Delirium, Confusion, and Agitation at the End of Life

Shuster, Jr. John L.

doi:10.1089/jpm.1998.1.177

Cited by 25 publications

(9 citation statements)

References 50 publications

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“…3¡ 7 The standard method for managing terminal restlessness in the terminally ill patient involves a combination of approaches; a search for underlying causes, correction of those factors if possible and management of the symptoms. 1,8 When a cause cannot be determined or is not treatable, the conventional treatment of symptoms is implemented, which usually involves the use of medications that sedate the patients and that may affect their ability to communicate with their families. 2¡ 6,9¡ 13 This happens at a very significant time in the trajectory of the patient's illness, the days or hours before death.…”

Section: Introductionmentioning

confidence: 99%

The impact on the family of terminal restlessness and its management

Brajtman

2003

Palliat Med

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The purpose of this qualitative study was to explore and describe the impact of terminal restlessness and its management upon family members who were witness to the event. Approximately 25%-85% of terminally ill patients may experience the symptoms associated with terminal restlessness during the hours or days before their death. They may be physically agitated and cognitively impaired and often appear to be suffering. Treatment of these severe symptoms usually involves the use of sedating medications that can affect these patients' ability to communicate with their families. Using a phenomenological research approach, two focus groups and 20 individual interviews were held with bereaved family members and hospice staff. A content analysis of the data resulted in the emergence of several core themes that reflected the participants' perceptions and experiences; the multidimensionality of suffering, the need for communication, feelings of ambivalence, the need for information and sensitivity and respect. It is suggested that the development and implementation of a multiprofessional team protocol could address the specific concerns, information and care needs of these families at this critical time.

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Section: Introductionmentioning

confidence: 99%

The impact on the family of terminal restlessness and its management

Brajtman

2003

Palliat Med

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“…T IS WELL DOCUMENTED THAT PAtients at life's end have unrelieved physical suffering, as well as significant emotional, spiritual, and social distress. [1][2][3][4][5][6] Patients who are near the end of life are frequently not recognized. 1,7,8 As a result, their suffering may not be properly appreciated or managed and may even be exacerbated by standard medical care, in which aggressive, futile, or even iatrogenically harmful treatments are often continued.…”

mentioning

confidence: 99%

Improving Processes of Hospital Care During the Last Hours of Life

Bailey

Burgio²,

Woodby³

et al. 2005

Arch Intern Med

117

102

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“…20 When moaning, groaning, and grimacing accompany the agitation and restlessness, they are frequently misinterpreted as physical pain. 21 However, it is a myth that uncontrollable pain suddenly develops during the last hours of life when it has not previously been a problem. While a trial of opioids may be beneficial in the unconscious patient who is difficult to assess, physicians must remember that opioids may accumulate and add to delirium when renal clearance is poor.…”

Section: Terminal Deliriummentioning

confidence: 99%

Competency in End-of-Life Care: Last Hours of Life

Ferris

Gunten

Emanuel

2003

Journal of Palliative Medicine

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Clinical competence, willingness to educate, and calm and empathic reassurance are critical to helping patients and families in the last hours of living. This review adapted from the Education for Physicians on End-of-Life Care (EPEC) Curriculum describes the predictable course that occurs as well as approaches to management. Management principles are the same at home or in a health care institution. However, death in an institution requires accommodations to assure privacy, cultural observances, and communication that may not be customary. In anticipation of the event, it helps to inform the family and other professionals about what to do and what to expect. Care does not end until the family has been supported with their grief reactions and those with complicated grief helped to get care. Care at the end of life is a core competency.

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Delirium, Confusion, and Agitation at the End of Life

Cited by 25 publications

References 50 publications

The impact on the family of terminal restlessness and its management

The impact on the family of terminal restlessness and its management

Improving Processes of Hospital Care During the Last Hours of Life

Competency in End-of-Life Care: Last Hours of Life

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