When an older person begins to decline, the changes aren’t always dramatic at first. Sometimes they appear as small differences in sleep, appetite, movement, communication, or the way they spend their day.

That can leave family members wondering: Is this simply part of getting older, or is something more serious happening?

There isn’t a checklist that can tell you exactly when someone will die. Every person’s situation is different, and some changes can also be caused by illnesses that may be treatable. But when several changes appear together in someone who is already living with advanced illness or severe frailty, they can be important signs that the person needs closer medical attention and supportive care.

Here are six changes worth understanding — and the last one is especially important because it can be easy for families to overlook.

1. They Become Much More Tired and Sleep More

One of the first changes families may notice is that the person simply doesn’t have the same energy they once did.

They may spend more time resting during the day, sleep longer at night, or become tired after activities that previously seemed easy. As someone becomes seriously ill or approaches the end of life, increasing weakness and drowsiness can become more noticeable.

This doesn’t automatically mean a person is dying. Fatigue can come from many conditions, medications, infections, anemia, poor nutrition, or lack of sleep.

But if the tiredness represents a clear change from the person’s usual baseline, particularly when other changes are happening at the same time, it deserves attention.

2. Everyday Tasks Suddenly Become Much Harder

Another change can be a gradual loss of independence.

A person who once dressed themselves, prepared meals, walked around the house, or handled personal care may begin needing assistance with these ordinary activities.

In the later stages of serious illness, people may become increasingly weak and eventually spend much of their time in bed or require help with most personal care.

For family members, this can sometimes be one of the clearest signs that something has changed.

The important thing isn’t one difficult day. It’s the overall pattern.

If someone who was previously independent is steadily losing the ability to manage everyday activities, it’s worth talking with their healthcare team about what may be causing the decline.

3. Their Appetite and Interest in Food May Change

Food can become less important as a person becomes increasingly frail or approaches the end of life.

They may eat smaller portions, lose interest in favorite foods, or simply say that they’re not hungry. In the final weeks of life, reduced appetite and eating less can occur.

This can be emotionally difficult for families.

Loved ones may feel that they need to encourage the person to eat more, especially when they notice weight loss. But during the dying process, the body’s needs and ability to process food can change. In the last days of life, reduced interest in eating and drinking is common.

That doesn’t mean every older person who eats less is dying.

A sudden appetite change can also result from medication, depression, dental problems, infection, digestive problems, or another treatable condition. That’s why a significant change should be discussed with a healthcare professional rather than automatically being interpreted as a sign of death.

4. They May Withdraw From Their Normal Social Life

Sometimes the change isn’t physical at all.

An older person may gradually stop participating in activities they once enjoyed. They might spend more time alone, talk less, or show less interest in visitors and conversations.

Social withdrawal can occur for many reasons, including loneliness, depression, cognitive changes, physical exhaustion, or serious illness.

Near the end of life, however, people can become less responsive and less interested in communicating with others as their condition deteriorates.

This is why context matters.

If an older loved one suddenly becomes unusually quiet or withdrawn, don’t immediately assume the worst. Look at what else is changing.

When withdrawal appears alongside increasing weakness, sleeping more, reduced appetite, and declining mobility, it becomes more important to involve the person’s healthcare team.

5. Confusion or Changes in Awareness May Appear

Changes in thinking and awareness can also occur when someone is seriously unwell.

A person may become unusually confused, have difficulty following conversations, become less responsive, or experience periods of restlessness or agitation. Delirium can occur during the final stage of life, although confusion can also have many other causes.

This is one area where families should be particularly careful.

New confusion should not simply be dismissed as “old age.”

Infections, medications, dehydration, metabolic problems, dementia, and other medical conditions can cause confusion, and some causes may be treatable.

If the change is sudden or significant, contacting a healthcare professional is important.

6. Their Overall Condition May Begin Declining Noticeably

The biggest clue usually isn’t one isolated symptom.

It’s the overall pattern of decline.

A person may become progressively weaker, spend more time in bed, need increasing help with personal care, eat and drink less, communicate less, and become increasingly sleepy or difficult to wake. These patterns are recognized among the changes that can occur when someone is entering the terminal phase of life.

At this stage, families may need more than an explanation of symptoms. They may need support with comfort, symptom management, care decisions, and communication with the medical team.

And importantly, these changes do not provide a precise countdown.

Some people decline quickly. Others experience changes over weeks or longer. Some people may have one or more of these symptoms because of a condition that can still be treated.

That’s why the safest approach is to look at the whole picture rather than trying to predict an exact date.

What These Signs Do — and Don’t — Mean

Seeing these changes can be frightening, especially when they involve someone you love.

But they shouldn’t be used as a way to predict that a person has exactly one year, one month, or one week left. Even healthcare professionals cannot always predict precisely when death will occur.

Instead, these changes can serve as a reason to pause and ask an important question: “Has this person’s health changed enough that we should talk with their doctor or care team?”

If the answer is yes, having that conversation sooner can help the family understand what’s happening and make sure the person’s comfort and wishes remain at the center of care. NIA recommends discussing end-of-life preferences and care plans with the healthcare team when it becomes clear that someone may be nearing the end of life.