Terminal Restlessness Is Part of the Way We Die.
Barbara Karnes, RN
Author of GONE FROM MY SIGHT aka: "the hospice blue book", NHPCO Hospice Innovator Award, End of Life Educator
Terminal restlessness is a medical term for agitation as end of life approaches. It usually begins one to?three weeks before death?from disease or old age.
The restlessness shows itself by random body movements, hands picking the air or clothing, mumbling, talking but not making sense, by just not being settled and quiet. The person is now beyond expressing with words. There are few if any rational conversations.
This restlessness can be a lack of oxygen to the brain but more likely it is just part of the?natural way we die.
We are all going to be afraid to some degree as we approach death. This is normal and natural. Also we know when we are dying. It is no secret. We live inside of our bodies--we know.?
In the months before death from disease we don’t believe we can’t be fixed but there comes a point where we indeed know the time is near (one or three weeks before we actually die from disease is about that timetable). Can the restlessness being experienced be an expression of fear? Maybe?
Realizing in the core of our being that we are going to die we become frightened and that fear shows itself in agitation. “If I lay down and close my eyes I may die” so we don’t lay still, we move about.
Most of the time this restlessness, this agitation is not destructive. It is not severe. If the movements become thrashing about or hurtful and become a danger to the person and/or others then a medication to calm is needed. That medication is not necessarily a narcotic. There are other drugs more effective for terminal restlessness than a narcotic. Most people, however, do not need medications for sedation or calming.
领英推荐
Again this activity is normal and natural. It is a part of the?dying process?from disease or old age. Nothing bad or unusual is happening. The restlessness is just a part of the way we die.
This activity is actually one of the signs we look for that says the “labor of dying” has begun. It is that normal.
Something More...?about Terminal?Restlessness Is?Part of the?Way We Die.
When the patient is a couple days to hours before death,?The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death?gives ideas for what to do and say as well as how to care for the person who is approaching death.?Caring for someone at end of life is different than caring for someone who will get better. I have put together a bundle of the most important resources to educate patients and families after a life limiting diagnosis has been given. It is called?The Family Support Bundle. It may be exactly what you need right now.?
--
1 年I have been a hospice nurse 8 years. I would like to present another perspective about what it means when someone is dying and is mumbling incoherently or moving their arms about. Because of what I have had the honor of witnessing through the years I believe that the dying person is often reliving events from this lifetime. My patients have told me it is like a dream state though much more vivid. I believe the mumbling or incoherent speech is them talking as they have these varied experiences. And I might add that I do not use the word hallucination as it minimizes the sacredness of the dying process. A dear man whom I cared for at the end of his life was ‘very ornery’ with his family his wife told me. He had always been very gentle. She asked me to speak with him. I went into his bedroom as he lay on his bed. I asked him if I could ask him a strange question and he agreed. I said, ‘Joe, are you seeing people your family cannot see?’ He broke into tears and held my hand as he sobbed for a good 5 minutes. He told me he thought he was losing his mind. I told him it was a very normal part of the dying process. There is a mystery here at end of life and it isn’t medical, it’s sacred.
BSN, RN Case Manager
1 年Thank you for sharing your wisdom on the dying process, so helpful!
LCSW-R, CCM, Geriatric Practice Fellow
1 年There is no blueprint. I had the honor of facilitating a meeting of a dying man saying good bye to his family. There were 16 people in the bedroom. We laughed, we cried, it was beautiful. Truly special.
??????
Retired but working...
1 年My father died from dementia. He had what was explained to us as terminal hallucinations. Very hard to watch.