Table of ContentsView AllTable of ContentsDeliriumTerminal RestlessnessCausesWhat to Do
Table of ContentsView All
View All
Table of Contents
Delirium
Terminal Restlessness
Causes
What to Do
It’s not uncommon for a terminally ill loved one to become unusually restless or even agitated, but it is often distressing for family and friends to witness.
The depth of such restlessness or agitation varies from patient to patient; in some cases, it can progress to a state known as “terminal restlessness,” or “terminal delirium.” Recognizing the symptoms can help you learn how to help a loved one who is experiencing them.
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What Is Delirium?
Deliriumis a complex psychiatric syndrome, also sometimes referred to as organic brain syndrome, confusion, encephalopathy or impaired mental status.
You may notice a sudden change in your loved one’s alertness and behavior. This change can sometimes fluctuate over the course of a day, and it usually gets worse at night.
Some other characteristics of delirium include:
What Is Terminal Restlessness?
Delirium is common towards the end of life and is a phenomenon that can have different causes. Sometimes it can be reversible if the culprit is easy to treat and the patient is stable enough (e.g., treating an underlyingurinary tract infectionthat contributed to delirium).
However, sometimes delirium is part of the final stages of dying—so-called terminal delirium or terminal restlessness—and it becomes an irreversible process that is often treated symptomatically, with the goal of providing comfort (i.e., sedation) instead of reversing the syndrome.
Terminal restlessness is distressing because it has a direct negative impact on thedying process. Everyone wants death to be a comfortable and peaceful experience, but when someone is dying with terminal restlessness, their death can be anything but.
When someone suffers from a terminal illness, they can become irritable, sullen, frustrated, and angry.
These kinds of mood shifts can be intense, and, when nearing the end, profound mood changes can occur. This can be particularly difficult for caregivers and loved ones to deal with, causing fear and a feeling of helplessness.
Terminal restlessness has the potential to be confused with a state callednearing death awareness, which is described as a dying person’s instinctual knowledge that death is near.
It’s important for loved ones and healthcare professionals to understand the phenomenon of nearing death awareness so they can be equipped to support a dying person’s unique needs.
Understanding and Recognizing Terminal Restlessness
Delirium and terminal restlessness have many causes. Some causes are easily reversed, while others are not.
Medications are one of the most common causes of delirium, includingopioids,anti-seizure drugs, steroids, and anxiolytics. Overuse of medications can cause toxicity and under-use can cause pain and discomfort, all which can further worsen delirium.
Some other common causes include:
Is Death Painful?
What Should You Do?
Multiple factors underlie delirium, and therefore actually reversing the process might be hard to achieve.
For example, dehydration often contributes to delirium at the end of life; however, aggressive hydration with intravenous fluids—intended to treat delirium—can lead to water in the lungs and a whole new set of problems.
If delirium is understood in the context of a patient’s last hours to days on earth, then the emphasis needs to be not on treatment of the underlying cause, but rather on decreasing the agitation, hallucinations, and behavioral issues.
This is largely accomplished with sedation or otherwise helping the patient stay comfortable in this stage of their dying process. If you have a hospice team, their extensive experience with this can be tremendously helpful.
Properly identifying the cause of delirium and treating it effectively may take several days, but with the support of the hospice team, close friends, and other family members, it is likely that your loved one will settle down and feel less distressed.
A Word From Verywell
Delirium isn’t the same in everyone. It can mimic other illnesses and syndromes, making it difficult to recognize and treat. If you notice your loved one is acting out of sorts, has new memory loss, or is experiencing changes in his sleeping pattern, contact their healthcare provider.
Preparing for a Loved One’s Death
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Agar M, Bush SH.Delirium at the end of life.Med Clin North Am. 2020;104(3):491-501. doi:10.1016/j.mcna.2020.01.006Boettger S, Boettger S, Breitbart W.The phenomenology of delirium: presence, severity, and relationship between symptoms.Journal of Geriatrics.2014;2014. doi:10.1155/2014/427042Bush SH, Leonard MM, Agar M, et al.End-of-life delirium: issues regarding recognition, optimal management, and the role of sedation in the dying phase.Journal of Pain and Symptom Management. 2014;48(2):215-230. doi:j.jpainsymman.2014.05.009Bramati P, Bruera E.Delirium in Palliative Care.Cancers (Basel). 2021 Nov 23;13(23):5893. doi:10.3390/cancers13235893Rossi Varallo F, Maicon de Oliveira A, Cristina Barboza Zanetti A, et al.Drug-induced delirium among older people. In: Teresa Herdeiro M, Roque F, Figueiras A, Magalhães Silva T, eds.New Insights into the Future of Pharmacoepidemiology and Drug Safety. IntechOpen; 2021. doi:10.5772/intechopen.95470Marcantonio ER.Delirium in Hospitalized Older Adults.N Engl J Med. 2017 Oct 12;377(15):1456-1466. doi:10.1056/NEJMcp1605501
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Agar M, Bush SH.Delirium at the end of life.Med Clin North Am. 2020;104(3):491-501. doi:10.1016/j.mcna.2020.01.006Boettger S, Boettger S, Breitbart W.The phenomenology of delirium: presence, severity, and relationship between symptoms.Journal of Geriatrics.2014;2014. doi:10.1155/2014/427042Bush SH, Leonard MM, Agar M, et al.End-of-life delirium: issues regarding recognition, optimal management, and the role of sedation in the dying phase.Journal of Pain and Symptom Management. 2014;48(2):215-230. doi:j.jpainsymman.2014.05.009Bramati P, Bruera E.Delirium in Palliative Care.Cancers (Basel). 2021 Nov 23;13(23):5893. doi:10.3390/cancers13235893Rossi Varallo F, Maicon de Oliveira A, Cristina Barboza Zanetti A, et al.Drug-induced delirium among older people. In: Teresa Herdeiro M, Roque F, Figueiras A, Magalhães Silva T, eds.New Insights into the Future of Pharmacoepidemiology and Drug Safety. IntechOpen; 2021. doi:10.5772/intechopen.95470Marcantonio ER.Delirium in Hospitalized Older Adults.N Engl J Med. 2017 Oct 12;377(15):1456-1466. doi:10.1056/NEJMcp1605501
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Agar M, Bush SH.Delirium at the end of life.Med Clin North Am. 2020;104(3):491-501. doi:10.1016/j.mcna.2020.01.006Boettger S, Boettger S, Breitbart W.The phenomenology of delirium: presence, severity, and relationship between symptoms.Journal of Geriatrics.2014;2014. doi:10.1155/2014/427042Bush SH, Leonard MM, Agar M, et al.End-of-life delirium: issues regarding recognition, optimal management, and the role of sedation in the dying phase.Journal of Pain and Symptom Management. 2014;48(2):215-230. doi:j.jpainsymman.2014.05.009Bramati P, Bruera E.Delirium in Palliative Care.Cancers (Basel). 2021 Nov 23;13(23):5893. doi:10.3390/cancers13235893Rossi Varallo F, Maicon de Oliveira A, Cristina Barboza Zanetti A, et al.Drug-induced delirium among older people. In: Teresa Herdeiro M, Roque F, Figueiras A, Magalhães Silva T, eds.New Insights into the Future of Pharmacoepidemiology and Drug Safety. IntechOpen; 2021. doi:10.5772/intechopen.95470Marcantonio ER.Delirium in Hospitalized Older Adults.N Engl J Med. 2017 Oct 12;377(15):1456-1466. doi:10.1056/NEJMcp1605501
Agar M, Bush SH.Delirium at the end of life.Med Clin North Am. 2020;104(3):491-501. doi:10.1016/j.mcna.2020.01.006
Boettger S, Boettger S, Breitbart W.The phenomenology of delirium: presence, severity, and relationship between symptoms.Journal of Geriatrics.2014;2014. doi:10.1155/2014/427042
Bush SH, Leonard MM, Agar M, et al.End-of-life delirium: issues regarding recognition, optimal management, and the role of sedation in the dying phase.Journal of Pain and Symptom Management. 2014;48(2):215-230. doi:j.jpainsymman.2014.05.009
Bramati P, Bruera E.Delirium in Palliative Care.Cancers (Basel). 2021 Nov 23;13(23):5893. doi:10.3390/cancers13235893
Rossi Varallo F, Maicon de Oliveira A, Cristina Barboza Zanetti A, et al.Drug-induced delirium among older people. In: Teresa Herdeiro M, Roque F, Figueiras A, Magalhães Silva T, eds.New Insights into the Future of Pharmacoepidemiology and Drug Safety. IntechOpen; 2021. doi:10.5772/intechopen.95470
Marcantonio ER.Delirium in Hospitalized Older Adults.N Engl J Med. 2017 Oct 12;377(15):1456-1466. doi:10.1056/NEJMcp1605501
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