In the days and hours leading up to an expected death, many physiological changes occur that signify the closing down of the body before death (Box 11.1). It is important for healthcare professionals to have an understanding of this process so that they can provide information and reassurance for patients and families. Cheyne–Stokes breathing and cardiovascular changes (e.g. peripheral vasoconstriction) are common. For the patient and their family to have sufficient time to express their preferences for end‐of‐life care, recognition of dying must occur as early as possible.

The last weeks of life for most people are characterized by a progressive physical decline, frailty, lethargy, worsening mobility, reduced oral intake, and little or no response to medical interventions. These changes can be subtle and can first be identified by nursing staff, allied health professionals or family members. In cancer, which characteristically has a smooth downward trajectory in the last few weeks, death can be easier to predict than in non‐cancer diseases such as chronic obstructive pulmonary disease and heart failure, which are characterized by relapses and remissions. Similarly, death from frailty or dementia can be difficult to predict because patients can live for a long time with a very poor level of function, making the dying phase difficult to distinguish (Sleeman [139]).