What science and medicine know about aging, dying and grief

Science describes how bodies and minds work. It does not, by itself, answer questions of meaning or what may follow death. People of every faith, and of none, use what science has learned.

Why we age

Aging is not one thing that goes wrong. Over a lifetime, small kinds of damage build up in cells and tissues: changes in DNA, worn-out proteins, cells that stop dividing, and weaker repair systems. The body becomes less able to recover from stress, illness or injury. Doctors call this frailty when it becomes marked.

People age at very different rates. Genes, lifelong health, exercise, social connection, and chance all play a part.

Feelings in later life

Research has found some things that surprise many younger people:

• Many older adults report less fear of death than middle-aged adults do.
• Many become more focused on what matters most. Psychologists have found that as people sense their time is limited, they tend to spend it on close relationships and meaningful activities, and often pay more attention to positive things.
• Looking back helps many people. Reviewing one's life, telling stories and sharing what one has learned (sometimes called life review) is linked with greater peace for many older people. Some palliative care teams offer "dignity therapy", where a person records their life story and messages for family.

What dying often looks like

Every death is different, but in a slow, expected death (for example from cancer, heart failure or dementia), hospice nurses often see these changes in the last days or weeks:

• Less eating and drinking. The body slows down and needs less. This is a natural part of dying, not starvation. Swabbing the mouth and lips helps comfort.
• More sleep, and harder to wake.
• Confusion or restlessness. Some people pick at sheets, or see or talk to people who are not there, often family members who have died. Many families find this comforting rather than frightening.
• Breathing changes. Breathing may become irregular, with long pauses. Saliva may collect in the throat and make a rattling sound. This usually bothers the family more than the person; changing their position can help.
• Cool, blotchy skin on the hands, feet and knees, as circulation slows.
• A brief rally. Some people become suddenly more alert, talkative or hungry shortly before death. In people with dementia, this is sometimes called terminal lucidity. It is not well understood.

Pain and breathlessness can almost always be eased. Palliative care and hospice teams specialize in this.

Hearing may last. A small study of hospice patients found that the brain still responded to sounds in some people who were no longer responsive. Many hospice workers encourage families to keep talking to their loved one.

Near-death experiences

Some people who survive cardiac arrest or come close to death later describe vivid experiences: peace, a light, leaving the body, meeting loved ones who have died. Researchers have studied these reports. Some explain them as effects of a brain under extreme stress. Others think they point to something beyond the brain. Science has not settled the question, and people interpret these experiences in light of their own beliefs.

What research says about grief

• There is no single "right" way to grieve. The famous "five stages" (denial, anger, bargaining, depression, acceptance) came from Elisabeth Kübler-Ross's 1969 work with dying patients. Researchers have since found that people do not move through fixed stages in order. The stages can still be useful words for feelings.
• Grief comes in waves. One respected model (the dual process model) describes healthy grief as moving back and forth between facing the loss and taking breaks from it to rest, work and deal with daily life.
• Most people are resilient. Many grieving people return to daily functioning over months, while still missing the person deeply.
• Continuing bonds are normal. Feeling a continued connection with someone who has died, talking to them, or sensing their presence is common and usually healthy.
• Some grief needs treatment. In a minority of people, intense grief continues for a long time without easing and makes daily life very hard. Doctors call this prolonged grief disorder, and specific therapies help.
• Anticipatory grief before a death is common among caregivers. It does not always make later grief shorter, but many people say it helped them prepare.

See also Fear, distress and grief: what helps.