What is Restlessness?
The last days and hours of life can be a time of peace and comfort. However, some patients may experience a period of restless confusion and appear fretful and uncomfortable. Restlessness is when the patient experiences agitation in the days to hours prior to death.
Signs of Restlessness
Prior to death the patient may become agitated, confused, and very restless. Some signs of this restlessness may include:
- Constantly moving in bed or trying to get out of bed
- Sleeping very little
- Pulling or picking at the bed linens, reaching out with arms extended
- Attempting to remove clothing
- Grimacing, clenching teeth
- Crying out, moaning, calling for someone
Some Causes of Restlessness
It is not always possible to determine why confusion and restlessness occurs. Your hospice team will look for these and other possible causes so that the symptoms can be managed:
- Medication side effects
- Metabolic changes
- Constipation or inability to urinate
- Need to be repositioned
- Being too hot or cold, being wet or soiled
- Reduced oxygen to the brain due to circulatory changes
- Unresolved spiritual or emotional issues
What You Can Do
Caring for a patient with restlessness can make you feel tired, overwhelmed, and frustrated. Call your hospice team immediately if the patient shows any signs of restlessness. They can work with you and your doctor to find treatments to help decrease restlessness. Some things you can do to help the patients are:
- Always identify yourself, even when the dying person knows you well. They are using their energy in other ways and may not be able to recognize you immediately. Encourage visitors to approach gently and to identify themselves.
- Keep the room as peaceful and quiet as possible. Keep noise levels low and avoid abrupt movements or sounds. Turn down bright lights, close curtains to reduce glare and muffle sounds.
- Gently reassure the patient and give the patient time to talk about any worries.
- Keep the room temperature comfortable for the dying person. They may have periods of feeling too warm and then too cool, so adjust covering as needed. Apply a cool moist cloth to forehead, wrists and neck if the person feels too warm. If they feel cold, warm a light blanket by placing it in the microwave for one minute.
- Try playing soft, soothing music. Use prayer, chanting or scripture if that is appropriate.
- Talk to the patient in a calm, quiet voice. Hold the person’s hand. When giving care, softly explain what you are doing. Explain to visitors the need for quiet, peaceful surroundings.
- Keep the patient safe by padding the sides of the bed with pillows or blankets.
- Provide frequent supervision. Ask family members, friends, and the Hospice team to help.
- Take time for yourself. Ask someone to stay with the patient while you rest, or visit with a friend or loved one.
There are medications that may be indicated, physical, emotional, and spiritual interventions that can help. Please call your Hospice team anytime for more information or support.
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