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Terminal Restlessness

Principles

As death approaches, some people develop confusion or agitation, commonly known as terminal restlessness. This can be distressing to watch. Any reversible causes of agitation, such as uncontrolled pain or urinary retention should be identified and managed appropriately.
Agitation and restlessness may accompany delirium.

Prescribing Guidance

palliAGEDgp smartphone application (available as an app or as online content) Tasmanian Adult Palliative Care Formulary

Useful information

Therapeutic Guidelines: Palliative Care (subscription required)

Remember

  • Delirium is common among older people at the time of a hospital admission or can develop during a hospital stay. The form of restlessness referred to in this page relates to restlessness in the terminal phase.
  • Causes of agitation that can be addressed include urinary retention (use a catheter if appropriate), faecal impaction (treat with a rectally-administered laxative), and uncontrolled pain or other symptoms.
  • Medicines can contribute to akathisia and restlessness, for example, antiemetics and antipsychotics.
  • Increasing agitation may be a sign of uncontrolled pain in a person with dementia.

  This page was updated on 21 February 2019