It starts with a small shift. Maybe your mom naps longer than usual, or your dad skips that chicken marsala he once loved. At first, you chalk it up to a busy week or a little fatigue—but over time, these subtle changes start to add up.
More families than ever are facing this reality. In the past decade, the number of Americans caring for aging parents at home rose from 18.2 million to 24.1 million, with caregivers spending an average of 17 hours per week assisting loved ones—and even more (31 hours) for those with dementia. By 2050, the population of adults over 85 is expected to triple, pressing even more families into these intimate and often challenging roles.
Noticing these signs early doesn’t have to be frightening. It can be a way to connect, to prepare, and to honor the journey of those who gave us so much.
Sleeping much more
Sleep patterns can change subtly as the body slows down, and this is especially common as life nears its final stage. You might find them spending long stretches resting and becoming less responsive than they used to be.
Even gentle attempts to wake them for meals can be met with a sleepy shrug, as if to say, “Can’t this wait a little longer?” Studies show that excessive sleep in the elderly—defined as sleeping 10 hours or more per day—is linked to an 83% increase in mortality risk, with both long and short sleep duration associated with higher rates of death from all causes.
While it can be worrying at first, this extra sleep is often the body naturally preparing itself, and it doesn’t necessarily indicate pain or discomfort.
Pulling back from social life
In a 2023 U.S. survey, 1 in 3 adults aged 50–80 (34%) reported feeling isolated, with 5% feeling isolated “often”. You may notice your parent becoming quieter, retreating from conversations, and showing less interest in social gatherings. Perhaps they used to light up the room with stories or call friends regularly, but now they seem content to sit quietly and reflect.
“Dying people lose interest in the outside world, limit visits, and withdraw into their own family circle, eventually retreating inside,” notes the Jewish Social Service Agency (JSSA). It can be difficult to watch and might even feel like rejection, but often it’s simply a protective mechanism.
Cherishing the moments when they do share, and allowing them the space to reflect, can be incredibly meaningful.
Changes in appetite
Food has always been a source of comfort and joy, but a noticeable loss of interest in eating or drinking can occur in the final stage of life. Up to 50% of older adults experience diminished appetite and related weight loss as part of aging and advanced illness, with prevalence up to 42% in hospitals and 38% in nursing homes.
Dishes they once loved may suddenly lose their appeal, swallowing may become difficult, and digestion may slow. CareSearch notes that appetite-related distress tends to decrease in the final 7–10 days as awareness diminishes and discomfort lessens.
Instead of pressuring them to eat, it’s far more helpful to offer small, gentle options and create peaceful, relaxed mealtimes. Even a sip of tea or a bite of something soft can provide comfort, and your calm presence can mean more than any meal ever could.
Fluctuating vital signs
Sometimes, the body communicates in ways words cannot fully capture. You may notice subtle changes like irregular breathing, periods of shallow or rapid breaths followed by pauses, cooler hands and feet, or slight changes in skin color such as mottling or a bluish tint.
More than half of dying patients experience breathlessness or irregular breathing, such as periods of apnea, Cheyne-Stokes breathing (periodic deep and shallow breaths), and the characteristic “death rattle” caused by fluid in the throat.
These shifts reflect natural declines in circulation and organ function. While they can be unsettling, being aware of them helps you respond calmly and provide comfort, rather than panic. Simply sitting with your parent, holding their hand, and offering reassurance can make a big difference.
Moments of confusion
Even parents who have always been sharp may experience occasional confusion as the body and mind slow down. You might notice they forget names, mix up familiar places, or even have trouble recognizing people they’ve known all their lives. Tasks that were once simple may suddenly seem overwhelming, and short-term memory lapses become more frequent.
Cognitive performance often steeply declines in the months or weeks before death, a phenomenon known as “terminal decline” observed in up to 70% of elderly nursing home residents. Delirium is marked by an abrupt onset, fluctuating course (worse at night), distractibility, inability to focus, and sometimes drowsy or semi-conscious states.
It can be frustrating, yes, but responding with patience and gentle guidance helps preserve their dignity and provides a sense of safety during a time when the world may feel uncertain to them.
Restlessness and agitation
Between 25 and 85 percent of dying patients experience some form of terminal restlessness or agitation in their final days. At times, you may observe your parent fidgeting, tugging at sheets, or moving repetitively. This restlessness can be unsettling for caregivers, but it is often a way the body expresses discomfort, anxiety, or neurological changes.
Small gestures—holding their hand, speaking softly, or playing gentle music—can provide immense comfort. These moments are reminders that your presence matters more than any quick fix, and that sometimes just being there quietly can soothe both of you.
Losing interest in hobbies or routines
Activities that once brought joy, like reading, walking, or hobbies, may lose their appeal. Your parent might no longer care about small daily routines or may defer decision-making to you. This is not giving up; it is a natural shift as energy and focus decline.
Supporting them gently, guiding them through choices, and being patient with the changes in their preferences can make them feel safe and valued, even as they slow down.
Changes in bathroom habits
Nearly all people with advanced dementia or neurodegenerative disease experience urinary or bowel incontinence in the later stages, ranging from occasional leakage to total loss of control. Brain changes can affect the ability to recognize the need to go to the bathroom or control muscles required for continence.
Anxiety may appear as agitation, insomnia, restlessness, panic, or irrational worries about the future, loved ones, or the dying process; these feelings may intensify in parallel with physical symptoms.
Providing discreet, dignified support can prevent embarrassment and maintain your parent’s comfort. Gentle routines, reassurance, and empathy are key here—sometimes small acts of care speak louder than words and show deep respect for their dignity.
Mood shifts
Even the most cheerful parent may experience emotional swings as they approach life’s final stage. The incidence of major depression among terminally ill patients ranges from 25% to 77%, though it is frequently underdiagnosed and undertreated. Low mood, irritability, or anxiety about leaving loved ones behind can emerge.
These mood shifts are not only common but expected. Your empathy and understanding can ease their distress, and seeking support for yourself—through counseling or caregiver forums—can help you manage the emotional weight of watching someone you love navigate this stage of life.
Breathing changes
Changes in breathing are often one of the most noticeable signs that life is drawing to a close. Shallow breaths, pauses, or the characteristic “death rattle” caused by fluid buildup in the lungs may occur. Patterns like Cheyne-Stokes breathing, which cycle between rapid breaths and pauses, are common.
Agonal or terminal breaths (gasps, sighs) may occur in the final moments, accompanied by grunting, groaning, or brief pauses between breaths; these behaviors are reflexive, not signs of distress or suffering for the dying person.
Hospice teams can provide guidance to manage discomfort and explain what’s happening medically. Awareness of these patterns allows you to stay calm, provide reassurance, and maintain a peaceful environment for your parent.
Preparing yourself and your parent
Recognizing these signs is just the first step. Preparing for what comes next—both practically and emotionally—can make an overwhelming experience more manageable.
Early conversations about care preferences, advance directives, and end-of-life wishes can prevent confusion and stress. Joining caregiver support groups, seeking hospice guidance, or even speaking with a grief counselor can provide crucial emotional support.
Celebrating your parents’ lives through stories, letters, or photo albums creates lasting memories and gives both of you moments of comfort. Practical help, like respite care or tools that make daily routines easier, reduces stress for everyone involved. Preparation is about creating a space of love, dignity, and presence.
The reality of caregiving
Caring for a parent in the final stages of life is emotionally and physically demanding. Caregivers often spend many hours per week providing support, and the time commitment can grow substantially for those caring for individuals with dementia.
By 2050, the number of Americans aged 85 and older is expected to triple, highlighting the growing importance of understanding and preparing for caregiving responsibilities. Recognizing the realities of this role and seeking support early is important for both your well-being and that of your parent.
Words of comfort
Even with preparation, loss is never easy. Experts remind us that the pain of losing a parent is profound, and yet, awareness and connection make the journey meaningful. One poignant reflection reminds us, “Nothing prepared me for the loss of my mother… Waking up in a world without her is like waking up in a world without sky: unimaginable.”
Another from Eskimo Legend, quoted by Choosing Therapy, offers hope in imagery: “Perhaps they are not stars in the sky, but rather openings where our loved ones shine down to let us know they are happy.”
A gentle reminder
Watching a parent near the end of life is difficult, but noticing subtle signs—like sleep changes, mood shifts, or breathing patterns—gives you the chance to prepare with love, compassion, and patience.
The most meaningful gift is your presence: listening, holding their hand, and sharing moments that honor their life. Because, in the end, it’s not about how long the journey lasts—it’s about how you walk it together.
Disclaimer – This list is solely the author’s opinion based on research and publicly available information. It is not intended to be professional advice.
Disclosure: This article was developed with the assistance of AI and was subsequently reviewed, revised, and approved by our editorial team.
