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First do no harm... Terminal restlessness or drug-induced delirium
Clare White1, Mary Ann McCann, Neil Jackson
1Northern Ireland Hospice Care, Belfast, Northern Ireland, United Kingdom. clarewhite100@hotmail.com
Journal of Palliative Medicine
|May 3, 2007
Summary
Terminal restlessness, often seen in end-of-life care, may actually be acute delirium caused by medications. Recognizing and treating this delirium is crucial for improving patient comfort and outcomes.
Area of Science:
- Palliative Care
- Geriatric Medicine
- Pharmacology
Background:
- Terminal restlessness describes unsettled behaviors near end of life.
- Clinical presentation often overlaps with delirium.
- Medication side effects can mimic or cause terminal restlessness.
Purpose of the Study:
- To explore the link between medications and terminal restlessness.
- To raise awareness of delirium as a potential cause.
- To guide appropriate diagnosis and management of end-of-life delirium.
Main Methods:
- Review of common end-of-life medications.
- Analysis of clinical presentations of terminal restlessness and delirium.
- Literature review on delirium recognition and treatment.
Main Results:
- Several common medications (opioids, NSAIDs, etc.) can induce delirium.
- Delirium is often reversible, potentially in up to 50% of cases.
- Misdiagnosis of terminal restlessness can lead to inadequate treatment.
Conclusions:
- Terminal restlessness may frequently be undiagnosed or misdiagnosed delirium.
- Identifying and treating medication-induced delirium is essential for palliative care.
- Effective delirium management significantly enhances end-of-life patient care.
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