Chapter 6: As death nears
If the person who is ill becomes confused or agitated
She became agitated, wanting to get out of bed. We were able to persuade her that she didn’t need to get up.
As death nears, the brain experiences the same burdens as the other systems of the body. With weakening function of organs such as the kidneys, the liver, and the lungs, a decrease in alertness and perhaps some degree of confusion (called “delirium”) may also occur.
People who are confused often also feel frightened and threatened by people and things around them. It can be very upsetting for family at the bedside to see and hear their loved one acting out of character or even being hurtful to others. Click the arrows below to see some ways this may impact the family and healthcare providers.
Children or grandchildren may be afraid to visit.
Friends and family may feel that they have lost the person already since the change in personality is so significant.
There may be concern about possible self-harm or harm to others if restlessness and agitation are serious.
The healthcare team may have difficulties administering medications and providing care.
People may stop seeing the person who is ill as worthy of respect, especially if they think the behaviour is embarrassing or undignified.
Most people would feel dismayed if they were aware of their behaviour in these circumstances. One approach to guiding care decisions about someone who is confused is to imagine that they could look in on themselves from the perspective of when they were well – how would they feel knowing their current circumstances? If they had a choice, most people would feel that such confusion and paranoid behaviour causes an unacceptable loss of dignity, and they would prefer to be sedated
What may help
It is not usually productive to contradict the statements of a paranoid, confused person; this may simply feed the feeling of being threatened. It is generally best to acknowledge the distress the person must be feeling, and to commit to trying to sort things out.
Helpful resources
