1. Loss of appetite and reduced fluid intake

One of the earliest and most noticeable changes is a decreased desire to eat or drink. As the body requires less energy, hunger naturally fades. Swallowing may also become difficult, making food or liquids uncomfortable. This is a normal part of the body’s process—not a sign that caregivers are doing something wrong.

2. Increased sleep and lower activity levels

A person nearing the end of life may spend much more time sleeping and show little response to conversation or surroundings. Even when awake, they may seem distant or fatigued. This happens because the body is conserving energy and gradually reducing its activity.

3. Changes in breathing patterns

Breathing may become uneven or noticeably different. There might be pauses between breaths, shallow breathing, or patterns such as alternating deep breaths followed by brief stops. These changes occur as the body’s systems begin to slow and regulate less consistently.

4. Skin and circulation changes

As circulation weakens, the hands, feet, and other extremities may feel cool and appear pale, bluish, or mottled. Blood flow is redirected to essential organs, causing these visible changes in the skin.