Terminal restlessness is a common phenomenon that occurs in the final stages of life. It is characterized by agitation, confusion, and distress. It can be challenging to recognize and manage, especially in patients who cannot communicate verbally. This article aims to share insights and tips from a hospice worker who learned how terminal restlessness can manifest differently in nonverbal patients and how to cope.
Signs of Terminal Restlessness in Nonverbal Patients
One of the most important lessons that the hospice worker learned is that terminal restlessness can present as a severe panic attack in nonverbal patients, unlike the more typical symptoms of restlessness, irritability, and insomnia. During a panic attack, the patient may exhibit signs of fear, anxiety, hyperventilation, sweating, trembling, and increased heart rate. The hospice worker may be so focused on helping the patient calm down that they may miss the fact that this is a sign of terminal restlessness and impending death.
How to Respond to Terminal Restlessness in Nonverbal Patients
The hospice worker suggests some strategies to deal with terminal restlessness in nonverbal patients based on their own experience and knowledge. These include:
Using medications such as Lorazepam (Ativan), Morphine (Roxanol), or Haloperidol (Haldol) to reduce anxiety, pain, and agitation.
Using non-pharmacological techniques, such as validation therapy, involves acknowledging and empathizing with the patient’s feelings without correcting or rationalizing them.
Journaling the event and asking oneself some questions to assess the patient’s condition and prognosis, such as:
Did the patient have falls in the past two weeks? If yes, this may indicate a decline in physical function and a higher risk of terminal restlessness.
Has the patient had increasing anxiety, though not at the panic level, in the past two weeks? If yes, this may indicate a decline in mental and emotional well-being and a closer proximity to death.
Has the patient had two or more declines per week over the past two weeks, including the panic attack? If yes, this may indicate that the patient has entered the dying process and may have only days or hours left to live.
Conclusion
Terminal restlessness is a complex and distressing phenomenon that can affect both the patient and the hospice worker. It can be especially difficult to recognize and manage in nonverbal patients, who may express it as a panic attack. The hospice worker can use medications, validation therapy, and journaling to help the patient and themselves cope with this challenging situation. By being aware of the signs and implications of terminal restlessness in nonverbal patients, the hospice worker can provide better care and support to the patients and their families in their final moments.
