Last Days and Hours: Confusion and Restlessness

Pre-death restlessness in hospice palliative care can take many forms in dying individuals. This podcast discusses how to recognize this symptom and how to work with individuals experiencing restlessness.


  • 0’00 Start
  • 0’21” Identify the normal changes and inform the team of normal changes
  • 1’10” Prepare the family for changes that are normal. Identify normal versus abnormal.
  • 1’35” How to assess and identify confusion and restlessness?
  • 2’00” Confusion wiht dying can be very confusing, as people experience symbolism and may return to events in the past.
  • 2’30” Question to ask family “Does this make sense to you?”
  • 4’00” Story – Is this like her? Can help find understanding.
  • 6’15” We do the best when we can understand the context of the patient’s behaviour and communication.
  • 7’00” Confusion can take the form of near death awareness, revisiting the past as well as symbolic communication.
  • 8″30″ Report your findings to the team.
  • 9’00” Restlessness without purpose can be a type of pain.
  • 11’00” Be open to different possibilities and explanations of behaviours.
  • 12’15” Can they hear me if they aren’t responding?
  • 13’40” Helping family to be with someone who is not responsive.
  • 16’40” Modelling how to be with unresponsive individuals.
  • 18’58” End.

Chapter 4, Last Days and Hours,Essentials in Hospice Palliative Care, 2nd Edition, Katherine Murray, 2009.
Study Guide for Nurses, Essentials in Hospice Palliative Care Workbook, 2009.

Written and preformed by Kath Murray and Elizabeth Causton, All Rights Reserved. Life and Death Matters, 2010.