What Is Terminal Restlessness?
Terminal restlessness is a symptom that many patients experience at the end of life. It typically manifests as inability to rest/relax, emotional distress, and/or worsening confusion. Extreme restlessness is sometimes referred to as agitation.
Recognizing and addressing terminal restlessness can help ensure the patient's final moments are as peaceful and comfortable as possible. It also provides caregivers with tools to help manage this potentially distressing symptom.
What Causes Terminal Restlessness?
The contributors to terminal restlessness can't always be pinpointed. Some known factors include:
- Pain or discomfort
- Pangangapos ng paghinga
- Lagnat
- Underlying infection
- Medication side effects (especially anticholinergics)
- Constipation
- Inability to empty one’s bladder
- Unmet physical needs (hunger, thirst, being soiled)
- Over- or under-stimulation
- Emotional or spiritual distress
- Natural changes as body systems shut down
Signs Caregivers Should Look For
Signs of terminal restlessness may include:
- Confusion or disorientation
- Inability to be still
- Fidgeting, rocking, squirming, or other repetitive movements
- Difficulty sleeping or inability to sleep
- Uncharacteristic behaviors, such as the use of profanity
- Picking or pulling at bed sheets or trying to get out of bed
- Crying, shouting, or grunting with no known cause
- Expressions of discomfort, such as grimacing or looking startled/alarmed
What the Hospice Team Will Do
Hospice teams are trained to recognize early signs and provide comfort through medication, environmental adjustments, and emotional support. The hospice team may assess the patient's symptoms to determine if there is an underlying cause of restlessness.
This could include evaluating pain levels, medication effects, or unmet needs.
What Caregivers Can Do
1. Create a Calm Environment
- Try to maintain a predictable, familiar routine.
- Dim the lights to reduce overstimulation (keep low lights on at night).
- Minimize noise (e.g., turn off the TV, lower voices).
- Play soft, soothing music or white noise.
- Remove unnecessary distractions or clutter from the room.
- Surround the patient with familiar and comforting items (e.g., photos, blankets).
- Limit the number of guests and duration of visits.
2. Address Physical Comfort
- Administer medications as directed.
- Determine if the patient is in pain/discomfort, has a fever, or is having difficulty breathing.
- Adjust pillows or reposition the patient for comfort.
- Ensure the patient is clean and dry (e.g., change bedding or clothing if needed).
- Offer small sips of water or ice chips if appropriate.
3. Provide Emotional Reassurance
- Speak in a calm, soothing tone.
- Use simple, reassuring phrases like, "You’re safe, I’m here with you."
- Validate the patient’s feelings; avoid arguing or correcting confusion.
4.Use Calming Techniques
- Guide the patient to take slow, deep breaths if possible.
- Use aromatherapy with calming scents if the patient is not sensitive to smells.
- Read favorite stories, prayers, or sing/hum familiar songs.
- Use a cool cloth on the forehead or a gentle massage to ease tension if they are receptive.
- Gently stroke their hands or forehead to provide comfort.
5. Contact the Hospice Team
If your loved one is a VITAS patient, contact us immediately if:
- Your loved one is becoming physically aggressive or combative.
- You are unable to administer prescribed medications.
- You notice a new or sudden change in the patient’s symptoms or condition.
- You can also contact us for more routine requests, including:
- You want to request a visit from any member of the hospice team.
- You are having trouble coping and need someone to talk to.
- You would like to discuss complementary therapies, such as music or massage.
Mga Bagay na Madalas Itanong
What is terminal restlessness?
Terminal restlessness is a symptom that many patients experience at the end of life. It typically manifests as inability to rest/relax, emotional distress, and/or worsening confusion. Extreme restlessness is sometimes referred to as agitation.
What should I do if the patient becomes restless at night?
Try to create a calm, quiet environment and contact the hospice team if the agitation persists.
Can terminal restlessness be prevented?
While it may not always be preventable, proactive care and a calming environment can help reduce its severity.
How long does terminal restlessness last?
Terminal restlessness typically occurs in the last few days to hours of life, though every patient is unique. In some rare cases, it can appear weeks before death and may persist intermittently.