How to Know When Someone With Dementia Is Nearing Death

Many people with dementia live to reach the most advanced stages of the condition. At this last stage, it’s hard for them to communicate what they’re thinking and feeling. And this makes it hard to know when they’re in the final days and hours before death. 

If you’re caring for someone with dementia, there are some signs to help you know when they are nearing the end of their life. And preparation can help alleviate some of the stress and grief that naturally occurs during this time. 

How do you know when someone is in the final stages of dementia?

Dementia is a progressive condition. This means it steadily gets worse with time. Everyone follows a different path through the stages of dementia. But there are some common signs that someone with dementia is in the final stages and nearing the end of their life. You will notice they: 

• Need more day-to-day help: They will need assistance with nearly all activities of daily living, like getting dressed and bathing.

• Eat and drink less: It’s normal for a person who is nearing death to lose interest in food and drink. 

• Have trouble swallowing: It will get harder for them to swallow their saliva. Because of this, they may have noisy breathing or increased coughing.

• Talk less: They may become less interactive and be able to communicate with only single words.

• Have difficulty walking: They will have less energy and strength to move around. This decline in mobility and balance might also mean they fall more often.

• Sleep more: As someone moves around less, this usually means they spend more time in bed. 

Even if someone is in the late stages of dementia, it doesn’t necessarily mean that death is near. For some, their condition can decline quickly. For others, it happens over the course of several weeks or months. But there are some additional signs that can signal someone is likely in their final days. 

7 signs that someone with dementia is near the end of life

The end-of-life journey looks different for everyone. But there are seven signs that suggest someone is likely in the final days or hours before death:

1. They have changes in behavior. You will likely notice a decline in their mental status. This may mean they’re more sleepy and less responsive. Or it may look like confusion, restlessness, and emotional outbursts. 

2. They stop speaking. A decline in their responsiveness may mean they may stop speaking or responding to you. 

3. They stop eating or drinking. A complete loss of interest in food or drink is common in the final stage before death. 

4. They have difficulty breathing. People who are close to dying may breathe quickly, slowly, or they may gasp for air. They may also have moments when they stop breathing completely for a few seconds before starting again.

5. Their body temperature drops. You may notice their skin, especially in their hands and feet, feels cooler to the touch. 

6. Their heart rate changes. Their pulse may speed up or slow down. But in the final minutes or hours, the heart rate typically slows down.

7. They have moments of clarity. This is also called “paradoxical” or “terminal lucidity.” It refers to the way someone with dementia may suddenly be able to recall memories and recognize family members moments before dying. 

Keep in mind that not every person with dementia will show these signs before death. And not all of these signs necessarily mean that death is near. Someone with signs of advanced dementia may live with these symptoms for several months. For most, it is a gradual decline. Someone with dementia is less likely to die suddenly, unless from another underlying health condition.

What are causes of death in someone with dementia?

For someone with dementia, the cause of death is not always obvious. And there may not be a definitive illness that precedes death. In fact, a person with dementia can die from dementia. 

But often, someone with dementia will die from another illness. And that illness may or may not be related to their dementia. 

Some complications from dementia that can lead to death include:

• Blood clot: When someone is not moving around much, they’re at higher risk of blood clots. Blood clots can then travel to the lungs or brain, where they can be fatal.

• Urinary tract infection (UTI): People with dementia may be at increased risk of developing UTI since their ability to empty their bladder is affected. And in older adults, UTIs can be more serious and lead to sepsis, which is life-threatening. 

• Pneumonia: Since dementia can affect a person’s ability to swallow, food and saliva may accidentally enter the lungs. This can then lead to pneumonia. And like a UTI, this infection can be life-threatening.

Caregiver advice: Preparing for the death of someone with dementia

If you’re caring for someone with dementia, an end-of-life care plan can help take away a lot of the stress and fear around death. Even though it can be hard to talk about these topics, it’s never too soon to discuss future care. This is especially true for people with dementia, since the condition can affect a person’s ability to make decisions for themselves in the final stages. 

Talk to the person about what they want

It’s important to discuss advance care planning with your loved one. This way, you know what types of treatment they want — or don’t want — when they are nearing the end of their life. And if they’re at a stage when they can no longer decide this for themselves, don’t hesitate to reach out to their healthcare provider. They can help guide you through what makes sense with their current health status.

Make legal and financial plans

There are many resources to help with the financial burden of caring for someone with dementia. And there are important legal documents to have in place that outline things like guardianship and power of attorney.

Provide comfort when you can

There are simple ways to provide comfort to someone with dementia who is dying. You can read to them, play music, brush their hair, or hold their hand. You can also use a scent that they like or give them something soft to hold. You can share a memory box with them. And just simply being present with the person may provide comfort for both of you.

Give yourself grace

Caregiving is a hard job. Many caregivers feel some sense of relief after a loved one with dementia dies. If you are caring for someone with dementia, it’s OK to take breaks when you need it. Taking time for yourself can help you better prepare and cope with their death. 

Mental health resources and support

While caring for someone with dementia, it’s important to also take care of yourself and get help with caregiving. You can do this in several ways:

• Join a support group. Search online for groups near you that arrange events in-person or virtually.

• Use relaxation techniques. There are many different breathing exercises you can try. A simple one is to close your eyes, picture a place that is calm, and focus on taking slow and deep breaths. This simple exercise can lower your stress level.

• Tap into community resources. The Alzheimer’s Association has an online community resource center for easy access to services like social engagement groups, education programs, and tools for self-care.

• Connect with friends and family. Create a calendar so that loved ones, friends, and others know when you need their support. And reach out to your support group when you need some company and time to unwind. 

• Find professional help. Mental health professionals can guide you through understanding and managing your feelings. Together, you can build a plan that helps you process the stress and grief you may feel before and after the death of a loved one.

Why trust our experts?

Written by:

Cherilyn Davis, MD

Cherilyn Davis, MD, is a board-certified pediatrician in New York City. She has held local and national roles at the American Medical Women’s Association including board member of the physician division and physician chair of social media.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Our editorial standards

Meet our experts