A Thorough Guide to Terminal Agitation

What is terminal agitation?

Terminal agitation, also known as terminal restlessness, refers to a change in a person’s demeanor and personality as they approach the end of life. It can cause individuals who are typically calm to become angry, upset, and display antisocial behavior. Symptoms of terminal agitation can vary in intensity, including demanding to do things they are too weak for, exhibiting aggressive language or behavior, confusion, delirium, and difficulty recognizing loved ones.

Major symptoms of terminal agitation

The following symptoms may indicate that a patient is experiencing terminal agitation:

  • Anger
  • Aggression
  • Shouting or screaming
  • General distressed behavior
  • Confusion
  • Hallucinations
  • Attempts at leaving their bed
  • Sleepiness during the day
  • Lack of sleep during the night
  • Lack of focus or inability to concentrate
  • Inability to relax
  • Jerking, twitching, or fidgeting

Causes of terminal agitation

Terminal agitation can occur as the body and internal organs begin to shut down during the end-of-life process. However, there are other specific causes that can contribute to agitation, such as medication, cancer treatment, alcohol or nicotine use or withdrawal, pain, urinary retention, constipation, nausea, brain tumors or swelling, organ failure, altered blood levels, oxygen deficiency, dehydration, and emotional or spiritual distress.

Guidelines for caring for someone with terminal agitation

While caregivers and family members cannot cure terminal illness, there are ways to alleviate terminal restlessness and agitation. Here are some strategies to consider:

  1. Eliminate obvious causes of distress unrelated to the body shutting down.
  2. Seek guidance from physicians to ensure the patient’s comfort and make necessary adjustments to medication and treatment plans.
  3. Continually assess the patient’s condition, monitor vital signs, and address any physical discomfort they may be experiencing.
  4. Consider the patient’s pain management and adjust medications accordingly.
  5. Pay attention to the patient’s facial expressions and body posture to gauge their level of comfort.
  6. Ensure proper bladder and bowel care for the patient.
  7. Evaluate for signs of infection or underlying medical conditions causing distress.
  8. Offer emotional and spiritual support through sessions with a minister or counselor, if desired.

Terminal agitation medication

In some cases, medication may be necessary to manage terminal agitation. Anti-anxiety medications like Lorazepam (Ativan) and Diazepam (Valium), as well as anti-psychotic medications such as Haloperidol (Haldol) and Chlorpromazine HCl (Thorazine) can be prescribed to provide relief. However, it’s important for medical professionals to carefully consider each patient’s unique condition and potential interactions with medication. The choice of medication should be tailored to the individual to ensure maximum comfort and minimize negative effects.

Considering all options

If family members or loved ones feel that the patient’s condition is not being appropriately managed, consulting a physician is recommended to explore alternative approaches. In cases where terminal agitation becomes a hospice crisis, continuous nursing care may be necessary in a care facility.


Terminal agitation is a common condition experienced by individuals nearing the end of their lives. While witnessing these symptoms can be distressing, responding calmly and following the guidelines outlined in this article can help make the patient’s final days more comfortable. Remember to seek professional medical advice and support throughout the process.


  1. Agitation, Marie Curie, mariecurie.org.uk
  2. Terminal Agitation: A Major Distressful Symptom in the Dying, Hospice Patients Alliance, hospicepatients.org
  3. Hosker CM, Bennett MI. Delirium and agitation at the end of life. BMJ. 2016;353:i3085. Published 2016 Jun 9. doi:10.1136/bmj.i3085

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