Most people will show signs of restlessness, agitation or delirium during the last few days or even weeks of their life. This can take many forms. They may have difficulty finding a comfortable position. They may pick at their clothing or blankets. You may notice them twitching, fidgeting or waving their arms. Some people seem to be reaching upwards, as if to be lifted.
Hallucinations and delirium Delirium is a mental state where the person seems confused or dis-oriented, not recognizing the room, or familiar people. Hallucinations are common (hearing or seeing things that others do not see). Unless the visions are upsetting to the patient, nothing really needs to be done. People in the last week or so often seem to speak to relatives or friends who have already passed on. Usually these are positive and comforting exchanges. There is no need to intervene. Action is only required if the patient is at risk of causing harm, to themselves or others.
Irritability
Emotionally, the patient may become irritable or paranoid. A normally calm individual may have mood swings and get quite angry.
As a family member, it can be distressing to watch a loved one behave so differently. Between 25-85% of terminally ill patients experience one or more of these symptoms, so in some ways it’s quite normal. Restlessness, agitation and delirium are often the result of organ systems, such as the kidneys, shutting down. Or dehydration as the patient loses interest in food or water. It is simply part of the last few days or weeks.
Normal or not, it is important to determine if there is suffering involved. If so, then there are several remedies to explore, depending on the cause:
Pain. Agitation and restlessness are common when people are in pain. For persons with dementia or people who have problems speaking, this non-verbal cue is the best way to express themselves. As a result, the first step with agitation is to look for possible causes of pain. Is there a sharp object somewhere? Twisted bedding around a foot or arm? Is there an infection? Address these possible sources of pain and see if the restlessness or agitation will go away.
Fever. High temperatures can cause a patient to become delirious. Perhaps there is an infection that needs treating. Or the fever may just be the body fighting off the terminal condition. Ask if there are appropriate medicines you can give to bring down the fever.
Constipation. When was the patient’s last bowel movement. The agitation could come from the discomfort of constipation. Ask what remedies would be most appropriate for your loved one’s stage of illness.
Full bladder. When was the last urination? Is there a blockage in a catheter?
Not enough oxygen. Shortness of breath can cause anxiety and agitation. If oxygen therapy is being used, is it set at the right level?
Too many medications. Especially as the body slows down, it takes longer for drugs to process out. If your loved one is on several medications, there may be a build-up of toxins causing problems of their own. Now may be a good time to re-evaluate which medicines are truly necessary and which are causing more harm than good.
Too much of a particular medication. People who have been on pain medicines for a long time may experience delirium and confusion. Or they may experience body jerks. It may be that your loved one would benefit from a lower dose, or a different medication.
Brain tumors. The pressure inside the skull can cause agitation. Ask about interventions to reduce fluid build-up or otherwise reduce the pressure.
Chemical imbalances. Some conditions, such as cancer, can cause mineral imbalances which in turn cause delirium or confusion. Between 10-30% of cancer patients, for instance, have too much calcium in the blood. Drinking lots of fluids can help. But it may be that your loved one needs to be on IV therapy to reduce the symptoms.
If you have determined that there is no physical pain involved, and no medical problem to fix, begin looking for opportunities to create a supportive, comforting environment.
Vision and hearing. Experiment to see if things are better for your loved one with or without glasses. With or without hearing aids. It might be that there’s too much stimulation. Or it may be that there’s not enough context for understanding what’s happening. Without optimal vision or hearing, your loved one may feel very scared or disoriented.
Reduce noise, lights and commotion. It may be wise for your loved one to have just one person in the room at a time. Turn the TV off. Keep conversations simple and friendly.
Calm music can be very helpful, for the patient and for everyone else.
No restraints. Tying someone’s hands to the bedrail is only likely to make them even more agitated. Unless they are a danger to themselves or others, try to simply have someone in the room with them to offer reassurance and support.
Encourage rest and sleeping. Sleep deprivation puts even healthy people on edge!
Try to regulate temperature. If your loved one’s restlessness is simply because the end is near, there may be other discomforts that are simply the body shutting down. It’s common, for instance, for people in the last few days to have very cold hands and feet, yet complain of feeling too hot. The internal thermostat simply stops working well. Having blankets and cool cloths at the ready can allow you to quickly switch back and forth as needed.
Concern about punishment
Some people worry at the very end that they did not live their life according to their spiritual beliefs. They may be worried about punishments after death. Or uncomfortable meetings with people who have already died.
Unresolved relationships
If could be that there are unfinished relationships, bad feelings with a sibling or child. This might be a source of anxiety or discomfort.
Chaplain or social worker
If you think that some of your loved one’s restlessness has an emotional or spiritual component, ask to speak with the social worker, or the chaplain. A chaplain is a person with religious training, however he or she does not push any particular religion. Chaplains simply specialize in helping people find their own answers to questions of faith, meaning, and life after death.
If a person is so agitated that he or she is at risk from harm, however, a sedative may be the best option after other possible causes have been ruled out.
Solace Hospice cared for my husband during the last weeks of his life. Our team was compassionate, professional, and always available to provide direct care, arrange transport, or just talk. We felt encompassed by their excellent care and commitment throughout this journey.
I really enjoyed my employment with solace hospice. The team of nurse's, CNA's, social workers and chaplain s work amazing together, always working as a team, including the administrative team.Maggie Welsh my supervisor is someone who has an open door policy. If you need to talk, she will drop everything she is doing without hesitation. She offers a listening ear, direction, encouragement and support. She is full of wisdom and loves teaching other's.I cannot begin to tell you how supportive she has been. The integrity she carries and dedication to not only her team but her employees.The owner, Thomas always made time to acknowledge his employees and constantly shows his apprection for each of them. I'm very grateful for the experience I have gained working for solace hospice. It's been a true honor working for this company.Shanna Arias
As an Aging Specialist, a Senior Resource Center and over 20 years experience with Seniors “Solace Hospice” has excelled in comfort care and palliative care! They have been one of our preferred providers for years in Arizona. Their involvement in the Industry, their caring staff and their professional approach is appropriate when families need them most. Costel Roman the Director of Business Relations is the biggest advocate I have met in his Industry. Solace Hospice you are appreciated by thousands of families and Senior Living Communities in Arizona.
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I had a great working experience with Solace Hospice and all of the staff I have encountered, open communication and great quality in their service. The people we worked with so far starting with Costel Roman, the RNs Gina and Heidi and amazing social worker Shana enabled us to continue to work with them and refer Solace Hospice.
Been working with Solace Hospice for over a year and never cease to amaze me! They cater to each individuals needs and go beyond the scope of service. Stephanie, Sammy, Diane and Costel are doing a fantastic job, giving 110% of love and hard work and making sure everything that it’s needed arrives within 24 hours. If you’re looking for a great Hospice give them a chance, they will never disappoint.
I can’t say enough about Solace Hospice. The level of care and attention to personal detail is so much higher than the other hospice company I dealt with. My family recently experienced the loss of our mother followed by our father in fairly close succession. All I can say is thank you Solace and I wish I had discovered you sooner. My mom’s passing was handled by another company. I can tell you they are not the same. Solace operates with a premium degree of care and compassion during such a difficult time
I cannot thank Solace Hospice enough for the amount of love and support they have provided my family with during this hard time. They were attentive, caring, informative and overall extremely experienced in this field.A special thanks to Maggie, Bevery, Katie, Janet, Diana, (just a few of the many) for the help you provided.Thank you all so much!!!Enea
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I would like to express my gratitude to Costel Roman - Director of Business Relation at Solace Hospice, Thomas Fedzin - Owner of Solace Hospice during a difficult time in my life. There is never an easy moment to loose a loved one. Costel Roman and Solace Hospice have helped my mother to go to Heaven and be with the angels peacefully. God bless all of you for being by my side!!!
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I've worked with multiple staff members at Solace Hospice and each and everyone is so incredible passionate about caring for the community. As a wife of a Director of Nursing at an assisted living facility, I hear often about how important great care -- Solace provides great care!
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I cannot begin to describe the gratitude and appreciation my family feels about the experience we had with Solace Hospice. I didn’t know quite what to expect at the time when my father was on your service. My father had such great care! My concerns were quickly relieved. Thank you for the kindness and compassion you have given to us and for the genuine concern for my father and for our family. We sincerely appreciate your tireless effort to care for all your patients and their loved ones, and your eagerness to assist at every turn.
I own 5 assisted living group homes around the Phoenix area. I am always relieved when my residents and their families choose Solace Hospice to help their loved one. I can always rely on Thomas and his staff to take care of my residents. They interact incredibly well with my caregivers and offer assistance 24/7. And they back it up. There have been numerous times when we needed some help from Solace in the middle of the night. Someone from Solace would come out to the home without hesitation and take care of everything. Thank you Thomas for running such a wonderful company!
Great professional help during a hard time. Thank you for making things easier to manage during our time of need. They gave our loved one lots of comfort any time he needed it. Which added relief to me as I knew he was in good hands. Thank you so much Thomas and staff!
As a care coordinator for multiple assisted living homes, I am grateful for the opportunity to have Solace Hospice care for our residents. Working closely with Thomas and his staff Is always a pleasure. All around, a great experience.
Thomas and staff were always friendly and available to help us. We learned so much about our Client’s situations. They are definitely very knowledgeable and confident of what they do to help our clients in our group home meet their needs.
Delirium is a mental state where the person seems confused or dis-oriented, not recognizing the room, or familiar people. Hallucinations are common (hearing or seeing things that others do not see). Unless the visions are upsetting to the patient, nothing really needs to be done. People in the last week or so often seem to speak to relatives or friends who have already passed on. Usually these are positive and comforting exchanges. There is no need to intervene. Action is only required if the patient is at risk of causing harm, to themselves or others.
