Can We Avoid Terminal Agitation?

When we prep for death, 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 prep for these issues and, as a result, experience discomfort of a different sort. The good news: anger and frustration don’t always have to accompany end of life. Here are some ways to understand and maybe avoid terminal agitation:

Common feelings at end of life

Everybody is different. No two lives are the same – and no two deaths are the same either. Nonetheless there are some commonalities to the dying process, including common feelings.

These are not necessarily negative 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. They may only want to be surrounded by very close loved ones.

The dying also take this time to contemplate, 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. Other times it involves talking about a trip or a “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 and appears toward the very end. It can show up as:

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

Plan for your death ahead of time

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

Sometimes it helps to educate your loved ones, so they aren’t surprised or upset.

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.

Be aware of what can cause terminal agitation

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. They can better medicate and keep you comfortable. This is one of several reasons why palliative care should be a treatment option sooner rather than later.

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 you are able, make a list of what you’d like to do before you die. A competent death doula helps you prioritize and figure out a death plan for what’s reasonable. Therapists or psychologists can also help ease suffering. They allow you to deal with unfinished business and 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 fail, 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

If you’re a caregiver, here’s what you can do

Understand that even though terminal agitation isn’t personal, there are things you can do 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 amount 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.

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.

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