Terminal restlessness, also called terminal agitation or terminal delirium, occurs in the daysleading to death.
People may beanxious, agitated, or show signs of cognitive decline.
This syndrome has many causes and treatment may not be needed, depending on the individual.
Verywell / Andrea Hickey
It can be distressing to watch your loved one go through this.
You may wonder if there is something you should do about it.
This article explains in more detail the changes that terminal restlessness may bring.
It offers some insights to help you promote your loved ones comfort during these final days.
Verywell / Andrea Hickey
Symptoms
Each life and death is unique.
The signs and symptoms of terminal restlessness may appear as aggressive behavior.
You also may see unusually calm behavior.
Emotionally, its the aggressive, often hostile behavior that is more difficult to watch.
It also may be harder for you to manage.
Some behaviors are quite common when a loved one has terminal restlessness.
Terminal restlessness describes a more sudden shift in behaviors at the end of life.
It is different from the anger, depression, or other emotions that are common during thestages of dying.
They may constantly pull at their clothes, bedsheets, and any intravenous (IV) lines.
Others may seem indecisive.
They look for items or ask for something, and then turn away from it.
They may seem mean-spirited or accuse people of offenses that may or may not make sense.
Sometimes, the restlessness appears briefly and then goes away on its own.
A number of other well-recognizedend-of-life symptomsalso may happen at the same time when a person has terminal restlessness.
These may include pulling away from intimacy with others or talking about dead family members.
Causes
There are quite a few likely causes of terminal restlessness.
Many of the physical changes that come with the dying process can lead to this punch in of delirium.
Some of these causes may be easy to reverse, while others are not.
The most common causes include:
Terminal restlessness is common at the end of life.
Your loved one may seem confused, agitated, or angry.
They may fidget with their clothes or become withdrawn.
Many causes, including organ failure or the drugs used to treat their illness, may be at work.
During this time, a person may experience outbursts and irrational behaviors.
With terminal restlessness, they occur in tandem with end-of-life decline.
However, the DABDA stages and the restlessness can occur at the same time.
Terminal restlessness is sometimes confused with nearing death awareness.
It may be hard to tell the difference.
Treatment
Terminal restlessness is usually only treated if the behaviors place the person or others at harm.
Options include mild tranquilizers calledbenzodiazepinesand anti-psychotic drugs calledphenothiazines.
However, its important to speak up if needed to ensure care for a loved one.
During the last four hours before death, 21.9% of the care goals for restlessness were not achieved.
When to Call a Healthcare Provider
Many people are comfortable as they approach the end of life.
Coping
How a dying person with terminal restlessness behaves is not always consistent with their lifelong personality.
Their actions do not always reflect how they feel about you.
Many emotions can come simply because you know death is near.
Your loved ones terminal restlessness may add to your distress because of what they say and do.
This may cause you to feel guilty about how you are handling your loved onesdying process.
Caregiving is hard work and often leaves limited time for self-care.
But its important that you do take breaks, so consider arespite careprogram in your community.
Summary
The symptoms of terminal restlessness are common when a person is close to death.
They may include agitation and aggressive behavior or even an unusual sense of calm and reflection.
There are many causes of terminal restlessness, such as pain, medications, and emotions about dying.
Treatment usually means keeping the person as comfortable as possible.
In some cases, mild tranquilizers and anti-psychotic drugs may be used to treat the symptoms of terminal restlessness.
Most people want death to be a comfortable and peaceful experience.
If your loved one is dealing with terminal restlessness, their final days may appear just the opposite.
Some families may be caught off guard by a loved ones terminal restlessness.
This can make you wonder if your experience is unusual.
It also can make you feel that you are not doing the right things for your loved one.
Many people benefit from medication when experiencing symptoms of terminal restlessness.
Its very common to find symptoms of terminal restlessness upsetting and confusing.
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