Terminal restlessness: causes, assessment and management

Abstract

One of the main wishes of people in the terminal phase of life is to be comfortable and free of unpleasant symptoms. Similarly, relatives also wish to see their loved one free of pain and distressing symptoms. Terminal restlessness is an unpleasant condition that may be observed during the last days or hours of life. It has been estimated that it affects between 25% and 85% of terminally ill patients. It is very upsetting for relatives and healthcare professionals to witness. Furthermore, relatives who observe a loved one in obvious distress at the time of death may deal with their bereavement less well, as a poor death lingers unpleasantly in the memories of those who live on. There exists some confusion and inconsistency in the terminology related to terminal restlessness. This article will provide an overview of the causes, clinical features, assessment and management of terminal restlessness. It will also examine the controversial subject of the use of sedation as a management strategy for terminal restlessness at the end of life. Conflicts of interest: none