Acute Medicine | Palliative care | Agitation and restlessness in the dying phase

Agitation and restlessness in the dying phase
Session overview
Description
This session provides a framework for assessing and managing agitation and restlessness in the dying phase, an experience which can be highly distressing for both patients and families. Poor management of this symptom is a frequent cause for admission and problems in bereavement.

This session was reviewed by Karen Baker and last updated in March 2024.

Learning objectives
By the end of this session you will be able to:

• define the terms 'restlessness' and 'agitation'
• describe the symptoms associated with agitation and restlessness in the dying phase
• list some of the common reversible causes of agitation and restlessness in the dying phase
• describe management options for agitation and restlessness in the dying phase, including non-pharmacological options
• describe how the concerns of carers/families can be addressed during the management of patients with agitation and restlessness in the dying phase

Agitation and restlessness are both physiological and psychological phenomena, the causes of which are varied and can be difficult to define.

When these symptoms are exhibited in the dying phase, the condition is often called 'terminal restlessness' or 'terminal agitation', and is commonly associated with confusion and impaired consciousness. This experience can be highly distressing for patients and their families.

This session describes the features of terminal agitation, discusses the assessment of potentially reversible causes, and outlines the drug and non-drug management of this distressing condition.