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.

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, , 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.

Resources

The Importance of Caregiver Journaling

Reporting Changes of Condition to Hospice

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The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease and Other Dementias

Dementia Home Care: How to Prepare Before, During, and After

The Dementia Caregiver's Survival Guide: An 11-Step Plan to Understand the Disease and How To Cope with Financial Challenges, Patient Aggression, and Depression Without Guilt, Overwhelm, or Burnout

Dementia Caregiving: A Self Help Book for Dementia Caregivers Offering Practical Coping Strategies and Support to Overcome Burnout, Increase Awareness, and Build Mental & Emotional Resilience

Navigating the Dementia Journey: A Compassionate Guide to Understanding, Supporting, and Living With Dementia

Ahead of Dementia: A Real-World, Upfront, Straightforward, Step-by-Step Guide for Family Caregivers

Four Common Mistakes by Caregivers of loved ones with Dementia and what do differently (video)

Eldercare Locator: a nationwide service that connects older Americans and their caregivers with trustworthy local support resources

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My Aging Parent Needs Help!: 7 Step Guide to Caregiving with No Regrets, More Compassion, and Going from Overwhelmed to Organized [Includes Tips for Caregiver Burnout]

Take Back Your Life: A Caregiver's Guide to Finding Freedom in the Midst of Overwhelm

The Conscious Caregiver: A Mindful Approach to Caring for Your Loved One Without Losing Yourself

Dear Caregiver, It's Your Life Too: 71 Self-Care Tips To Manage Stress, Avoid Burnout And Find Joy Again While Caring For A Loved One

Everything Happens for a Reason: And Other Lies I've Loved

The Art of Dying

Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying

Tips for new nurse — Terminal Restlessness

The importance of caregiver journaling for the patient and family

Validation Therapy — a useful tool for any family member or healthcare team member

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

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Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side , A Guide for Caring for the Dying at Home

Behaviors Related To Terminal Restlessness

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