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Terminal restlessness is a frequent issue in palliative care, with 25% to 88% of dying patients experiencing this condition. In the final days, patients can develop complications, leaving them anxious, irritable, lethargic, or even aggressive. 

This form of unrest presents a major challenge for the patient’s loved ones and close friends. To improve patient care and the psychological state of visitors during terminal illness care, it is important to raise awareness about the recognition and management of this condition. 

What Is Terminal Restlessness?

Terminal restlessness is an agitated delirium during the final days or weeks of a patient’s life. It leads to unsettled behaviors. The condition is more intense than normal aggression or mood swings. This unusual change in behavior is often sudden and unpredictable. 

Signs of Terminal Restlessness

This complication affects patients’ perceptions and experiences, causing a range of symptoms. Although the signs will vary from person to person, they are often recognized by:

  • Aggression – Patients can toss, turn, hit, push, or insult their family members or caregivers. This behavior can feel particularly distressing to family members. But, you should know that this is not real anger, but a mental distortion often caused by an end-stage organ failure. (3)
  • Lethargy – Patients feel sleepy, exhausted, or sluggish. They are in a state with little to no energy.
  • Agitation – Patients have trouble relaxing or staying still. They can fidget, and pull their bedsheets, or clothes.
  • Wandering – Patients might not be mobile, but they can still try to get out of bed and leave the room.
  • Confusion – Patients start to forget things or can’t concentrate.
  • Hallucinations – Patients may start hearing or seeing things that are not physically there.


How Long Does Restlessness Last Before Death?

Terminal restlessness typically happens in the last couple of days of a person’s life. Roughly 42% of patients in palliative care feel agitated in their last 48 hours. Others, however, can develop the symptoms sooner, which might not dissipate until death. 

Although there are many exceptions, the pre-active dying phase typically lasts 2 weeks. This is the time when patients experience increased restlessness, exhaustion, longer sleeping periods, reduced liquid and food intake, discomfort, etc. 

Management of Terminal Restlessness

Experts often treat terminal restlessness, if the behavior is placing the patient and others at harm. Alleviating these severe symptoms can involve the use of sedating medications. The medicine can affect the patient’s ability to communicate. 

At Lucky Palliative Services, Inc, patients get a special kind of care that maximizes comfort and reduces pain and discomfort. Hospice care can help address the psychological, physical, spiritual, and social needs of patients and their families.

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