Dying is something we all will do, yet most of us have little experience with the realities of end-stage illness and death. Death can come suddenly, but more often, death comes after a time in which there is a natural slowing down of the body's physical and mental systems.

As the body's systems slow down and function less efficiently, you will notice many changes. It may help to remember that dying is not like you may have seen on television or in the movies. In reality, people look differently than they did when they were healthy. They may talk or make noises, move around, feel confused or disoriented, have times when they are unresponsive and times when they are more alert, and will depend on others to meet some, if not all, of their personal care needs.

These changes are natural. They may not be neat and tidy, but this time can still offer opportunities for sharing love and respect.

As illness makes the body less able to function normally, you may notice some, or all, of the following signs.

• Increased drowsiness and sleeping
• Withdrawal from family and friends
• Increased weakness
• Feeling afraid  
• Increased spirituality
• Changes in pain
• Loss of appetite
• Changes in bowel and bladder function
• Decreased swallowing reflex
• Changes in skin color
• Skin breakdown
• Fever
• Breathing changes
• Restlessness or agitation
• Near death awareness