Concept of pre-death. Restlessness in dementia

The circumstances surrounding the deaths of 23 patients on a behavior stabilization unit during a 1-year period were examined. The death rate was more than double that of previous years, and raised concern for the staff. The majority of deaths (n = 17) occurred within 2 months of admission to the unit, and 16 of the patients who died had a diagnosis of vascular or mixed dementia. The presenting behaviors for these patients may be similar to those of pre-death restlessness, a condition that may affect individuals in their last hours or days of life. No literature can be found linking pre-death restlessness with end-stage vascular dementia. The memory of how a person dies can linger for family and loved ones (Enck, 1992). Distress caused by behaviors with end-stage dementia may be alleviated if the symptoms of pre-death restlessness are recognized. It may be a relief for family and staff to know the patient is indeed dying, rather than exhibiting new and seemingly uncontrollable behaviors. In that situation, appropriate palliative care could be initiated for the patient's and family's comfort. Accurate nursing assessment, evaluation, communication, and documentation of both the behaviors and interventions is vital in supporting both patients and families.