is a common phenomenon that occurs in the final stages of life, characterized by , confusion, and distress. It can be challenging to recognize and manage, especially in patients who are unable to communicate verbally. This article aims to share some insights and tips from a hospice worker who learned how can manifest differently in nonverbal patients, and how to cope with it.

Signs of Terminal Restlessness in Nonverbal Patients

One of the most important lessons that the hospice worker learned is that terminal can present as a severe panic attack in nonverbal patients, unlike the more typical symptoms of , irritability, and insomnia. During a panic attack, the patient may exhibit signs of fear, , 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 , pain, and .
  • Using techniques such as , which involves acknowledging and empathizing with the patient's feelings and emotions, without trying to correct or rationalize 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.


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, , 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 patient and their family in their final moments.


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