Can We Avoid Terminal Agitation?

When we prepare for death, we don’t often think about or prepare for terminal agitation.

Instead, we think about the physical components. For example, we get a room ready. Order a portable potty chair or hospital bed to help make us more comfortable. We ask a lot of questions about what our bodies will do as we slow down.

However, there are equally important emotional and psychological changes coming. Unfortunately, we don’t always think about these issues and, as a result, experience discomfort of a different sort.

The good news: anger and frustration don’t always have to accompany the end of life. Here are some ways I help my clients to understand and maybe avoid terminal agitation.

Common Feelings at the End of Life

Everybody is different. No two lives are the same – and no two deaths are the same either. Nonetheless, I’ve seen some commonalities in the dying process, including common feelings.

These are not necessarily negative feelings either.

Dying people become understandably less interested in the outside world. They’ve got a lot going on inside themselves and sometimes withdraw from family and friends. This is called a “life review.” As a result, during this important introspection, my clients may only want to be surrounded by very close loved ones.

During this time, my clients often spend their days contemplating everything, which can mean letting go and saying goodbye.

As death draws near, people sometimes experience unique conscious awareness and communication that confuses caregivers and visitors. For example, dying people will talk to loved ones the rest of us can’t see or hear.

Other times they talk about a trip or “going away” somewhere.

A person close to death may have trouble remembering something that just occurred while remembering with great detail the events of long ago.

It’s not unusual for someone close to death to experience delirium. This can be the result of a drug’s side effects or changes in metabolism. Delirium looks different depending on the person and can include hallucinations or changes in consciousness. Medication can often help ease symptoms.

Signs of Terminal Agitation

Terminal agitation is more extreme than the above examples and appears toward the very end of life. It can show up as:

• Verbal outbursts
• Anger
• Hostility
• Someone pulling at their clothes, bedsheets, or medical tubes
• Indecisiveness
• Restlessness

Plan for Your Death

Before you start actively dying, build a supportive team. People familiar with end-of-life issues, who respond positively to the ways of dying, make all the difference in the world.

When I spend time educating care teams and other loved ones, they aren’t surprised or upset by the dying process. That helps them to be calm and more supportive.

You want caregivers who won’t discount what you’re feeling or become negative in this space you’ve created for a peaceful death. You also want a medical team who can make sure you’re physically comfortable.

Causes of Terminal Agitation

There are many possible causes when someone experiences terminal agitation. I often work with experienced hospice nurses to find out why our clients are uncomfortable so we can help them feel better.

Pain

It’s hard to be comfortable when you’re experiencing physical pain. This is especially true if you aren’t under palliative or hospice care. My clients who choose hospice sooner rather than later are better medicated and avoid physical suffering. This is one of several reasons why more awareness is needed for those at the end of life.

Emotional Suffering

Perhaps you are angry about dying. This doesn’t just happen to the young. We can all feel like we’re leaving too soon – no matter our age.

While my clients are able, we make a list of what they’d like to do before they die. I help them prioritize and figure out a death plan for what’s reasonable.

Therapists or psychologists can also help ease suffering. They allow my clients to deal with unfinished business and the emotions that come along with it.

Confusion

Those suffering from dementia especially get angry because they can’t cope with being so confused. A team with some experience in this realm will respond in ways that help dementia patients transition more peacefully and with less irritation.

Drugs and Side Effects

Some medicine that reduces anxiety also increases the risk of delirium. An experienced medical team should be able to adjust medication as symptoms vary from person to person.

Organ Failure

When the liver and kidneys start to slow down, metabolism and chemistry can alter your personality. Heart and lung failure also results in lower oxygen levels and irritation can follow.

Medical teams also help alleviate:

• Anemia
• Infections
• Fevers
• Urinary retention 
• Constipation

How to Help with Terminal Agitation

Understand that even though terminal agitation isn’t personal, there are things you can do as a caregiver to make it less of an issue.

For example:  

• Remember and apply the Ring Theory. You’re going to naturally feel sad, but it’s your role to “comfort in, dump out.”
• Find a solid support system to work through any troubles or emotional pain you’re experiencing as a result of providing care.  
• Take time to process your feelings and take time for yourself. This is how you better care for others.
• Stay calm when interacting with your dying loved one. Remember to lower your voice, even if your loved one gets louder. Do not argue.
• Sit down rather than stand over the person. This will help lower their anxiety.
• Keep your body open and receptive. For example, uncross your arms and legs. Take breaks to meditate and breathe.
• Create a calm, peaceful space. Make sure only positive people visit and hold vigil.
• Turn the lights down, play soft music, and limit the number of visitors.
• Accept reality. Don’t try to cure or fix anything. Ask if you can hold their hands and be okay sitting in silence.
• Check with the medical team frequently. Make sure they are doing everything in their power to ensure your loved one is comfortable.

Preparation Is Vital

Treatment at the end of life usually means keeping the person as comfortable as possible. In some cases, mild tranquilizers and anti-psychotic drugs may be used to treat terminal agitation. Dealing with pain or discomfort as gently as possible, for you and your caregivers, can help make the last few days easier for everyone involved.

As a death doula, I can help you avoid terminal agitation. Get in touch today.