Doctors, nurses, and hospice caregivers often observe a set of physical and mental changes when a person enters the final stage of life. These signs help families understand what is happening and allow caregivers to focus on comfort and dignity. Not every person shows all signs, and timing varies, but the following are commonly reported indicators.

- Extreme Fatigue and Weakness – The person sleeps most of the time and feels exhausted after small movements or short conversations due to low energy reserves.

- Reduced Appetite and Thirst – Food and fluid intake naturally decline as the body’s need for nutrition decreases near the end of life.

- Breathing Changes – Breathing may become shallow, rapid, irregular, or labored. Periods of pause between breaths can also occur.

- Changing Pain Levels – Pain may increase or fluctuate depending on illness and organ function, but it is often manageable with proper medication.

- Anxiety and Restlessness – Some patients become unsettled, fidgety, or fearful, sometimes linked to emotional stress or chemical changes in the body.

- Nausea and Vomiting – Digestive slowdown, medication effects, or organ failure can trigger stomach upset in late stages.

- Constipation – Less food, dehydration, and strong pain medicines frequently lead to difficult bowel movements that need treatment.

- Social Withdrawal – Many people speak less and prefer quiet, showing reduced interest in conversation as they turn inward.

- Loss of Bladder and Bowel Control – Muscle weakness reduces control, making supportive hygiene care important for comfort.

- Cool Skin and Color Changes – Hands, feet, and limbs may feel cold, with bluish or purple mottling as circulation slows.

- Confusion or Delirium – Disorientation, hallucinations, or unusual speech can appear due to low oxygen or metabolic imbalance.

- “Death Rattle” Sound – A rattling noise during breathing may occur from throat secretions; repositioning often reduces the sound.

These signs guide comfort-focused care and help loved ones prepare with understanding and compassion.

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