such as going home from the hospital, may also lead to updates to your plan.

To learn more, please visit https://www.nia.nih.gov/health/diabetes/diabetes-older-people.